BURNSPROTOCOL

PLASTI
CSURGERYUNI
TATBUTH,
BAUCHI
Forpat
ient
swi
thmaj
orbur
ns(
20%/
10%adul
tand10%/5%paedi
atr
icTBSAf
orshal
l
ow/
deep
r
espect
ivel
y)

1.Ai
rwayandBr
eat
hing

Passendot
racheal
tubeandv
ent
il
atewi
th100%oxy
gen

2.Fl
uidResusci
tat
ion:

A. Getvenousaccesswi t
hwi debor
ecannulaex2(appropr
iat
eforage)andt
akesampl
e
forPCVasbaseline.RepeatPCVaft
erresusci
tat
ion.

B. I
fthi
sisdi
ffi
cul
tdon'
thesi
tat
etopassasmall
ercannulat
hatcanreadi
l
ybepassedand
r
esusci
tat
ioncommencedwhilesear
chf
orbet
teraccesscont
inues

C. Getacent
ral
li
nef
ort
hosewi
th40%andabov
eTBSA

D. Passur
ethr
alcat
het
erandempt
ytheur
ine,
not
ethet
imet
hisi
sdone

E. Li
stenf
orpr
esenceof
bowel
soundsandpassNGTf
orf
eedi
ngt
hosewi
th>|
=40%TBSA

F. Wei
ght
hepat
ient
,andcheckhei
ghtf
orpaedi
atr
ics

G. Est
imat
etot
albodysur
facear
ear(
TBSA)bur
ntusi
ngLundandBr
owderchar
t

H. Calcul
atefl
uidr
equi
rementusi
ngPar
klandf
ormul
a4ml sxweighti
nKgxTBSAburnt
per(fi
rst
)24hours(
tomax.of50%TBSA)ofwarm Ri
nger
slactat
e(Har
tmann'
ssol
uti
on)

I
. Gi
vehalfofcal
cul
ated24hourf
lui
dov
erf
ir
st8hour
sfr
om bur
ns,
remai
ninghal
fspr
ead
ov
ernext16hours

J. Monit
orhour
lyur
ineout
put(
0.5ml/
Kg-adult(
30Kgandabove)and1ml/
Kg-paedi
atr
ic;
nott
oexceed1ml/Kgor2ml
/Kgforadul
tandpaedi
atr
icr
especti
vel
y)

K. ReduceI
VFt
omai
ntenanceaf
terf
ir
st24hour
sifpat
ienti
smaki
ngadequat
e.

I
fpat
ientpr
esent
shour
slat
er:

Cor
rectdef
ici
tusi
ngant
i-
shockr
egi
ment
ogetpat
ientmaki
ngadequat
eur
ine(
clearamber
col
ouredur
ine)
Thencont
inuewi
thr
ateofadmi
nist
rat
ionoff
lui
dfort
hepr
esentt
ime.

Ur
ineout
putshoul
dbe1ml
/Kg(
adul
ts)and2ml
s/Kg(
paedi
atr
ics)i
nel
ect
ri
cal
bur
ns

Moni
torv
ital
signshour
ly

NB:

1.Nur
sesdot
hemoni
tor
inghour
lybutdoct
orsshoul
dcheckt
hechar
t4hour
lyf
oradequacy

2.Al
way
sauscul
tat
ethel
ungbasi
sforf
lui
dov
erl
oad

3.Anal
gesi
cs:

 Pent
azoci
ne(
60mg(
adul
ts)0.
5mg/
Kg(
paed.
)6hour
lyI
V

 Par
acet
amol
600mgadul
tsand10mg/
Kgpaedi
atr
icsI
V

 Av
oid:
NSAI
D(st
ressul
cer
)PCM

4.Ant
ibi
oti
c:Gi
vepr
ophy
lact
icant
ibi
oti
csf
orGr
am +v
ebact
eri
afor5day
s.Rev
iewi
fper
sist
nt
f
ever(
>38.
5°C)f
or>72H.

