Complications Of Burns

By | 2012-10-23

Infection is a serious and frequent complication of burns and must be addressed at an early stage. For the most part, normal skin commensal organisms such as Streptococcus equi var. zooepidemicus, Staphylococcus aureus, and Pseudomonas aeruginosa are encountered with some complicated by other gram-negative species, such as E. coli and Clostridia spp., and yeasts can be found. Silver sulfadiazine (Silvadene) is a useful broad antibacterial that has little or no harmful effects on wound healing.

Some horses suffer from renal shutdown after sustaining a severe burn and renal function must be encouraged and repeatedly checked. Diuretics such as furosemide are often indicated but should be used with considerable care.

Smoke inhalation or internal burns can cause serious pulmonary edema and thus must be controlled. Oxygen supplied directly to the trachea or nasally may be helpful. A single intravenous dose of dexamethasone (0.5 mg/kg) may assist. Intravenous administration of dimethyl sulfoxide (DMSO) at 1 g/kg over the first 2 days may be helpful in reducing the pulmonary edema. All cases in which smoke inhalation has occurred must have systemic antibiotic therapy because the respiratory tract is particularly susceptible to serious infection after inhalation damage. Obtaining a transtracheal aspirate for culture if the chosen antibiotics do not appear to be helping is justifiable. Fungal infections pose a particularly serious threat that may be untreatable.

Cornea] and eyelid damage is particularly dangerous because of the delicate nature of the tissue and their intolerance to injury. In cases in which the face has been involved in the burn (to any extent at all) the corneas should be medicated carefully with artificial tears. In all cases the cornea should be stained with fluorescein to check for ulceration and necrotic tissue. All necrotic tissue should be gently removed with a saline-soaked cotton swab. Under no circumstances should corticosteroids or any strong chemicals such as chlorhexidine or povidone iodine be applied to the eye. Topical antibiotics (e.g., triple antibiotic or gentamicin) should be applied with atropine to control any reflex uveitis. If the eyelids are involved or are suspected to be involved, then particular care must be taken to protect the corneas with artificial tears (applied every hour), and, if necessary, a third eyelid flap can be drawn over the eye to afford sustained protection.

Healing of burn sites is reported to be slower than other types of wounds. This is possibly because the full extent of the injury is not apparent from the outset; furthermore, the damaged tissue is usually slow to separate from the healthy underlying structures. Scarring is inevitable and can be either functionally limiting (e.g., the eyelids or over joints), cosmetically unacceptable, or both. Most serious burn cases have degrees of immunosuppression, which renders them liable to infection and delayed wound healing.

Healing burn sites are often pruritic, and self-inflicted damage can be severe. Suitable sedation may be required (usually acepromazine is effective) to prevent self-inflicted trauma. Cross-tying, neck cradles, or muzzles can also be useful. These measures will require extra nursing observation.

Other complications from burns include colic (usually an impaction) or laminitis. Inappetence or failure to drink are serious potential complications and must be managed early. Fresh green grass is usually a good stimulant to appetite and also provides significant water intake. Caustic burns can result in absorption of the caustic material; thus serious systemic effects may occur.