58.16 The saline method for burns

The aim of this method is to keep a burn constantly wet with half strength saline until it heals—full strength physiological saline is painful. As usually described this method requires that the burnt part be dipped into a bath of saline. If it is large, this is inconvenient. A simpler alternative is to pour saline over the burn from a jug, and catch the excess in a mackintosh. This makes the saline method practical in a ward, rather than always in a sluice room.

The saline method: (1) Reduces the time in hospital compared with the exposure method. (2) Uses the minimum of equipment and materials. (3) Is painless, and so enables a patient to start moving his joints early, thus minimizing stiffness and contractures. (4) Allows partial thickness burns to heal promptly and eschars to separate early, leaving healthy granulation tissue nearly ready for grafting. (5) Uses the minimum of dressings and no topical antiseptics. (6) Is popular with mothers and nurses.

This is probably the best method for deep burns in district hospitals, especially if they are extensive—provided: (1) your nursing care is not too bad, (2) your sluice arrangements are reasonable, (3) the climate or the ward is warm about 28C). In practice, you will find the saline method very usefull for full thickness burns, while using the exposure method for superficial ones.

Early on, a wide variety of organisms are likely to be present including Pseudomonas. Later on, the predominant organisms will probably be Staphylococci. These are unlikely to need treating unless a patient has symptoms of generalized infection. If he does, he will be easier to treat than he would be if he were infected by Pseudomonas.

THE SALINE METHOD FOR BURNS

EOUIPMENT A mackintosh sheet and a variety of buckets, jugs, and basins.

SALINE Make half strength (0.5%) saline. You can make small quantities by dissolving a teaspoon of salt in a litre of ordinary tap water. Make larger ones by dissolving some suitable measure of salt in a much larger quantity of water. Learn what half strength saline should taste like, and test its concentration by tasting it first.

TEMPERATURE Keep the room comfortably warm. A patient should not go out into a cold bathroom.

METHOD Start at 48 hours with minor burns, and as soon as shock is over with major ones. Meanwhile, keep the burn moist with saline.

If you are using a jug, put a thick gauze dressing on the burn, and put a plastic sheet under it. If convenient, arrange this so that saline poured over the burn flows into a bucket. Keep the saline in a jug beside the patient’s bed. If he is a child, ask his mother to pour a little saline over the burn every hour or so to keep it wet. Renew the dressing and clean the wound 4 hourly. Some sloughs will come off in the dressing.

CAUTION! Keep the sloughs wet.

If you are going to immerse a burn, find some suitably sized container, such as a baby’s bath, fill this with saline. Encourage the patient to keep dipping his burnt limb into it. Renew the saline at least daily. If you cannot let him have his own bath all the time, let him dip his burn into a bath of saline for 20 minutes twice a day. Let him exercise his burnt joints passively and actively while his burn is in the bath. If he has a deep burn, apply soaks between the baths.

The sloughs on a deep burn will usually separate about the the 12th day, and be ready for grafting on about the 15th to the 17th day. As soon as the granulations are favourable, graft them (58.19). If possible, do regular culture and sensitivity tests.

DIFFICULTIES WITH THE SALINE METHOD

If SLOUGHS DO NOT COME OFF COMPLETELY in the dressings, take the patient to the theatre for’sloughectomy’ (58.18).

If BATHING A BURN IS PAINFUL, sedate him first. Make sure the saline is not too strong.

If he has EXTENSIVE BURNS, he should ideally be lowered into a stainless steel bath.

If his FACE IS BURNT, wash it in saline gently and continually.

If he is in danger of DEVELOPING CONTRACTURES, splint his limb appropriately (58.24).