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Burns 139

indicated by examination. Radiographic
changes in the lungs may progress after
VetBooks.ir • Baseline aerobic wound culture to allow Diseases and Disorders
injury.
targeted antibiotic therapy.
• Co-oximetry (if available) to measure car-
boxyhemoglobin concentrations. Pulse
oximetry and arterial blood gas analysis may
provide falsely elevated oxygen levels after
carbon monoxide exposure.
Advanced or Confirmatory Testing
• Central nervous system imaging (CT, MRI)
for unexplained alteration in mentation
• If pneumonia is suspected, airway lavage for
appropriate antibiotic selection, assuming
patient is stable (p. 1073)

TREATMENT BURNS A puppy with severe burns after being placed in hot water.
Treatment Overview
Goals are to maintain a patent airway and
oxygenation, support arterial blood pressure albumin has been associated with severe tubes are indicated (p. 1107). Concurrent
and plasma oncotic pressure, maintain adequate anaphylaxis and death in some dogs. partial parenteral nutrition can be administered
urine production, and manage wounds to ○ Stored or fresh-frozen plasma may be to achieve full energy requirements.
prevent tissue loss and reduce risk of infection considered in patients in need of colloid
or septic complications. Intravenous fluids, support who cannot receive synthetic Behavior/Exercise
broad-spectrum antimicrobials, and in some colloids or for secondary coagulopathy • For third- and fourth-degree burns, espe-
cases, supplemental oxygen are cornerstones of (fresh-frozen plasma) (p. 1169). cially when involving tissues affected by
treatment. • Oil-based wound dressings (e.g., Vaseline- motion (e.g., limbs, axilla, inguinal region,
impregnated gauze) should be avoided. flank), strict rest for 3-4 weeks may be
Acute General Treatment • Third- and fourth-degree burns may necessary.
• Rapidly cooling burns within 20 minutes require early escharotomy (debridement) • Physical therapy or hydrotherapy may be
of injury is beneficial to prevent ongoing or fasciotomy to limit wound sepsis and beneficial to patients with large body surface
tissue damage. Continuous lavage with cold compartmentalization. regions affected.
(15°C) tap water for 20 minutes is recom- • Broad-spectrum antimicrobial coverage if
mended. Avoid ice. evidence of pneumonia until culture results Possible Complications
• Support respiratory function are available (e.g., ampicillin 22 mg/kg IV Wound infection, pneumonia, nosocomial
○ Oxygen supplementation for patients with q 8h plus enrofloxacin 10 mg/kg IV q 24h, infection, sepsis, limb ischemia from wound
carbon monoxide poisoning from smoke or 5 mg/kg IV q 24h in cats). contracture, coagulopathy
inhalation (pp. 919 and 1146) • First- and second-degree burn wounds may
○ Maintain airway patency in presence of require little debridement; application of Recommended Monitoring
pharyngeal or laryngeal edema (intubation antimicrobial topical creams (silver sulfadia- • Close initial monitoring of vital parameters
if necessary) (p. 1166). zine or 0.5% silver nitrate) is recommended. • Arterial blood pressure
○ Mechanical ventilation (p. 1185) may be • Quantification of urine production
required for management of direct lung Chronic Treatment • Oxygen saturation (or ideally co-oximetry)
injury from inhalation of carbon debris, • Small eschars should be debrided for primary • Serial CBC, serum biochemistry profile,
aspiration pneumonia, or pulmonary closure early during wound care. coagulation tests
edema. • Large eschars not amenable to primary
• Intensive intravenous (IV) fluid resuscitation closure should be debrided, allowed to form PROGNOSIS & OUTCOME
with crystalloid fluids during the initial 8-12 granulation tissue, and grafted. Vacuum-
hours after injury to maintain adequate mean assisted wound closure (VAC) has been used • Outcome is generally good for first- and
arterial blood pressure and urine production successfully for large burn wounds. Moist second-degree burns and guarded for third-
at 1-2 mL/kg/h. Avoid overhydration and wound care should be used with open wound and fourth-degree burns.
complications secondary to edema (subcu- management (e.g., manuka honey and • Prognosis is guarded to poor for moderate
taneous, pulmonary, cerebral) formation. nonadherent dressings). Avoid wet-to-dry to severe inhalation injury.
• Systemic inflammation and leaky vessels dressings, which can delay formation of • Prognosis relies on response to fluid resuscita-
may result in protein loss and severe granulation tissue. tion in severe burn injury. Prognosis improves
hypoalbuminemia. • Extensive/deep burns involving the limbs with appropriate and successful wound
○ Judicious use of IV synthetic colloids (e.g., should be debrided to avoid limb ischemia management and worsens with development
Hetastarch 20 mL/kg/24h, Vetstarch and treated with variations of splinting to of complications.
20-40 mL/kg/24h) to maintain colloid avoid contracture.
oncotic pressure and mean arterial blood PEARLS & CONSIDERATIONS
pressure. Avoid synthetic colloids if there Nutrition/Diet
is kidney dysfunction or thrombocytope- Severe burns cause increased metabolic demand Comments
nia (platelet count < 75,000/mcL). and significant protein losses; early enteral • Third- and fourth-degree burns and/or
○ Canine or human albumin may be nutrition should be instituted. In critically ill inhalational injuries are best treated in a
transfused for oncotic pressure. Human patients, nasoesophageal or nasogastric feeding tertiary care facility with 24-hour intensive

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