Clinical Application of BRT with MEBT/MEBO作者：Rong Xiang Xu 出版社：KARGER 发行日期：In 2004
(1) Treatment condition: Strictly sterilized conditions are not emphasized. Debridement using any disinfectant, saline or water is forbidden. Small burns can be dealt with at home with MEBO. Moderate and minor burns encountered in the battlefield can also be treated with BRT with MEBT/MEBO. For treating large burns, the room should be kept at a temperature of 30℃-34℃ and first-aid apparatus or devices should be equipped.
(2) General application: Directly smear MEBO onto the wounds with a thickness of 1 mm. At the beginning, no debridement is required except for chemical burns or dirty wounds. Renew MEBO every 3~4 h, before which wiping off the residual ointment and liquefaction products with gauze or tissue paper (gentle and careful renewal is demanded to avoid pains and bleeding). For wounds with blisters, be sure to preserve the blister skin, directly apply MEBO until the blister skin is removed 5 days later. For deep second-degree burns, after applying MEBO, dermal tissue in the necrotic layer begins to liquefy on day 7 postburn. Renew MEBO and wipe off liquefaction product timely. After the complete discharge of necrotic tissue, apply less MEBO and renew every 4~6 h till the wounds heal. For third-degree burns, treatment with a special debridement technique can be applied coordinately.
(3) Special application: For treating not easily exposed small burns wounds, apply MEBO with a thickness of 2~3 mm, then apply decompression bandage using dry gauze. Before changing dressing every 12 h, gently remove the drug sediment and liquefied necrotic tissue. For treating traumatic, ulcerative and operative wounds, 1-2 layers of gauze impregnated with MEBO also could be used.
(4) Principle of systemic treatment: Burn is a systemic disease caused by thermal injury. The changes in topical treatment directly affect the systemic pathophysiological status. BRT with MEBT/MEBO systemic treatment is essentially different from conventional surgical dry therapy. While using BRT with MEBT/MEBO, the protocol of surgical dry therapy is forbidden. Two principles should be followed in this treatment on extensive deep burns: (1) In the early stage, a comprehensive antishock treatment principle is applied, which involves enhancing cardiac function, protecting renal function and supplementing effective blood volume according to the vital signs. (2) In the middle and later stages, expectant treatment is applied, with a protocol of keeping a water-electrolyte balance, nutritional support and maintaining a comprehensive balance. In the anti-infection treatment, a large dose of strong and powerful broad-spectrum antibiotics should be used in the early stage for 7-10 days and then withdrawn immediately, in order to protect and enhance the anti-infective function of the internal organs. For nutritional supporting treatment, a protocol of oral administration is desired. Others are dealt with according to the case.