BURNS - Medicine for Mountaineering and Other Wilderness Activities - page 178

Unbroken blisters generally should be left intact. However, the blister fluid is an ideal
medium for bacterial growth, and blisters larger than 2 to 3 inches (5 to 8 cm) in diameter
probably should be opened (without contamination) to reduce the potential for infection.
A protective dressing should be applied to prevent rupture of smaller blisters and infection
and should be changed every three or four days until healing is complete.
Full-thickness burns six to eight days old are covered by a thick, leathery layer of
parched, dead skin that may range in color from white to dark brown or black. The dead
skin is usually insensitive to touch. If the depth of the burn—whether it is partial or full
thickness—isuncertain,gentleprobingwithasterileneedleorpinisagoodwayoftesting.
If the burn is full thickness, it should be rebandaged and the person evacuated. Even
under ideal conditions these wounds essentially always become infected. They require op-
erative care, including skin grafting, which can be provided only in a hospital.
FLUID REPLACEMENT
The most urgent aspect of treatment for a major burn is the administration of fluids to pre-
vent or treat shock.
Calculating Fluid Volumes
A convenient formula for determining the volume of intravenous fluids to be admin-
istered during the first twenty-four hours following a major burn is:
Weight (kg) x Percent Surface Area x 3 = Volume of Fluid to Be Administered
Thebodyweightinkilograms(2.2pounds=1kilogram)ismultipliedbythepercentage
of the body surface covered by the burn, and that product multiplied by three equals the
volume (in ml) of fluids to be given. The percentage of the body area covered by the burn
can be estimated from Figure 13-1 .
The fluid requirements for the first twenty-four hours after a burn for a 176-pound
(80-kg)manwitha30percentbodysurfaceareaburn(approximatelyonearmandoneleg)
would be calculated as follows: