Burn patients

Normal saline is an isotonic fluid composed of water, sodium, and chloride. It provides primarily ECF replacement and can be used for virtually any cause of TBW depletion. Common uses of normal saline include perioperative fluid administration volume resuscitation of shock, hemorrhage, or burn patients fluid challenges in hypotensive or oliguric patients and hyponatremia. 

Most clinicians agree that crystalloids should be the initial therapy of circulatory insufficiency. Crystalloids are preferred over colloids as initial therapy for burn patients because they are less likely to cause interstitial fluid accumulation. If volume resuscitation is suboptimal following several liters of crystalloid, colloids should be considered. Some patients may require blood products to assure maintenance of 02-carrying capacity, as well as clotting factors and platelets for blood hemostasis. 

Decontamination Soap and water, or diluted sodium hypochlorite solution (0.5 percent). Smallpox has great potential for person-to-person exposure. Removal of potentially contaminated clothing should be done by people in full protective clothing in an area away from non-contaminated persons. All infectious cases should be quarantined for seventeen days following exposure for all contacts, and strict isolation would apply to any victims. All material used to treat victims or coming in contact with victims should be autoclaved, boiled or burned. Patients should be considered infectious until all scabs separate. 

Artificial skin had been made from a bilayer fabricated from a cross-linked mixture of bovine hide, collagen, and chondroitin-B-sulfate derived from shark cartilage with a thin top layer of siloxane. The siloxane layer acts as a moisture- and oxygen-permeable support and to protect the lower layer from the outer world allowing skin formation to occur in conjunction with the lower layer. Poly(amino acid) films have also been used as an artificial skin. Research continues in search of a skin that can be effectively used to cover extensive wounds and for burn patients. 

Burn patients In patients with extensive burns, altered pharmacokinetics may result in reduced serum concentrations of aminoglycosides. 

Children It is recommended that IM injections be given preferably in the mid-lateral muscles of the thigh. In infants and small children, use the periphery of the upper outer quadrant of the gluteal region only when necessary, such as in burn patients, in order to minimize the possibility of damage to the sciatic nerve. 

Topically active sulfonamides are useful in preventing infections in burn patients. Mafenide acetate... 

Pharmacokinetics Rapid, complete absorption after IM administration. Protein binding less than 30%. Widely distributed (doesn t cross the blood-brain barrier low concentrations in cerebrospinal fluid (CSF). Excreted unchanged in urine. Removed by hemodialysis. Half-life 2-4 hr (increased in impaired renal function and neonates decreased in cystic fibrosis and febrile or burn patients). 

Overdose or overexposure may result in serious blistering and burning. Patient/Family Education... 

Robert, R., Blakeney, P.E., Villarreal, C., Rosenberg, L., and Meyer, W.J. (1999) Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder a pilot study./ Am Acad Child Adolesc Psychiatry 38 873-882. 

Losytska V, Naida I, Tsiganov V (1997) Toxin-binding abihty of blood serum proteins in burned patients with the use of Enterosgel. In Biosorption methods and preparations in prophylactic and therapeutic practice, Eirst Conference, Kyiv (In Ukrainian), pp 121-122... 

Amongst 377 patients with chemical bums admitted to a bum center in Guangdong province, China from 1987-2001, 337 (88.5%) were accidental and 40 (10.5%) were from deliberate chemical assault [33]. Of the total number of chemically burned patients, ocular bums occurred in 55 (14.6%) [33]. 

Alvarez E. Neutropenia in a burned patient being treated topically with povidone-iodine foam. Plast Reconstr Surg 1979 63(6) 839-40. 

Pietsch J, Meakins JL. Complications of povidone-iodine absorption in topically treated burn patients. Lancet 1976 l(7954) 280-2. 

Robertson P, Fraser J, Shield J, Weir P. Thyrotoxicosis related to iodine toxicity in a paediatric burn patient. Intensive Care Med 2002 28 1369. 

Aiba M, Ninomiya J, Furuya K, Arai H, Ishikawa H, Asaumi S, Takagi A, Ohwada S, Morishita Y. Induction of a critical elevation of povidone-iodine absorption in the treatment of a burn patient report of a case. Surg Today 1999 29 157-9. 

Singh KP, Prasad R, Chari PS, Dash RJ. Effect of growth hormone therapy in burn patients on conservative treatment. Burns 1998 24(8) 733-8. 

White MG, Asch MJ. Acid-base effects of topical mafe-nide acetate in the burned patient. N Engl J Med 1971 284(23) 1281—6. 

Peng X, Yan H, You Z, et al. Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients. Bums. 2004 30 135-139. 

Patterson DR, PtacekJT, Carrougher G, et al. The 2002 Lindberg Award. PRN vs regularly scheduled opioid analgesics in pediatric burn patients. J Bum Care Rehabil. 2002 23 424-430. 

Topical application of neomycin rarely results in detectable serum concentrations. However, in the case of gentamicin, serum concentrations of 1-18 g/mL are possible if the drug is applied in a water-miscible preparation to large areas of denuded skin, as in burned patients. Both drugs are water-soluble and are excreted primarily in the urine. Renal failure may permit the accumulation of these antibiotics, with possible nephrotoxicity, neurotoxicity, and ototoxicity. 

Transient local necrosis and congestion were reported after smoking particles of white phosphorus were discovered in the tarsal and bulbar conjunctival sacs of a dermal burn patient (Scherling and Blondis 1945). The conjunctival effects were completely absent by 4 days post-exposure. 

Blister fluid obtained from patients with cutaneous thermal injury had TAC 24% lower than that of blood serum. This may reflect oxidative stress and consumption of antioxidants in the blister site (H8). However, TAC of blood serum of severely burned patients was increased in 42% of the patients (mean value of TAC was elevated by 11% in the whole group of burned patients) (F2). 

F2. Farriol, M., Fuentes, F., Venereo, Y., Solano, I., Orta, X., and Segovia, T., Antioxidant capacity in severely burned patients. Pathol. Biol. 49, 227—231 (2001). 

Onarheim, H., Reed, R.K., and Laurent, T.C., Elevated hyaluronan blood concentrations in severely burned patients, Scand J. Clin. Lab. Invest., 51, 693, 1991. 

---