After the emergency burn treatment and patient stabilization, a detailed secondary survey of the injuries is made. Injuries often missed in the secondary survey include damage to the eyes and genitals.
Doctors typically order blood and urine tests: complete blood count, electrolytes, blood urea nitrogen, creatinine, glucose, venous blood gas (VBG), and carboxyhemoglobin. If the doctor is worried about damage to organs, he or she might order urine myoglobin, serum creatine kinase, or serum lactate tests. Arterial blood gas (ABG), chest radiograph, and an electrocardiogram (ECG) are obtained in any patient at risk for inhalation injury.
Patients with extensive burns have weakened immune systems. The immune system cells (neutrophils) can both overshoot and undershoot in response to the trauma, and the T lymphocyte dysfunction and cytokines they release are off balance. Patients often get bacterial infection in the burn area. The burn also destroys the physical barrier to tissue invasion, which permits spread of the bacteria deeper into the skin and through the lymph system. The dead (debris) tissue at the burn site is a breeding ground for parasites. Bacteria can get in the bloodstream. To protect against these nasty events, the doctor and nurses take action to prevent infections.
Tetanus immunization is given if the patient has not had one in the recent past, because of the increased risk of infection. The treatment team (doctors or nurses) almost always puts topical antibiotics on non-superficial burns. Some caregivers apply antibiotics to burn blisters; some do not. If the patient is moved to a burn center, burns are covered with clean, dry dressings and antibiotics are applied at the burn center. Cleaning and antibiotics are employed until skin grows over the burned area.
