ICU · Burns
Burn Wound Care & Infection
Also known as Burn wound management · Burn infection · Burn wound sepsis · Silver sulfadiazine · Early excision and grafting · Acticoat · Biobrane · Integra · ABA burn sepsis criteria
Burn wound care and infection — cleaning/debridement, topical antimicrobials (silver sulfadiazine, mafenide, silver nitrate, nanocrystalline silver), dressings and skin substitutes (Biobrane, dermal regeneration templates), early excision and grafting. Infection (colonisation to invasion; Gram-positive early, Gram-negatives later, fungal late). Burn patients have SIRS at baseline — sepsis is recognised with the modified ABA 2007 criteria (temperature, progressive tachycardia and tachypnoea, thrombocytopenia, insulin resistance, feeding intolerance — a trigger for concern, not a SIRS count). Burn wound sepsis remains a leading cause of death in severe burns. Continuous prophylactic systemic antibiotics are NOT recommended (weak evidence, resistance cost) — prevention rests on topical antimicrobials plus early excision plus infection control.
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A 50-year-old man is on day 6 of admission for a 45 per cent TBSA flame burn. He was extubated on day 3, is enterally fed, and had tangential excision with split-thickness skin grafting to the anterior torso on day 4. His documented baseline since day 3 is heart rate 104, respiratory rate 22, temperature 38.2 degrees C, platelets 320 and rising, glucose 8.5 on a sliding scale. This morning: heart rate 122, respiratory rate 28, temperature 39.4, platelets 95, glucose 14 despite unchanged insulin, and he is mildly confused. The grafted abdomen shows a 4 cm patch of dark, haemorrhagic discolouration with premature separation at the graft edge.[1]
Two facts make this sepsis, not baseline. Every abnormal number on its own is normal for a major burn — but together they are a change from his own documented baseline, and the dark haemorrhagic patch on the graft is a wound that is changing. That combination is the American Burn Association trigger for burn sepsis, and it is the single hardest call to make on the burns unit.[3]
References24ShowHide
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