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Primary Surgery Vol.2 – Trauma : Burns : How should the burn itself be treated?

58.13 How should the burn itself be treated?

You will probably find yourself treating burns in overcrowded wards with more than one patient in the same bed, with few imperfectly trained nurses, and with the minimum of dressings drugs and equipment. Which methods are best suited to these extreme limitations? Here are the possibilities: (1) The open (exposure) method which leaves a burn open to the air and encourages it to form a dry crust. (2) The closed (occlusive) method in which the burn is isolated from the environment by thick dressings. (3) A method in which the burn is kept continously wet with saline. (4) The plastic bag method for burnt hands or feet. (5) Early excision and grafting. Each method has its own advantages and disadvantages, and there is no ’best method’. Instead, combine the best of all methods to suit the needs of a particular patient. The combination that you are likely to and best is the exposure method for a patient’s superficial burns, sane soaks for his deep ones, and the plastic bag method for his hands and feet.

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