outpatient burns: prevention and care jade hennings r1 american family physician 01.0.1.12
TRANSCRIPT
Outpatient Burns: Prevention and Care
Jade HenningsR1
American Family Physician 01.0.1.12
ObjectivesDifferentiating between classification of burns
Current evaluation and management of minor burns in the outpatient setting
Indications for referral to specialty care or for transfer to a burn unit.
Types of BurnsThermal
Electric
Radiation (sun)
Cold (frost bite)
Inhalation
Chemical
Minor BurnIsolated injury (ie, no suspicion of inhalation or
high-voltage injury)
May not involve face, hands (fingers), perineum, or feet
May not cross major joints
May not be circumferential
Classification of Burns By Depth of Injury
Superficial Burn
Superficial Partial Thickness
Deep Partial Thickness
Full Thickness
Percentage of Total Body Surface Area Burnt
Management of Burns: Initial & Long Term
GOALS OF
BURN CARE
Rapid Healing
Pain Control
Return of full
functionGood
Aesthetic
Results
Initial Management
1) Primary survey
2) Secondary SurveySize (TBSA), depth and circumference of burn
evaluatedAbuse?
*Airway: Burns to the face and neck, regardless of size, should be promptly assessed as risk of asphyxiation is possible.
3) Pain Control:
Running cool water vs Ice water
Cool water is an acceptable home txt for minor burns but ice water immersion is not because it can lead to further injury and hypothermia.
Recommended judicious use of narcotic analgesics
4) Wound Cleaning
Clean with Sterile water
Do NOT clean with iodine/chlorhexidine
5) Wound Dressing
Classification ManagementSuperficial Aloe vera, lotion, honey, Abx ointment.
Topical steroids NOT recommended
Partial Thickness Heal best in Moist, not wet environments best created by applying topical Abx ointment or absorptive occlusive dressing.
Full Thickness Surgically treated
Fourth Degree Surgically treated- debride with skin grafts
** Prophylactic oral antibiotics did not improve mortality and therefore generally not recommended
Management of BlistersControversial???
However, extensive evidence recommend that small blisters <6mm should be left alone.
Large blisters with thin walls should be debrided from a pressure and infection standpoint so that dressings can be applied directly to the wound bed.
Blisters that prevent proper movement of a joint or that are likely to rupture should be debrided
Long Term ManagementCellulitis: Staph aureus, Strep pyogenes,
Pseudomonas, Acinetobacter, Klebsiella
Pruritus: txt with Zyrtec
Neuropathic pain: Recent retrospective study found that Lyrica reduced neuropathic pain in 69% of patients
When to Refer…
Stages of Healing
1 Week
1 Month
10 Months
Blistering burns that blanch with pressure characterize…
They are also typically moist and weep.
Easily unroofed blisters that do not blanch with pressure and have a waxy appearance
typify…
Burn areas that are waxy white or leathery gray and insensate characterize...
Extends through the skin to the underlying tissue such as fascia, muscle, and/or bone…
Red burns that blanch are typical of…
Be Vigilant…Child abuse burns have characteristic markings.
Questions???