Page 314 - Learnwell EVS
P. 314
10. Medical and minor surgical procedures
• Rem o ve blisters with fo rcep s and scisso rs.
• Rinse with 0 .9 % so d ium chlo rid e o r sterile water.
• D ry the sk in by blo tting with sterile co m p resses.
• A p p ly silver sulfadiazine d irectly by hand (wear sterile glo ves) in a unifo rm lay er o f
3 -5 m m to all burned areas (excep t ey elid s and lip s).
• A p p ly a greasy d ressing (Jelo net® o r p etro latum gauz e) using a to -and -fro m o tio n
(d o no t use circular d ressings).
• C o ver with a sterile co m p resses, unfo ld ed into a single lay er. N ever encircle a lim b
with a single co m p ress.
• W rap with a crep e band age, lo o sely ap p lied .
• E levate extrem ities to p revent o ed em a; im m o bilise in extensio n.
– F requency : ro utinely every 4 8 ho urs; d aily in the event o f sup erinfectio n o r in certain
areas (e.g. p erineum ).
– M o nito ring
• D istal isch aem ia o f th e burned lim b is th e m ain co m p licatio n d uring th e first
4 8 h o urs. A ssess fo r signs o f isch aem ia: cy ano sis o r p allo r o f th e extrem ity ,
d y saesthesia, hy p eralgia, im p aired cap illary refill.
• M o nito r d aily : p ain, bleed ing, p ro gressio n o f healing and infectio n.
IV. Surgical care
– E m ergency surgical interventio ns:
• E scharo to m y : in the case o f circum ferential burns o f arm s, legs o r fingers, in o rd er
to avo id isch aem ia, and circum ferential burns o f chest o r neck that co m p ro m ise
resp irato ry m o vem ents.
• T rach eo to m y : in th e event o f airw ay o bstructio n d ue to o ed em a ( e.g. d eep
cervico facial burns). T racheo to m y can be p erfo rm ed thro ugh a burned area.
• T arso rrhap hy : in the event o f o cular o r d eep ey elid burns.
• S urgery fo r asso ciated injuries (fractures, visceral lesio ns, etc.).
– B urn surgery :
• E xcisio n-grafting o f d eep burns, in the o p erating ro o m , und er general anaesthesia,
between D 5 and D 6 : excisio n o f necro tic tissue (eschar) with sim ultaneo us grafting
with auto grafts o f thin sk in. T his interventio n entails significant bleed ing risk , d o
no t invo lve m o re than 1 5 % o f B S A in the sam e surgery .
• I f early excisio n- grafting is no t feasible, d efault to th e p ro cess o f slo ugh ing-
granulatio n-re-ep ithelisatio n. S lo ughing o ccurs sp o ntaneo usly d ue to the actio n o f
sulfad iaz ine/ p etro latum gauz e d ressings and , if necessary , by m echanical surgical10
d ebrid em ent o f necro tic tissue. T his is fo llo wed by granulatio n, which m ay require
surgical red uctio n in the case o f hy p ertro p hy . T he risk o f infectio n is high and the
p ro cess is p ro lo nged (> 1 m o nth).
V. Pain management
A ll burns require analgesic treatm ent. P ain intensity is no t alw ay s p red ictable and
regular assessm ent is p aram o unt: use a sim p le verbal scale (S V S ) in child ren > 5 y ears
and ad ults and N F C S o r F L A C C scales in child ren < 5 y ears (see Pain, p age 2 9 ).
271
• Rem o ve blisters with fo rcep s and scisso rs.
• Rinse with 0 .9 % so d ium chlo rid e o r sterile water.
• D ry the sk in by blo tting with sterile co m p resses.
• A p p ly silver sulfadiazine d irectly by hand (wear sterile glo ves) in a unifo rm lay er o f
3 -5 m m to all burned areas (excep t ey elid s and lip s).
• A p p ly a greasy d ressing (Jelo net® o r p etro latum gauz e) using a to -and -fro m o tio n
(d o no t use circular d ressings).
• C o ver with a sterile co m p resses, unfo ld ed into a single lay er. N ever encircle a lim b
with a single co m p ress.
• W rap with a crep e band age, lo o sely ap p lied .
• E levate extrem ities to p revent o ed em a; im m o bilise in extensio n.
– F requency : ro utinely every 4 8 ho urs; d aily in the event o f sup erinfectio n o r in certain
areas (e.g. p erineum ).
– M o nito ring
• D istal isch aem ia o f th e burned lim b is th e m ain co m p licatio n d uring th e first
4 8 h o urs. A ssess fo r signs o f isch aem ia: cy ano sis o r p allo r o f th e extrem ity ,
d y saesthesia, hy p eralgia, im p aired cap illary refill.
• M o nito r d aily : p ain, bleed ing, p ro gressio n o f healing and infectio n.
IV. Surgical care
– E m ergency surgical interventio ns:
• E scharo to m y : in the case o f circum ferential burns o f arm s, legs o r fingers, in o rd er
to avo id isch aem ia, and circum ferential burns o f chest o r neck that co m p ro m ise
resp irato ry m o vem ents.
• T rach eo to m y : in th e event o f airw ay o bstructio n d ue to o ed em a ( e.g. d eep
cervico facial burns). T racheo to m y can be p erfo rm ed thro ugh a burned area.
• T arso rrhap hy : in the event o f o cular o r d eep ey elid burns.
• S urgery fo r asso ciated injuries (fractures, visceral lesio ns, etc.).
– B urn surgery :
• E xcisio n-grafting o f d eep burns, in the o p erating ro o m , und er general anaesthesia,
between D 5 and D 6 : excisio n o f necro tic tissue (eschar) with sim ultaneo us grafting
with auto grafts o f thin sk in. T his interventio n entails significant bleed ing risk , d o
no t invo lve m o re than 1 5 % o f B S A in the sam e surgery .
• I f early excisio n- grafting is no t feasible, d efault to th e p ro cess o f slo ugh ing-
granulatio n-re-ep ithelisatio n. S lo ughing o ccurs sp o ntaneo usly d ue to the actio n o f
sulfad iaz ine/ p etro latum gauz e d ressings and , if necessary , by m echanical surgical10
d ebrid em ent o f necro tic tissue. T his is fo llo wed by granulatio n, which m ay require
surgical red uctio n in the case o f hy p ertro p hy . T he risk o f infectio n is high and the
p ro cess is p ro lo nged (> 1 m o nth).
V. Pain management
A ll burns require analgesic treatm ent. P ain intensity is no t alw ay s p red ictable and
regular assessm ent is p aram o unt: use a sim p le verbal scale (S V S ) in child ren > 5 y ears
and ad ults and N F C S o r F L A C C scales in child ren < 5 y ears (see Pain, p age 2 9 ).
271
