The Chinese Journal of Burns Wounds and Surface Ulcers 1997, (4): 28-29

Twenty-eight Cases of Burn Treated With MEBO

Hou Shiming1, Wang Dongliang1 1.The staff-worker hospital, SanXing Chemical Group, Anhui Province [Abstract]: Groups of burned patients caused by various reasons increased continually in recent years. Our hospital received a group of 28 workers burned by fireworks in 3 P.M., December 15th, 1996. Among them there were 13 severe burned patients. The patients were brought into our hospital one hour after the accident. The oldest patient was 68 years old while the smallest was 15 years old. There were 13 cases with TBSA over 50% and 7 cases with TBSA 30%~49%. Fifteen patients were also accompanied by inhalation injuries and 2 patients had 3rd degree burns. All the 28 patients recovered without disability after MEBO treatment together with early resuscitation and anti-infection treatments. Our hospital received a group of 28 patients in December 15th, 1996. Among them, there were 13 cases of extensive burns. All the 28 patients were healed up successfully since our early treatments were prompt and proper. Our clinical experiences were summarized as follows: 1. Clinical data A firecracker factory exploded at 3 P.M. in December 15th 1996 and 28 workers were burned. They were sent to our hospital one hour after the accident and among them there were 13 severe burned patients. All the patients were females with the age range from 15 to 68 years old. There were 3 patients over 50 years old, 13 patients in the age of 30~49, 10 patients in the age of 20~29 and 3 patients in the age of 15~19. There were 13 cases with TBSA over 50%, 8 cases with TBSA 30~49% and 7 cases with TBSA 10~29%. Two patients had 3rd degree burns over 50% and fifteen patients also had inhalation injuries. The details were listed in Table 1.
Table 1.
Case 1 2 3 4 5 6 7 8 9 10 11 12 13 Gender female female female female female female female female female female female female female Age 25 30 28 55 41 24 26 32 48 21 68 29 39

The conditions of 28 patients burned by powder

TBSA/2nd degree burned area (%) 89/72 82/56 81/21 79/10 76/8 74/7 72/5 70/2 62/2 60/1 56/1 53/0 52/0 Inhalation injury severe light light light light light light light light light light light light Post treatment healed healed healed healed healed healed healed healed healed healed healed healed healed

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The Chinese Journal of Burns Wounds and Surface Ulcers 1997, (4): 28-29

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

female female female female female female female female female female female female female female female

24 46 37 20 62 35 19 48 47 42 33 22 15 17 20

49/0 42/1 40/0 40/0 39/1 37/2 34/0 31/0 29/1 27/0 26/1 25/0 21/0 18/1 13/1

light light light

healed healed healed healed healed healed healed healed healed healed healed healed healed healed healed

2. Early fluid replenishment for anti-shock In the first 24 hours of the shock stage, transfusion of crystal colloid was carried out to treat the 13 extensive burned patients. The crystalloid composed of sodium chloride solution, 5% sodium bicarbonate solution and balanced solution. The colloid solution composed of albumin, plasma, small and medium molecular Dextran and whole blood. The details were listed in Table 2, 3.
Table 2 The volumes of input and output in 13 extensive burned patients in the first 24 hours
Case 1 2 3 4 5 6 7 8 9 10 11 12 13 Total input volume (ml) 8600 8200 8000 7950 7500 7400 7300 7200 6650 6500 6200 5900 5800 Crystalloid volume (ml) 3800 3700 3400 3200 3100 3000 3100 2800 2600 2510 2400 2100 2000 Colloid volume (ml) 2800 2400 2500 2400 2600 2500 2300 2400 2050 1990 1800 1800 1750 Urine volume (ml) 2900 2500 2250 2050 1900 2100 2325 2100 2325 1920 1750 2100 1950

Table 3 The volumes of input and output in 13 extensive burned patients in the second 24 hours
Case 1 2 3 4 Total input volume (ml) 5450 5350 5250 5100 Crystalloid volume (ml) 2000 2100 1950 1700 Colloid volume (ml) 1450 1200 1150 1300 Urine volume (ml) 2505 2100 2230 1950

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The Chinese Journal of Burns Wounds and Surface Ulcers 1997, (4): 28-29

