Cutis
-
The initial therapy of thermal injuries is directed at removal of loose debris and necrotic epidermis, alleviation of pain, and prevention of infection. Following initial wound debridement, bacterial growth in the wound itself is controlled primarily through the use of tropical antibiotic agents and daily hydrotherapy to clean the wounds and remove any loose eschar. Effectiveness of topical therapy is monitored by quantitative burn wound biopsy cultures; growth of greater than 10(4) micro-organisms per gram of tissue indicates invasive burn wound sepsis. ⋯ Once eschar separation has exposed healthy granulation tissue, the burn wound must be covered with suitable biologic dressings prior to autografting. All open wounds may then be autografted with sheet grafts to the face, neck, and areas exposed to trauma or by expansion mesh grafts to cover large areas from limited donor sites. Upon completion of autografting, a vigorous physical therapy program is necessary to rehabilitate victims of massive thermal injury to a functional existence.
-
Treatment of burned patients begins at the scene of the accident, continues in the emergency department, and terminates in the burn center. The "burn team" of specialists includes the paramedic at the scene of the accident, the physician and nurses in the emergency room, and the burn center staff. Since the early stages of treatment often predetermine the final outcome, every physician or nurse who may someday be involved with the initial assessment and management of a severely burned patient should review a plan of evaluation and treatment. Thus, patient salvage from devastating burn injuries will continue to improve.