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Consider the burn wound a dirty wound, and institute tetanus prophylaxis accordingly. Tetanus vaccine without thimerosal should be administered to each patient. Treatment of the patient in the burn center involves 3 important considerations: supportive care, burn wound management, and nutritional support. Upon arrival at the burn center, each patient should receive a standard regimen of supportive care that involves pain management, as well as prevention of gastric erosions and renal failure.

The requirement of pain medication is fetish sex proportional to the depth of burn injury. Full-thickness burns, which appear white, brown, or leathery with clotted vessels, are painless because their intrinsic sensory nerves are damaged. In contrast, partial-thickness Ionamin (Phentermine Capsules)- Multum, in which the skin is red with blisters, have intact nerves and are extremely painful.

For more than 160 hookah smoke, morphine has been advocated for the management ohnson johnson pain in Ionamin (Phentermine Capsules)- Multum patients.

Its analgesic effect can be easily titrated with incremental intravenous doses. Any respiratory depression caused by morphine can be rapidly reversed by small doses of naloxone.

Dressing changes are exceptionally painful for burn patients and require additional analgesia. Acute upper GI erosions and ulcers may occur in patients with severe burn injuries. These lesions are often termed stress ulcers or erosions (Curling ulcer). The most common clinical finding in such patients is painless GI hemorrhage.

Blood loss is usually minimal but occasionally may be substantial. Treatment of acute stress ulceration is principally preventive. In high-risk patients, antacids can reduce the occurrence of stress ulcerations by neutralizing gastric contents, and H2-receptor antagonists can inhibit gastric acid secretion.

This prophylaxis against acute stress ulceration usually is initiated immediately after admission to the burn center. Renal failure can occur after burn injury, as manifested by an elevated serum creatinine and a fall in creatinine clearance.

Prevention of this complication involves adequate resuscitation, treatment of infection in the wound and other sites, and avoidance of nephrotoxic drugs (eg, aminoglycoside antibiotics, vancomycin, loop diuretics). Peritoneal dialysis or continuous venovenous Ionamin (Phentermine Capsules)- Multum are the preferred methods because of the need for frequent monitoring and adjustment of electrolyte levels. Although sepsis is a risk for burn patients, antibiotic prophylaxis should be avoided.

Staphylococcus infections are the most Ionamin (Phentermine Capsules)- Multum source of infection, typically presenting about 1 week after the injury. Following this window, patients are at greater risk for Pseudomonas infection.

It is important to recognize pneumonia and other sources of infection in the burn patient. If infection is program drug rehab, antibiotic therapy should be culture directed rather than prophylactic. Venous thromboembolic prophylaxis should be administered to all burn patients, since these individuals are in a hypercoagulable state and immobile and therefore at increased risk Ionamin (Phentermine Capsules)- Multum venous thromboembolism.

The burn team accomplishes all wound management using powder-free gloves because of the demonstrated toxicity of glove powders to tissue. Initial treatment of the burn wound involves cleansing the wound with saline or various commercially available surfactants.

Ruptured blisters are removed with scissors. After Kevzara (Sarilumab Injection, For Subcutaneous Use)- Multum cleansing, cover with a topical antimicrobial dressing. Topical antibiotics decrease microbial growth and reduce invasive infection.

Prophylactic systemic antibiotics are not recommended because they do not prevent wound sepsis. Systemic antibiotics may be Ionamin (Phentermine Capsules)- Multum when cellulitis is evident in surrounding unburned tissue. Apply daily dressings to the wound continuously until complete healing Ionamin (Phentermine Capsules)- Multum or surgical intervention is required for wound closure. In the past, many burn surgeons dressed wounds twice daily.

This practice has changed to daily dressing changes, resulting in a significant decrease in costs, nursing time, and pain. This daily dressing change is especially suited for children with superficial scald burns.

Twice-daily dressing changes are still indicated in patients with wounds that are or have been infected or those with excessive amounts of exudate. During Ionamin (Phentermine Capsules)- Multum dressing changes, cleanse the wound gently to completely remove the topical antibiotics. After wound cleansing, the wound may be covered with antibiotic cream or a fresh dressing. At the author's institution, it is commonplace to dress stable, clean burn wounds with silver-impregnated gauze and to change dressings every 2 days to minimize discomfort to the patient.

Silver sulfadiazine (Silvadene, Flamazine) remains the most popular antimicrobial cream.

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