421 Stage One Touch Burn Treatment for Pediatric Patients with DACC (Dialkylcarbamoyl Chloride)

Abstract

Single-stage one touch burn treatment for pediatric patients is a significant improvement over traditional treatments for young burn patients. Local wound and burn care in pediatric patients is problematic secondary to the amount of pain patients’ experience. Most burns that occur in the pediatric population are scald burns and second-degree burns which require local treatment including daily wound care. A 2% total body surface area burn increases the amount of pain a pediatric patient undergoes due to daily wound care and debridement. Further complicating daily wound care for pediatric burn patients is that often prescribed pain medication is poorly tolerated and suboptimal for daily debridement. Therefore, noting these issues treatment protocols had to be adjusted and changed in order to improve outcomes. Patients with burn injuries are usually seen in the emergency room or by a PCP in the first 24 hours for stabilization. The patient is then brought to the operating room within 72 hours sedated, debrided, and a complete dressing change is performed. Initially silver wound dressings were used in this population. A sterile moist silver dressing is applied covered with Kerlix and a cohesive dressing and changed weekly. Of concern with the pediatric patients is transcutaneous absorption of silver for large total body surface areas. Treatment of these patients has now progressed to use of DACC coated dressings. DACC is a hydrophobic fatty acid derivative that irreversible binds with bacteria rendering then inert. Since DACC is not a chemical agent it avoids the risk of systemic absorption and is safe for use in this population. DACC is applied with the use of a hydrogel and then wrapped in a similar manner and changed weekly. 98% of patients had full closure of second-degree burns after one week. Burn areas of the fingers, chest, legs, and trunk were easily treated with this method. Facial burns proved to be slightly more problematic and required different more appropriate covering dressings. This method of using the DACC coated dressing is cost-effective, safe for patients, and reduces the amount of pain medication required. Patient and family compliance was much higher and outcomes were much improved. This method has decreased the need for silver in burn wounds and alleviated concerns of transcutaneous absorption and toxicity. The introduction of DACC resulted in greater cost savings, anesthetic cosmetic results, and improved safety profile. The one touch technique in pediatric patients with sedation or anesthesia eliminates pain and recurrent dressing changes. It is well tolerated in the pediatric population and compliance is easily attained, with excellent outcomes.