Car
eful
wit
hami
nogl
i
cosi
desi
nbur
ns

5.Tet
anusi
mmuni
zat
ion:0.
5ml
sTT,
ant
it
etanusi
mmunogl
obul
i
nasi
ndi
cat
ed

6.Dr
essi
ng:

a)Debr
idebur
nwoundandcl
eanwi
thwar
mfl
uid(
sal
i
ne,
ringer
sorpackagewat
er)

b)Doescar
otomyf
orci
rcumf
erent
ial
deepder
mal
bur
ns

c)Consi
derf
asci
otomyf
orel
ect
ri
cal
bur
ns

d)Dresswoundwithder
mazineorpov
idonei
odi
ne,
orhoneyasappr
opr
iat
eand
applyt
hickgamgeedressi
ng

e)Ensur
epat
ienti
scov
eredwi
thcl
ean,
drybl
anketi
nwar
m env
ironment

f
) Changedr
essi
ngwi
thi
n6hour
sofst
ri
ket
hroughori
mmedi
atel
yifbadodour
not
ed

g)Dr
essi
ngcanbel
eftf
or5day
sifnopr
obl
ems

h)El
evat
eaf
fect
edl
i
mbs
7.Ant
i-
ulcerdr
ug:

Omepr
azol
e20mg12hr
ly(
5-10Kg=5mg,
10-
20Kg=10mg,
>20Kg=20mg)I
V

Al
lowli
ber
alor
ali
ntakeast
oler
atedi
fnoti
nshock.Commenceaf
tercor
rect
ingshockf
ort
hose
i
nshock.

8.Nut
ri
ti
on:

UseCur
rer
ifor
mul
a(25Kcal
/Kg+40/
TBSA)f
orcal
ori
einadul
tsand2g/
Kg/
dayofpr
otei
n

Vi
tami
ns-
A(10,
000I
U),
C(1,
000mg)
,E(
1,000I
U)f
or2/
52

Paedi
atr
ics:

 Cal
ori
e-1, m2 +1,
800/ m2 BSAB
300/

 Pr
otei
n-3g/
Kg

 Vi
tami
ns-A(
2500t
o5000I
U),
C(250t
o500mg)
,E(
1,000I
U)

9.Pr
ophy
laxi
sforcont
ract
ure:

 Spl
i
ntaf
fect
edj
oint
s

 Rangeofmot
ionexer
cisedur
ingdr
essi
ngandi
nb/
wasal
l
owed

 I
nvi
tePhy
siot
her
api
st

10.Pr
ophy
laxi
sfordeepv
enoust
hrombosi
s:

 Chestphy
siot
her
apy

 Pr
adaxa(
Dabi
gat
ran)
:220mg/
dPO(
saf
ety
/ef
fi
cacyf
or<18y
ear
snotest
erbl
i
shed)or

 SCcl
exane40mgdai
l
y(1mg/
Kg)

11.Ot
hermeasur
es:

 Weekl
ywei
ghi
ngofpat
ient

 Weekl
yPCV

 Ser
um pr
otei
n(t
otal
andal
bumi
n)asi
ndi
cat
ed

 U/
E/Crasi
ndi
cat
ed

 FBCasi
ndi
cat
ed
I
NHALATI
ONI
NJURI
ESCARE

1.I
nvi
teAnaest
hesi
ologi
stt
oassessandi
ntubat
epat
ientasadar
eemer
gency

2.Nebul
i
sepat
ientwi
th:

 Sal
but
amol
5mgev
ery4hour
s

 Hepar
in1000i
nter
nat
ional
uni
tev
ery4hour
s

 Acet
ylcost
ume30%ev
ery4hour
s

Thesehel
pst
ocausebr
onchodi
l
atay
ionsandpr
eventexcessi
vesecr
eti
onandcast
for
mati
on.

NB:
1mcgofv
it.A=3.
33I
Uofv
it.A.1mgofAl
fat
ocopher
ol=1.
5IUofv
it.E

BSAB=Bodysur
facear
eabur
ned.

Bl
oodt
ransf
usi
onf
ormul
aforpaedi
atr
ics:

Vol
umeofRBCs=Wei
ght(
Kg)xI
ncr
ementdesi
red(
g/dl
Hb)x5/
Hct
.