'Lethal' Burns

Sixteen consecutive patients, nine of whom also had inhalation injury, had burns over 72% body surface area or more. The expected death rate was 94%. In fact, all of the eight patients still alive after 48 hours survived. The early deaths were primarily due to inhalation injury, the treatment of which remains an unsolved problem. A mixture of cerium nitrate and silver sulfadiazine was used for topical wound antisepsis. The wound flora was sparse: 447 of 814 wound-surface cultures were sterile; Gram-negative bacteria were recovered in 13%. This efficacious wound bacteriostasis appeared primarily responsible for the absence of late death.