5 6 7 8 9 10 11 12 13

5003 4900 4800 4950 4500 4450 4200 4050 3950

1600 1540 1500 1400 1300 1250 1200 1050 1005

1300 1200 1100 1050 950 805 1800 1800 1750

2210 3050 2100 1950 2120 1850 1750 1960 1805

3. The early treatment of inhalation injury Among the 28 patients, there were 15 patients accompanied with inhalation injuries, including 14 light injuries and one case of severe injury. The 14 light injury patients were given Dexamethasone transfusion together with fluid replenishment to keep the respiratory tract smooth. The severe injury patient was given tracheotomy and mechanical respiration immediately since her respiration became extremely difficult when the inspection frequency increased gradually. 4. The treatment of wounds Wounds treatment was very important in groups of burns. Different treatments should be carried out in different wounds. Debridement could be carried out to minimize infection and the absorption of toxin if the situation allowed. Discharge the fluids in superficial 2nd degree and deep 2nd degree wounds without removing the covers of blisters and then apply MEBO. In 3rd degree burns, the combination of MEBO and skin ploughing treatment should be applied to promote and growth of granulation tissues to heal the wounds. Grafting was necessary in joints in order for the patients to do early exercise and thus minimize the disability rate. 5. Early intra-intestinal and extra-intestinal nutrition supplement Thirteen patients went through their shock stage smoothly. They were given Liquid Diet 24 hours after the burns. In addition, they were given amino acids, albumen and 10% fat emulsion supplements via intravenous injection during the first 4 weeks after the burns. The daily energy intake was more than 3000 cal. 6. Discussion 1All the 28 patients were successfully treated because of our effectively treatments carried out immediately after the accident on spot. As a result, the patients were all healed up while our team got a good chance to practice. 2) The early fluid replenishment should suit to local conditions. In the early stage of extensive burns, vasopermeability had changed and this could cause the extravasation of body fluids and blood volume deficiency, especially the microcirculation filling deficiency. The result was hypovolemic shock. It was for this reason that improving the perfusion became the most important thing to do. In groups

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The Chinese Journal of Burns Wounds and Surface Ulcers 1997, (4): 28-29

of burns, since blood plasma was limited in a short time, other emergent methods should be adopted. Since the first hour of the accident, sodium chloride solution, balanced solution and small molecular Dextran were mainly applied. Half the total volume should be replenished in the first 8 hours in order to maintain the satisfactory urine output. Our experience indicated that fluid expansion with balanced solution, Dextran, albumen and correction of acid poisoning should be done in the first 24 hours. In the second 24 hours, blood plasma and whole blood could be supplied step by step so that the patient could go through the shock stage smoothly and maintain the urine output (over 60-70 ml). During this period, hypoproteinemia did not occur. 3) Try to maintain the respiratory tract smooth. Severe burns accompanied by severe inhalation injury was one of the difficulties in treatment. Our experience indicated that the block in respiratory tract should be treated timely otherwise the patient would die from asphyxia. Although some patients could live through the shock stage reluctantly, the difficulty and complexity of anti-shock treatment would increase and the viscera anoxia would aggravate and even cause MOF. In the past, the incision of trachea was strictly controlled and the operator always had lots of hesitation in conducting this operation. This could aggravate the illness and miss the best chance of treatment. There was one patient with severe burns in the head and facial area accompanied by severe inhalation injury. Early tracheotomy was carried out immediately before fulminating anoxia occurred to maintain the respiratory tract smooth, thus saved the life of this patient. 4) Since the wounds was always wet, it could easily be infected by the busy treatments on the spot. As a result, debridement and bandaging with aseptic gauze could be carried out if not affecting the treatments of systemic severe patients. MEBO had the advantages of convenient, safe, pain-relieving, no sequel and not limited by medical conditions. The liquefied products should be discharged completely every one to two hours in the crest-time of liquefaction stage. MEBO should be applied in the wounds evenly in order to exert its best effects. The treatment of deep wounds was the most important component in the whole burns treatment. As a result, choosing the proper external medicine was not negligible. Our clinical data indicated that after MEBO was applied, the wounds became wet and this could accelerate the liquefaction and drainage as well as the growth of granulation tissues. The survival rate of grafting in 3rd degree burns was quite high. All these areas were MEBOs advantages in treating 3rd degree burns. In general, MEBO was the best medicine to treat burns by far, which could be proved by the fact that 28 patients healed up in only 36 days without functional disturbance.

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