Dressings for burns

In the complex treatment of patients with burns and preparing them for the rapid restoration of the integrity of the skin, dressings take a leading place, so the dressing nurse has a crucial role. In the burn dressing should work two sisters. The first of them ensures strict sterility of all types of dressing work, the second prepares dressing for work and participates directly in dressings. When dressing in patients with burns, the first dressing nurse in sterile underwear and gloves should be at the sterile table, deliver the necessary instrument and dressing material to the treating doctor performing the dressing. The second dressing sister controls the order of dressings and participates in them. In the first place, dressings are performed in patients with smooth surgical course( after autodermoplasty), then in patients with uncomplicated course of surface burns, granulating wounds and, lastly, in patients with profuse suppuration of the burn wound, which is to be treated with stage necrosectomy.

All dressings, except for urgent, are performed four times a week. In days free of dressings, the staff prepares and sterilizes instruments, replenishes supplies of medicines, and covers the table with sterile instruments.

The burn dressing should have a sufficient number of tools to ensure an uninterrupted rhythm of work. For 20 daily dressings on the instrument table, there should be the following set of tools:

• surgical tweezers - 25 pcs.;

• anatomical tweezers - 10 pcs.;

• Cooper shears - 15 pcs.;

• pointed scissors - 5 pcs.;

• Scissors for cutting dressings - 25 pcs.;

• Scalpels peritoneum and pointed - 3 pcs.;

• hemostatic clamps - 10 pcs.;

• Needle holders - 2 pcs.;

• surgical cutting needles - 5 pcs.;

• serrated hooks - 4 pcs.;

• Plate hooks - 2 pcs.;

• gouging probe - 2 pcs.;

• button probe - 1 piece;

• Leader - 3 pieces;

• kidney basins - 15 pcs.;

• 10 ml syringes with needles - 2 pcs.;

• 20 ml syringes with needles - 2 pcs.;

• Janet syringe - 1 unit;

• glasses for solutions - 5 pcs.

An increase in the number of surgical tweezers and scissors in the tool set is necessary because at least two physicians are involved in the dressing of each patient with extensive burns. In addition to the listed instruments, it is necessary to have plaster scissors, saws, gypsum pliers, a metal spatula, a suture material( sterile silk from No. 3 to G), chrome-plated catgut( from No. 2 to 4) in the dressing room.

In dressing burn patients, there should be a large number of medications of different groups:

• furacilin in a solution of 1: 5000, used as a preventive and therapeutic antiseptic for wetting of adherent dressings, for toilet burns and gauze dressing wet-drying bandages;

• Rivanol in a solution of 1: 1000 is used for the same purposes and in case of allergy to furacilin;

• Hydrogen peroxide in the form of 1 - 2% solution is used for soaking and less painful removal of the dried dressings, cleaning the burn wounds from the wound and purulent discharge;

• Novocaine 1-2% solution is used to quickly achieve an analgesic effect when removing bandages in patients with increased pain sensitivity. For this, two-layer gauze is impregnated with novocaine solution and applied to the wound for 2-3 minutes;

• Silver nitrate in the form of a 0.5% solution is used to apply the dual-layer gauze wipes moistened on it to the granulating wounds in preparation for autodermoplasty. In the form of a 30% solution used to cauterize granulations with excessive growth;

• potassium permanganate in the form of a 5% solution is used as a drying and deodorizing agent in the treatment of dry necrosis, as well as for soaking bandages in patients with burns of hands and feet;

• a hypertonic solution of sodium chloride 5-10% is used to enhance the outflow of wound and purulent discharge into the bandage during the demarcation inflammation and when there is abundant suppuration in the burn wound;

• methyluracil in the form of 0.8% solution is used to restore the disturbed metabolism of tissues and stimulation of regenerative processes in the burn wound, when preparing patients for surgery;

• furatsilinovuyu, streptotsidovuyu ointment, ointment Vishnevsky, sintomitsinovuyu emulsion 5% -y used in the local treatment of superficial and deep burns;

• 30% salicylic ointment is used to accelerate the removal of necrosis as a keratolytic agent after completion of the demarcation process, on the 7-9th day after the burn;

• enzymatic agents of trypsin or chymotrypsin, ointment of Iruxol cause enzymatic rejection of necrosis;

• Ointments containing glucocorticoids( hydrocortisone, prednisolone, fluorocort, etc.), and aerosol emulsions containing glucocorticoids and antibiotics( such as "oxycort"), are used to reduce edema of granulations and inflammatory phenomena in the wound when preparing them for surgery;

• solution of 2-3% boric acid - to suppress the growth of Pseudomonas aeruginosa;

• Vaseline sterile oil is used to impregnate dressings on donor wounds on the eve of their removal;

• glue is used to fix the dressings;

• camphor alcohol intended for treating the skin around decubitus;

• 96% alcohol, solutions of brilliant greenery and iodine.