Page 114 - Journal of Special Operations Medicine - Winter 2016

Appendix F Summary Table (cont.)
Extremity Burns
Best • Elevate, exercise
• Monitor pulses hourly, Doppler flowmeter
• Escharotomy if circumferential third degree burn
Better • Elevate, exercise
• Monitor pulses hourly
• Escharotomy only if unable to palpate distal pulses and evacuation delayed
Minimum • Elevate, exercise
• Monitor pulses hourly
Pain Management
Best • Ketamine infusion
• Supplement with IV opioids and midazolam (e.g., Versed), frequent small doses
Better • Ketamine IV
• Supplement with IV opioids and midazolam, frequent small doses
Minimum • Fentanyl lozenge
• Oral acetaminophen/oxycodone (e.g., Percocet, Endo Pharmaceuticals, http://www.endo.com/)
Infection
Prevent Infection
Best • Clean wound and debride loose dead skin using gauze and Hibiclens in clean water
• Apply antimicrobial cream (Silvadene or Sulfamylon, cover with gauze)
• Alternative: Apply Silverlon dressings to clean wounds, cover with gauze
Better • Clean wound and debride loose dead skin using any antibacterial soap in clean water
• Apply any available dressing
• Optimize wound care and hygiene to extent possible
Minimum • Cover with clean sheet or dry gauze
• Leave blisters intact
Treat Infection
Best • If cellulitis (spreading erythema around edge of burn), treat with IV antibiotics (e.g., cefazolin or
clindamycin)
• If invasive infection with sepsis, foul smell, or burn wound color change, cover gram-positive, gram-
negative, and Pseudomonas bacteria (e.g., ertapenem + ciprofloxacin)
Better • Same as minimum
Minimum • If cellulitis (spreading erythema around edge of burn) or invasive infection, treat with any available
antibiotic

98 Journal of Special Operations Medicine Volume 16, Edition 4/Winter 2016