3-22. MEASURE URINE OUTPUT
In the first 24 hours, urine output should NOT be greater than 60 cc per hour.
The only exception is the output of an electrical burn casualty who has gross
myoglobinuria (the cherry-red or black-colored urine caused by dying muscle tissue).
Urine output for this casualty should be as high as needed to achieve normal-color
urine. When normal-color urine is attained, urine output should be held between 30 to
60 cc per hour. The most important limits for adequate fluid resuscitation are adequate
urine output defined as not less than 30 cc per hour; clear sensorium (the state of being
mentally alert and conscious); and blood pressure which is normal for the casualty.
Urine output requirement for the second 24-hour period is much less than the first 24-
hour period. Adequate urine output of no more than 30 cc per hour should be
maintained. Consider fluid replacement on an individual basis after deciding the
amount of fluid the casualty is losing and checking laboratory test results.
3-23. GENERAL INFORMATION
In an area where aseptic conditions prevail after a patient's burn has been
treated, an appropriate topical agent can be applied. The burn is then covered with
sterile dressings. There are several types of dressings that can be used on burns. The
most common are silver sulfadiazine (SilvadeneR), mafenide acetate (SulfamylonR), and
silver nitrate soaks. Each treatment has advantages and disadvantages. Look at the
advantages and disadvantages of each agent.
3-24. SILVER SULFADIAZINE (SILVADENER)
a. Advantages. Silver sulfadiazine is most effective when it is applied to burns
immediately after the thermal injury. A broad antimicrobial agent which can penetrate a
eschar, silver sulfadiazine is pain-free and clear so that the burn area remains visible.
(The eschar is the dead skin caused by the burn.) An occlusive dressing is not required
when this medication has been applied. The treatment is compatible with other injuries,
and medication does not impede motion of the joints.
b. Disadvantages. The medication does NOT penetrate through dead skin that
resulted from the burn. This may cause a delay in epithelialization (the final stage of
healing of a surface burn). Bone marrow is suppressed. Some people experience
hypersensitivity reactions. Eschar (scab) separation is delayed. Certain gram-negative
organisms are resistant to this medication.