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SECTION
FIVE:
INITIAL
WOUND MANAGEMENT
Hot
Water (Superficial Dermal Burn)
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TREATMENT
1) Cold compress to control pain
2) Gentle wash
3) Xeroform- bacitracin (or biobrane) followed by
thick layer of gauze (except face)
4) Use flexnet or flexible variant to hold on
dressing
5) Clinic 24 - 48 hrs because of age and difficulty
of home care |
FLASH
BURN (SUPERFICIAL 2nd Degree) HOT WATER BURN
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TREATMENT
1) Wash
2) Debrided blisters and loose skin
3) Closed dressing with Xeroform and bacitracin
(or biobrane) followed by gauze and ace
4) Clinic 1-2 days because dressing will become
saturated. |
MID
PARTIAL THICKNESS SCALD BURN (Dorsum of Hand)
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TREATMENT
1) Consider admission for elevation, debridement,
pain control
2) Admit if both hands involved
3) Initially, cold compresses very effective pain
relief
4) Use xeroform, bacitracin (can use skin
substitute)
5) If outpatient; need to return in 24 hrs due to
area involved. |
SUPERFICIAL
DERMAL BURN (STEAM)
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TREATMENT
1) Could compress to control pain
2) Remove blisters, loose skin
3) Xeroform (or other grease gauze) with or without
antibiotic ointment
4) Soft gauze dressing
5) Consider skin substitute (Biobrane) |
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Note:
Skin substitute (Biobrane) in place at 24 hrs
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TREATMENT
1) Admit to Burn Center due to size i.e., >15%
TBS
2) Too big to use cold dressings except for a very
brief initial period
3) Use topical antibiotic in view of age, high risk
of conversion, infection
4) Alternative: bioengineered skin substitute to
generate wound closure |
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TREATMENT
1) Cold water to control pain
2) Gently cleanse
3) Grease gauze, plus gauze dressing (closed
technique)
4) Can use antibiotic ointment (not silver
sulfadiazine) (Not required)
5) Apply dressing to allow for mobility of hand |
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Treatment
1)
Admission is preferred but can be treated briefly
(24 hrs) as an outpatient prior to surgery
2) SSD used after initial washing
3) Early surgery for best cosmetic and functional
result and also to minimize disability time
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Treatment
1)
Same as for deep burn
2) Maintaining body T0 more critical in
view of size
3) Early excision and grafting
4) Consider use of permanent skin substitutes in
view of burn size (70% TBS)
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Visually
Deceiving Burn
Some burns usually
caused by contact with flames or extremely hot temperature,
like explosion, have the destroyed epidermis still present on
the wound. The depth can be underestimated unless the wound is
gently washed and debrided after which the size and depth is
more clearly defined.
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FLAME
BURN (DIRECT CONTACT)
Looks superficial with blisters but mechanism
suggests deep burn |
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When
gently cleaned, wound is noted to be a combination
of deep second and third degree burn |
TREATMENT
1) Gentle wash, removing loose epidermis
2) SSD, preferably twice daily, under closed
dressing
3) Excision and grafting will be needed for deep
burn |
Mid-Dermal
Burn (HOT GREASE)
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TREATMENT
1) Admit to burn center due to location (bilateral
feet)
2) Temporary use of cold to control pain
3) Debride loose tissue
4) Grease gauze, topical ointment (possibly SSD)
with closed dressing
5) Consider temporary skin substitute |
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the Image to Enlarge
Skin
Substitute at day 1 and day 5
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TREATMENT
1) Admit to Burn Center due to size, i.e. > 15%
TBS
2) Too big for cold dressings (avoid hypothermia)
3) Gently clean, Debride loose tisue
4) Mid dermal areas, use grease gauze, antibiotic
ointment. Deeper areas, especially arm, use Silver
sulfadiazine
4) Dry gauze dressing changed at least daily
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TREATMENT
1) Gently clean with mild soap
2) Apply topical antibiotic ointment or cream
followed by xeroform and soft gauze dressing
3) Perineum treat open
4) Meets criteria for Burn Center due to high risk
location |
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TREATMENT
1) Consider
admission because of area involved (hand)
2) Use topical antibiotics
3) Closed dressing which allows function
4) May require grafting
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TREATMENT
1) Admit as
edema process may require escharotomies
2) Clean wound then apply SSD with closed dressing
3) Early excision and grafting indicated
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TREATMENT
1) Clean.
Apply topical antibiotic
2) Clean dry dressing applied
3) Plan early excision and grafting
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TREATMENT
1) Admit to
burn center due to size and depth
2) If circumferential, consider escharotomy prior to
transfer
3) Gently cleanse and debride
4) Apply SSD (in view of depth) plus gauze dressing
(closed)
5) Early excision and grafting
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