A 22-year-old male patient, weighing 70 kg, with a second degree military affliction, presented with a second degree cleft on the face of the forearm and right arm (7% internal explosion since 72 hours ago).
Topical treatment was applied which was ineffective.
Due to the torpid evolution of the lesion, it was decided to perform a local mechanical debridement and application of argenic diazine dressing and Tulgrasum® scarring antibiotic impregnated bimixin sulfate (bacitracin).
Midazolam (3 mg i.m) was administered before the procedure, and 200 mg i.m. administered 5 minutes later.
Analgesia was achieved (grade 1 according to the verbal pain scale) and sedation was given at 12 minutes (score 3 on the Rami scale). Cure was achieved without incidents for 16 minutes.
Patients sensitivity and wakefulness were determined 55 minutes after treatment administration.
The degree of amnesia of the surgical procedure assessed by the Korttila and Linnolia scale was total.
Both cases presented a favorable evolution without adverse effects during subsequent cures.
In the combat zone, it is common to find wounds that present burns of different degrees and extension mainly due to the use of explosive devices by the contenders.
In a study of 256 people injured by firearms or improvised explosive devices treated at the Spanish military hospital in Herat (Afghanistan) between 2005 and 2008, 23 (9%) suffered burns.
At appropriate doses, the use of midazolam and kerosol achieves an adequate analgesic, hypnotic and anxiolytic state with marked hemodynamic stability and spontaneous maintenance of respiratory function.
In addition, the possibility of using both drugs intramuscularly significantly minimizes the logistic requirements required for each patient.
Sedation with midazolam should be performed prior to administration of k; otherwise, marked cardiovascular stimulation may occur and unpleasant psychomimetic reactions may occur upon awakening.
Atropine could also be added to minimize the possible occurrence of sialorrhea, although neither of the two cases was administered nor increased secretions appeared in these patients.
These characteristics make these drugs of choice for anesthesia in austere environments, such as the Afghanistan war.
1.
Ricardo Navarro Suay1, Sergio Castillejo Pérez2, Ja de las Heras Díez3 and Rafael Tamburri Bariain4 1Cte.
Doctor.
2Cap.
Doctor.
3Cap.
Doctor.
Anesthesiology and Resuscitation Service 4Cte.
Doctor.
Traumatology Service.
Hospital Central de la Defense «Gómez Ulla».
Madrid
