Practice development


be carried out after 3–5 days provided there are no signs or symptoms to suggest infection. However, daily wound inspection and dressing change is indicated if there is evidence of infection. Deep dermal burns need daily dressing until the eschar has lifted and re-epithelialisation is underway, then the frequency of dressing changes can be reduced.


Management of major burns All major burns should initially be managed initially according to the following trauma resuscitation guidelines: A: Airway maintenance with cervical spine control


Page points


1. The victim of a burn should be removed from the source but without danger to rescuers


2. Any clothing, except that adhering to the skin, should be removed immediately.


3. The burn should be cooled with tepid water


4. Do not use cold or icy water as this will cause vasoconstriction, worsening tissue ischaemia and deepening the wound


B: Breathing and ventilation C: Circulation and haemorrhage control D: Disability – neurological status E: Exposure and environmental control F: Fluid resuscitation proportional to burn size. Fluid resuscitation proportional to burn


size is essential for burns that are over 10% in children and 15% in adults. The volume required is calculated on body weight and the TBSA that has been burnt. Thus, the frequently used Parkland formula12


n


Remove all clothing as soon as possible (unless adherent to underlying skin, eg nylon)


n


Cool the burn with cool/tepid running water for at least 20 minutes. Do not use very cold or icy water as this causes vasoconstriction, worsening tissue ischaemia and deepening the wound


n


Cover the burn, preferably with polyvinyl chloride film or a sterile cotton sheet


n


Do not use topical creams or agents such as silver sulphadiazine as this makes subsequent assessment of burn depth difficult.


defines the amount of


fluid that should be given as 3–4ml/kg/%/TBSA burn in the first 24 hours, with half given in the first eight hours. The resuscitation period starts from the time of injury, and thus any delays in presentation or transfer to the hospital/ specialist unit should be taken into account and fluid requirement calculated appropriately. Other key measures include:


n


Remove the victim from the source of the burn without endangering the rescuers


n


Assist the victim to ‘drop and roll’ if any clothing is alight


CONCLUSION Providing effective wound care in such resource-constrained settings is challenging. In the developed world, essential equipment such as cannulae for intravenous access and fluid-giving sets are taken for granted, whilst these are considered to be a privilege in many hospitals in Uganda. Practising medicine in this environment creates a greater awareness and understanding of the ongoing problems that countries such as Uganda continue to face in providing effective healthcare.


AUTHOR DETAILS Dr Yuran Zheng, MBChB is in Foundation Year 1 in Vascular Surgery, Bradford Royal Infirmary, Bradford, UK


Stuart Enoch, MBBS, PhD, MRCSEd, PGC (Med Sci), MRCS (Eng) is Programme Director, Doctors Academy; Visiting Scientist, University of Manchester; Specialist Registrar in Plastic Surgery and Burns, University Hospitals of Manchester.


BURN DEPTH APPEARANCE BLISTERS Epidermal


Superficial dermal (superficial partial thickness)


Deep dermal (deep partial thickness)


Full thickness References


12. Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 1968; 150(3): 874–94.


Red and glistening Pale pink


Dry, blotchy and cherry red


Dry, white or black Eschar may be present


None Yes May be present None


CAPILLARY REFILL


Brisk Brisk Absent Absent SENSATION Painful Usually painful Dull absent Absent


Table 1 – Important features of different burn depths.


21


Wounds International Vol 2 | Issue 1 | ©Wounds International 2011


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