Treatment of the first period of burn injuries

2021-01-30 12:00 AM

Especially effective for the first 20 minutes, if left to soak in cold water for 30 minutes, it no longer valid

Treatment of the first-period burn wound

Purpose

Exclude the remaining burn causes in the burn, dirt, foreign objects if any. Diagnose the area and depth of the burn.

Take medicine and treatment in place.

Request

As soon as possible, do not cause further pain to the patient.

Ensure sterile, gentle and thorough action.

Contraindicated

When there is shock or the threat of shock.

Steps taken

Immediately upon burn:

Soak the burned area in cold water (16-20 0 C) for 20-30 minutes. Especially effective for the first 20 minutes, if left to soak in cold water after 30 minutes, it no longer valid

Dress the burned area tightly (to limit the development of burn fluid and oedema).

If burned, chemicals must be used to neutralize.          

Management of burns at the grassroots level:

Pain relief: If the burn is extensive, use aesthetic to change the bandage. Commonly used drugs are Ketalar (ketamine) 10 mg / kg intramuscularly, 2 mg / kg intravenously.

Analgesic:

Dolacgan 0.1. 1 heap.

Pipolfen 0.05.1 tube.

Intramuscular injection before changing the bandage 15 minutes.

For children, the dose must be reduced by weight.

Tape change principles:

Guaranteed sterile:

The dressing must be changed in the sterile dressing chambers.

Changing bandages must wear clothes, working hats, steam masks, wash hands according to sterile regulations, and wear steamed gloves.

Tools means, and dressing change materials are sterilized.

Patients: Before removing the bandage, wipe off any non-burned parts, remove dirty clothing from the hospital ward before entering the dressing room.

When washing the wound, observe the following rules:

Wash from clean area - dirty area (first, face first, foot area, perineal last wash).

The healthy skin around the burn is washed with cool boiled water and soapy water (1 liter of boiling water + 5 grams of soap to cool), dry and apply iodine or 70 0 alcohol.

In the burn area, wash with mixed soapy water, rinse with 0.9% NMSL solution, remove the foreign body, remove the burned dome, remove the necrotic skin. Wash again with NMSL 0,9% blotting dry.

Diagnose the area of ​​the depth of the burn, but the drug into local treatment.

Exposure: face area. perineal layer burns IV dry necrosis - ointment is red.

For open sale: degree II burns, clean without infection.

Apply membrane-forming drugs for burns of degree II, III until the early infection is not infected. (Do not apply in the face, motor joints, episiotomy, head limbs).

Cover the burn until late, already infected, burn with wet necrosis, apply antibiotic gauze, topical medicine, put dry gauze, absorbent bandage, bandage.

Handling some common burn agents

Burns caused by hot lime:

Wash with 0.9% NMSL solution

Wash again with NH4CL solution: 3%, 5%.
Ca (OH) 2 + 2 NH4CL ----> CaCL2 + 2NH4OH.

Remove the burned dome, remove the foreign body, rinse with 0.9% NMSL.

Put gauze soaked in mild acid solution such as Boric acid 3%, a.Acetic 6%, bar vinegar, lemon juice, sugar ... Put dry gauze, bandage tightly.

Management of acid burns:

Use mild basic solutions to neutralize such as 10-20% sodium bicarbonate solution, soapy water, and 5% lime water.

Soak the basic solution in a gauze pad to cover the burn area, and place a dry bandage tightly over the area.

H2SO4 used Magesulphat sprinkled on the burn or injected Gluconate under the burn.

Carbonic use herbal oils, glycerin, alcohol, alcohol to wash.

Fenic, Phenol uses herbal oils to cover and cover.

The dressing changes

Purpose

Eliminate purulent fluid from the burn, remove necrotic tissue, wash the burn wound.

Put the drug in local treatment, supplement the diagnosis.

Request

Ensure sterile, prevent cross-infection, gentle, gentle.

Anti-pain, does not cause bleeding or peeling skin graft.

Dressing only

Change the dressing regularly:

Depending on the condition of the wound, if the wound is large with pus fluid, change the bandage every day, if the area is narrow, with little pus change the dressing every other day.

For burns with film forming agents:

If the film is dry, let it go away.

If the infection is under the drug membrane, use scissors to remove the infected membrane, wash it with 0.9% NMSL and apply medicated gauze to the cut membrane area.

For burns with film forming agents:

If dry, do not treat.

If wet, rinse with 0.9% NMSL and continue to apply red exposing medicine.

For burns to semi-open gauze:

If it is dry, do not treat it to expose itself.

If wet, use scissors to remove the wet gauze, wash it and apply a semi-exposed bandage.

Regulations on sterility in dressing changes:

After changing the dressing for a patient, hands must be soaked and washed, each patient must use a separate bandage change diet to avoid cross-contamination.

The ration of dressing changes includes: 2 pea trays, 2 diapers (1 hauled, 1 nappy), 1 curling scissors, bandage, gauze, just enough medicine, all are sterile steamed.

Order of patients to change the dressing:

Priority is given to patients who need initial treatment, post-skin transplant patients, followed by patients with a narrow burn area, low pus fluid, then patients with extensive burns, and finally infected patients. severe bacteria.

Take the patient to the dressing room, except for patients with severe burns, with a table and a mobile crew.

Bacteriophage: transfer patient to the dressing room, and transfer patient to ward, use a felt, pull off the bandage and outer gauze. Pour 0,9% NMSL or dilute purple medicine to moist gauze, help sterile people, bandage the wound with proper technique.

Dressing technique:

Use 2 felt to gently peel off the inner layer of gauze so that the gauze pad is parallel to the skin surface. Use a felt with a squeeze of the water-squeezed sphere so that the area of ​​the cotton when dabbing the wound is much, but the nose does not touch the wound.

Pay attention not to cause bleeding, affecting the grafted skin piece, if the grafted skin piece is removed, it must be replaced.

Use gauze to gently absorb the wound, remove the pseudomembrane, cut the necrosis, wash the wound clean.

Put on medicated gauze or apply for the medicine directly (as prescribed by a doctor), then apply water-absorbent gauze (if skin grafting area adds paraffin gauze). The next layer of gauze is placed 1cm on the gauze layer. The thickness of the gauze depends on the secretion, pus of the wound.

For seed tissue prepared for skin grafting, do not apply grease directly to the seedbox 3-5 days before surgery.

The drugs are often used in the dressing chamber

Solution form:

Including NMSL 0.9%. Becberin 0.1%. a.Boric 3%, silver nitrate 0.25%, 10%, 5% CuSO4, red medicine, iodine alcohol, turmeric juice, salt water 5%, Betadine 10% ...

Type of grease, oil:

High yellow fat, Vaseline grease, antibiotic grease, Chitosan ...

Powder form:

Cheesy, tea soda, B76 powder, a.Boric powder ...

Change the bandage after surgery

Thin skin grafting: change the bandage once a day, if it's clean once every 2 days.

WK skin grafts: after 7 days of first dressing change, 9-12 days of thread trimming.

Change skin flap: after 5-7 days to change the first bandage.

Italian skin flap transplant: 3-4 days to change the first bandage, if a lot of pus fluid is 1-2 days, change the bandage 1 time.

Filatop office: 3-5 days to change the first postoperative bandage.