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| ==Burn Dressings==
| | #REDRECT[[Burn dressings]] |
| *Clean, moist is the goal
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| *Eschar must be removed as soon as possible or it will be infected
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| {| class="wikitable"
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| ! Dressing <ref>MetroHealth Medical Center BICU Handbook (Not a policy manual), Cleveland, OH.</ref> !! Indications !! Special considerations
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| | Biobrane || Partial thickness burns at time of admission; clean, fresh scald burns or donors; must be pink, moist, sensate, blanching || Apply shiny side out; secure with benzoin steristrips; no antimicrobial activity; wrap with Kerlix and Ace, to be examined in 24 hrs; fluid accumulations may be aspirated with tuberculin syringe
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| | Xeroform || Clean partial thickness wounds or donor sites || Promotes epithelial migration on clean, well vascularized wounds. Minimal antimicrobial activity; use with bacitracin or bactroban
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| | Bacitracin || Partial thickness burns, anti-Staph agent; also topical agent for superficial facial burns || No penetrating ability; good to remove tar and asphalt (especially around eye). Combine with NS wet-to-dry to increase debriding; do not use on eschar
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| | Santyl (Collagenase) || Deep partial thickness wounds with eschar || Layer needs to be "nickel" thick; Use with bacitracin and xeroform (BX); Santyl also dries wounds, and is best mixed with something moist
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| | Bactroban (mupirocin) || Staph infections, impetigo, facial burns || Apply thin layer and use with Xeroform
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| | Mepilex (Ag) || Partial thickness wounds/donors; low to moderate exuding wounds that need to be covered for extended time || May be left intact without dressing change for 3-7 days. Has increased antimicrobial activity as compared to Polymem
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| | Polymem || Partial thickness wounds; cleanses, fills, absorbs, moistens. Santyl-Polymem is good for deep partial thickness wounds, but this dressing must be changed daily and has no inherent antibacterial properties|| May be left intact up to 7 days if Polymem alone
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| | Sloppy (5% Mafenide acetate) || Used for new grafts || With fine mesh gauze covered with sloppy moistened burn pads; wet downs as needed
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| | Burows (Domboros, Aluminum acetate) || Gram-negative bacilli (pseudomonas) || Creates acidic, drying environment due to its hyperosmolar features; Somewhat toxic to tissues, but more important for skin grafts to take. Fine mesh gauze are covered with Burows moistened burn pads; 2 packets dissolved in 1 L sterile water
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| | Silvadene (silver sulfadiazine) || Full thickness burns. Post traumatic wound infection or cellulitis. Keeps burns moist as opposed to Santyl-Bacitracin-Xeroform, and may be used in the first few days if there are areas of partial thickness burns around full thickness that silvadene is applied to (healing of partial thickness takes a few days to start) || Nonpainful with antibacterial spectrum similiar to Sulfamylon. Does not penetrate dry, leathery eschar. Some gram-negative resistant Enterobacter. Neutropenia may occur within 24-48 hrs. CONTRAINDICATED: 1) Partial thickness which may heal (Silvadene inhibits keratinocytes), 2) Sulfa allergy, 3) Causes kernicterus - pregnant women approaching term, premature infants, newbborns during first 2 months of life
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| | Sulfamylon (Mafenide) || Full thickness burns with eschar (including leathery eschar); deep cartilage burns (ears, nose); alternate to Silvadene in marked leukopenia; sulfamylon liquid (5% soln) for wetting heavily contaminated meshed skin grafts or excised but not grafted areas (not for eschar) || Penetrates eschar, significantly reduces pseudomonas. Painful 20 minutes after application. NOT a sulfa drug, ok in sulfa allergy. May cause metabolic acidosis. CONTRAINDICATIONS: 1) Hypersensitivity reaction, 2) Near the eyes, 3) Large burns in children - causes hyperpnea via inhibition of carbonic anhydrase
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| | Dakins and glycerin (half-and-half, D&G)|| Rarely used now. Wetting agent similar to Sulfamylon liquid. || 0.5% Chloramine-T (similar to bleach) and 50% glycerin. Must be stored in the dark. Oxidized form has no bacteriocidal activity - must smeel strongly of bleach. CONTRAINDICATIONS: 1) Eschar, 2) Invasive infection
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| | Scarlet red || Rarely used now. Barrier dressing to prevent desiccation of underlying wound || Must be clean wound since it has no antibacterial activity (as opposed to Xeroform)
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| | Xenograft (pigskin) || Biologic dressing that protects wounds free of eschar, wounds awaiting epithelial migration for closure, or wounds needing application of autograft || Examine daily and removed if evidence of fluid accumulation or purulent material underneath; may be changed q48-72 hrs. Generally pts develop antibodies to graft after 7-10 days
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| | Allograft (cadaver) || Temporary closure of wounds free of eschar, awaiting autograft; May be used to cover fragile autograft || Viable for up to 5 days after harvesting; must be stored in biologic refrigerator at 4 degrees C
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| |}
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| ===Sources===
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| <references/>
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| [[Category:Derm]] | |
| [[Category:Trauma]]
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