Third-degree bums

Sample problem 9.1.S demonstrated the calculation of thermal radiation from the BLEVE of a tank truck. This 6000-gallon (22.7 m ) tank was 90% filled with propane, and burst due to fire engulfment at an overpressure of 1.8 MPa (18 bar). The resulting thermal radiation was sufficient to cause third degree bums to a distance of 300 to 360 m. 

The sulfonamides are often used to control urinary tract infections caused by certain bacteria such as Escherichia coli, Staphylococcus aureus, and Klebsiella-Enterobacter. Mafenide (Sulfamylon) and silver sulfadiazine (Silvadene) are topical sulfonamides used in the treatment of second- and third-degree bums. Additional uses of the sulfonamides are given in the Summary Drug Table The Sulfonamides. 

A topical enzyme aids in the removal of dead soft tissues by hastening the reduction of proteins into simpler substances. This is called proteolysis or a proteolytic action. The components of certain types of wounds, namely necrotic (dead) tissues and purulent exudates (pus-containing fluid), prevent proper wound healing. Removal of this type of debris by application of a topical enzyme aids in healing. Examples of conditions that may respond to application of a topical enzyme include second- and third-degree bums, pressure ulcers, and ulcers caused by peripheral vascular disease An example of a topical enzyme is collagenase (Santyl). 

Anyone who has been asphyxiated or even seen some large third degree bums caused by chemicals or heat, will be able to relate to the rigid safety measures I will impose on you in this chapter. 

More problematic than topical devices, however, are devices that penetrate the dermis and are therefore rightfully deemed implantable. This category includes devices used to treat third-degree bums. In current practice, the affected area is excised and a dressing is placed within the wound and perhaps sutured. The dressing is considered an implant from a device-safety perspective. 

An interesting application is the use of bromelain in the debridement of third degree bums [112], in the treatment of blunt injuries to the musculoskeletal... 

Expts have shown that if TEA is thickened with only 1% polyisobutylene (instead of the usual 6%) it is possible to produce a chemical fireball which radiates sufficient thermal energy to destroy or damage military targets. It is reported that such a weapon could cause third degree bums on occupants of bunkers within a few seconds, whether or not the agent hit individuals. Previously only nuclear weapons were able to produce damaging levels of thermal radiation (Ref 5)... 

An 11-month-old infant with second- and third-degree bums over 30% of the body was treated topically with silver sulfadiazine (36). From day 2 there was significant neutropenia, maximal at day 3. The silver sulfadiazine was withdrawn. The neutropenia was followed by anemia, which was maximal on day 5. Finally, thrombocytopenia developed. In spite of blood transfusions and recovery of the neutropenia and thrombocjrtopenia, infection occurred and the patient died from respiratory failure. 

SutHains. USP. Sutilains (Travase) is a proteolytic enzyme obtained from cultures of Bacillus. uhiilis and used to dissolve necrotic tissue occurring in second- and third-degree bums as well as bed sores and ulcerated wounds. 

Use Prevention, treatment of infection in second-and third-degree bums, protection against conversion from partial-to full-thickness wounds (infection causes extended tissue destruction). Treatment of minor bacterial skin infection and dermal ulcer. Half-life UK Onset on contact Peaks 2 1 hours Duration as long as applied... 

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