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11-18-2009, 08:33 PM
Treatment of major burn : > 15 % in adult , > 10% in child.
(1) Ist Aid measures:
Care of respiration .
Establishment of continuos patent venous line.
Antitetanic serum.
Give strong analgesics.
(2) Hospitalization :
(A) Assessment of the degree and extent .
(B) Central venous catheterisation for:
I.V. morphia.
Blood sampling "bl. grouping, blood analysis".
I.V. fluid. "see below"
Measurement of C.V. pressure.
(3) I.V Fluids :
Many fromulae are designed one of them Brooke 's Formula :
q According to this Formula we give :
Crystalloid "Glucose , Saline, Ringer lactate"
1.5 ml / kg body weight / burnt surface area .
Colloids "Plasma, Plasma substitutes"
0.5 ml/ kg body weight / burnt surface area .
FNB:The previous formula is designed to replace fluid loss .We add the daily water need in the form of 2000 ml glucose 5% for adult .


The calculated formula is given over the 1st 24 hours.
In the second day we give 1/2 of the calculated formula of colloid and crystalloid:
Criteria , on which we depend on, in evaluation of fluid therapy :
1- Thirst points to water need to give glucose.
2- Irritability and disorientation == Electrolyte disturbance.
3- Urine output : Not less than 1/2 ml / minute.
4- C.V.P : Not more than 20 cm H2O to prevent pulmonary oedema .
5- Pulse and bl. pr.
6- Base of the lung "auscultation " if crepitation pulm. oedema.
7- Fundus examination for papilloedema.
Fluids must be given with caution in the following conditions .
1- Extreme of ages " young child and elderly patients " .
2- Patients with renal or cardiovascular disease .
3- Patients suspected to have pulmonary injury.
4- Deep burns in the head and neck .
F N.B.:
Paralytic ileus may occur early in burn So , oral fluids is prevented in the 1st 24hs.
Bl. tr. is not needed early as plasma loss causes hemo concentration but after 3 days due to catabolism the haematocrite value will decrease below 40% and blood is needed .
(4) Management of the burn wound:
Dressing is done under general anaesthesia as mentioned before in minor burns.
SOURCE: DR. AYMAN SALEM'S BOOK
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