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ns
Control of infection
P recautio ns against infectio n are o f p aram o unt im p o rtance until healing is co m p lete.
Infectio n is o ne o f the m o st frequent and serio us co m p licatio ns o f burns:
– F o llo w hy giene p recautio ns (e.g. sterile glo ves when hand ling p atients).
– Rigo ro us wo und m anagem ent (d ressing changes, early excisio n).
– S ep arate “new” p atients (< 7 d ay s fro m burn) fro m co nvalescent p atients (≥ 7 d ay s
fro m burn).
– D o no t ad m inister antibio therap y in th e absence o f sy stem ic infectio n. I nfectio n is
d efined by th e p resence o f at least 2 o f 4 fo llo wing signs: tem p erature > 3 8 .5 °C o r
< 3 6 °C , tachy card ia, tachy p no ea, elevatio n o f white blo o d cell co unt by m o re than
1 0 0 % (o r substantial d ecrease in the num ber o f white blo o d cells).
– In the event o f sy stem ic infectio n, start em p iric antibio tic treatm ent:
C hild ren > 1 m o nth:
cefazolin IV : 7 5 m g/ k g/ d ay in 3 injectio ns + ciprofloxacin P O : 3 0 m g/ k g/ d ay in 2 d o ses
A d ults:
cefazolin I V : 6 g/ d ay in 3 injectio ns + ciprofloxacin P O : 1 .5 g/ d ay in 3 d o ses
– L o cal infectio n, in th e absence o f signs o f sy stem ic infectio n, requires to p ical
treatm ent with silver sulfad iaz ine.
Other treatments
– Omeprazole IV fro m D 1 :
C hild ren: 1 m g/ k g o nce d aily
A d ults: 4 0 m g o nce d aily
– T etanus im m uniz atio n/ p ro p hy laxis (see Tetanus, p age 1 7 0 ).
– T hro m bo p ro p hy laxis: nadroparin S C beginning 4 8 to 7 2 h p o st-injury . H igh risk
d o sing
p ro to co l if the B S A is > 5 0 % and / o r in the event o f high- vo ltage electrical injury ;
m o d erate risk d o sing p ro to co l if the B S A is 2 0 to 5 0 % and / o r in the event o f burns o f
the lo wer lim bs.
– P hy sio therap y fro m D 1 (p reventio n o f co ntractures), analgesia is necessary .
– Intentio nal burns (suicid e attem p t, aggressio n): ap p ro p riate p sy cho lo gical fo llo w-up .
III. Local treatment
Regular d ressing ch anges1 p revent infectio n, d ecrease heat and fluid lo sses, red uce
energy lo ss, and p ro m o te p atient co m fo rt. D ressings sh o uld be o cclusive, assist in
relieving p ain, p erm it m o bilisatio n, and p revent co ntractures.
– B asic p rincip les
• Rigo ro us ad herence to the p rincip les o f asep sis.
• D ressing changes require m o rp hine ad m inistratio n in the no n-anaesthetised p atient.
• T h e first d ressing p ro ced ure is p erfo rm ed in th e o p erating ro o m und er general
anaesthesia, the fo llo wing in an o p erating ro o m und er general anaesthesia o r at th e
bed sid e with m o rp hine.
– T echnique
• A t the tim e o f the first d ressing p ro ced ure, shave any hairy areas (arm p it, gro in,
p ubis) if burns invo lve the ad jacent tissues; scalp (anterio rly in the case o f facial
burns, entirely in the case o f cranial burns). C ut nails.
• C lean th e burn w ith polyvidone iodine scrub so lutio n ( 1 vo lum e o f 7 .5 % P V I +
4 vo lum es o f 0 .9 % so d ium chlo rid e o r sterile water). S crub gently with co m p resses,
tak ing care to avo id bleed ing.
1 Open technique « naked burn patient under a mosquito net » and water immersion therapy are obsolete and
should no longer be used.
