Practical aspects of the management of severely burned children

Abstract

The care of extensively burned children requires untiring attention to a multitude of problems, beginning with the control of shock and continuing until full coverage of the wound is obtained. Such care is best accomplished in a hospital unit which is staffed by a dedicated team of hospital personnel and provided with centralized ward facilities which make efficient management possible. Infection is the most serious threat to life in these patients. Early debridement and adequate drainage are the most important principles in the control of local infection. Management of septicemia includes use of systemic bactericidal antibiotics, employment of blood transfusions and local care of wounds to remove necrotic tissue and provide drainage. Nutritional losses are prevented by nasogastric tube feedings. Anemia and blood volume deficits are forestalled by repeated blood transfusions. Early operative removal of the burn slough and prompt skin grafting are replacing the older methods of allowing the eschar to separate spontaneously. Debridement, beginning on the fourth day after burn, allows grafting to begin by the tenth to fourteenth day. Local care of the burn prior to and between graftings include tubbing and saline compresses. Since lengthy operations are poorly tolerated by these patients, careful planning must precede and adequate personnel must be available to permit expeditious and efficient procedures.