The burn surface should be cooled with running tap water for at least 20 minutes within three hours of the burn injury. Patient education during primary care visits may be an effective prevention strategy.īurn patients who meet American Burn Association referral criteria should be promptly transferred to a burn center. Burn injuries are more likely to occur in children and older people. Pruritus, hypertrophic scarring, and permanent hyperpigmentation are long-term complications of partial-thickness burns. People with diabetes mellitus are at increased risk of complications and infection, and early referral to a burn center should be considered. Prophylactic antibiotics are not indicated for outpatient management and may increase bacterial resistance. Full-thickness (third-degree) burns involve the entire dermal layer, and patients with these burns should automatically be referred to a burn center. Deep partial-thickness burns require immediate referral to a burn surgeon for possible early tangential excision. Superficial partial-thickness burns extend into the dermis, may take up to three weeks to heal, and require advanced dressings to protect the wound and promote a moist environment. Partial-thickness (second-degree) burns are subdivided into two categories: superficial and deep. Superficial (first-degree) burns involve only the epidermal layer and require simple first-aid techniques with over-the-counter pain relievers. Initial treatment is directed at stopping the burn process. All burn injuries are considered trauma, prompting immediate evaluation for concomitant injuries. Two key determinants of the need for referral to a burn center are burn depth and percentage of total body surface area involved. Tissue silver concentrations in one burn patient who died of renal failure after eight days of treatment were 970, 14, and 0.2 micrograms/g wet tissue in cornea, liver, and kidney, respectively.Most patients with burn injuries are treated as outpatients. After absorption, silver was found to be deposited in various tissues. Silver in urine is detectable after one day of treatment and may reach a maximum of 400 micrograms/day. In SSD cream-treated burn patients, plasma concentrations may be as great as 50 micrograms/L within 6 h of treatment and can reach a maximum of 310 micrograms/L. The concentrations of silver in blood, urine, liver, and kidney of subjects without industrial or medicinal exposure are less than 2.3 micrograms/L, 2 micrograms/day, 0.05 microgram/g wet tissue, and 0.05 microgram/g wet tissue, respectively. The detection limit is 0.4 microgram/L the within-run precisions (CV) are 5.16%, 3.83%, and 2.79% for concentrations of 5, 13.5, and 42 micrograms/L, respectively and the between-run precisions are 4.3% and 3.2% for concentrations of 13.5 and 42 micrograms/L. We have developed a flameless thermal atomic absorption spectrophotometric method to measure silver concentrations in blood, urine, and other tissues. Monitoring concentrations of silver in blood and urine of patients receiving this treatment has become necessary, but sensitive and suitable methods adaptable to a clinical laboratory are still needed. Silver deposition has been found in the skin, gingiva, cornea, liver, and kidney of patients treated with this cream, causing argyria, ocular injury, leukopenia, and toxicity in kidney, liver, and neurologic tissues. Silver sulfadiazine cream (SSD) has been used successfully in the management of burn wound sepsis.
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