270
Control of infection
P recautio ns against infectio n are o f p aram o unt im p o rtance until healing is co m p lete.
Infectio n is o ne o f the m o st frequent and serio us co m p licatio ns o f burns:
– F o llo w hy giene p recautio ns (e.g. sterile glo ves when hand ling p atients).
– Rigo ro us wo und m anagem ent (d ressing changes, early excisio n).
– S ep arate “new” p atients (< 7 d ay s fro m burn) fro m co nvalescent p atients (≥ 7 d ay s
fro m burn).
– D o no t ad m inister antibio therap y in th e absence o f sy stem ic infectio n. I nfectio n is
d efined by th e p resence o f at least 2 o f 4 fo llo wing signs: tem p erature > 3 8 .5 °C o r
< 3 6 °C , tachy card ia, tachy p no ea, elevatio n o f white blo o d cell co unt by m o re than
1 0 0 % (o r substantial d ecrease in the num ber o f white blo o d cells).
– In the event o f sy stem ic infectio n, start em p iric antibio tic treatm ent:
C hild ren > 1 m o nth:
cefazolin IV : 7 5 m g/ k g/ d ay in 3 injectio ns + ciprofloxacin P O : 3 0 m g/ k g/ d ay in 2 d o ses
A d ults:
cefazolin I V : 6 g/ d ay in 3 injectio ns + ciprofloxacin P O : 1 .5 g/ d ay in 3 d o ses
– L o cal infectio n, in th e absence o f signs o f sy stem ic infectio n, requires to p ical
treatm ent with silver sulfad iaz ine.
Other treatments
– Omeprazole IV fro m D 1 :
C hild ren: 1 m g/ k g o nce d aily
A d ults: 4 0 m g o nce d aily
– T etanus im m uniz atio n/ p ro p hy laxis (see Tetanus, p age 1 7 0 ).
– T hro m bo p ro p hy laxis: nadroparin S C beginning 4 8 to 7 2 h p o st-injury . H igh risk
d o sing
p ro to co l if the B S A is > 5 0 % and / o r in the event o f high- vo ltage electrical injury ;
m o d erate risk d o sing p ro to co l if the B S A is 2 0 to 5 0 % and / o r in the event o f burns o f
the lo wer lim bs.
– P hy sio therap y fro m D 1 (p reventio n o f co ntractures), analgesia is necessary .
– Intentio nal burns (suicid e attem p t, aggressio n): ap p ro p riate p sy cho lo gical fo llo w-up .
III. Local treatment
Regular d ressing ch anges1 p revent infectio n, d ecrease heat and fluid lo sses, red uce
energy lo ss, and p ro m o te p atient co m fo rt. D ressings sh o uld be o cclusive, assist in
relieving p ain, p erm it m o bilisatio n, and p revent co ntractures.
– B asic p rincip les
• Rigo ro us ad herence to the p rincip les o f asep sis.
• D ressing changes require m o rp hine ad m inistratio n in the no n-anaesthetised p atient.
• T h e first d ressing p ro ced ure is p erfo rm ed in th e o p erating ro o m und er general
anaesthesia, the fo llo wing in an o p erating ro o m und er general anaesthesia o r at th e
bed sid e with m o rp hine.
– T echnique
• A t the tim e o f the first d ressing p ro ced ure, shave any hairy areas (arm p it, gro in,
p ubis) if burns invo lve the ad jacent tissues; scalp (anterio rly in the case o f facial
burns, entirely in the case o f cranial burns). C ut nails.
• C lean th e burn w ith polyvidone iodine scrub so lutio n ( 1 vo lum e o f 7 .5 % P V I +
4 vo lum es o f 0 .9 % so d ium chlo rid e o r sterile water). S crub gently with co m p resses,
tak ing care to avo id bleed ing.
1 Open technique « naked burn patient under a mosquito net » and water immersion therapy are obsolete and
should no longer be used.
270
