Partial thickness <10% of BSA in patients 10-50yrs old
Partial thickness <5% of BSA in patients under 10 or over 50yrs old, Full thickness burns <2% of BSA in any patient without other injury, Isolated injury
May NOT involve face, hands, feet, perineum or genitalia, May NOT cross major joints
May NOT be circumferential
Should err on the side of caution to reduce risk of complications and adverse outcomes.
-Approach:Cool burns immediately in cool/room temperature water, Pain management (NSAIDs, opiods—these hurt, may use IV pain rx), Clean burns with mild soap and water., Larger blisters (>2cm), or blisters that have a likelihood of rupturing (over a joint), or blisters that are painful should be drained and debrided.
Topical antibiotic ointments should be applied
Silver sulfadiazine (1%) [silvadene] is most common (not if <2yr old), Can also use bacitracin, triple antibiotic ointment or honey
Tetanus immunization or tetanus Ig
At final phase of healing, non-perfumed moisturizing cream (Vasline Intensive Care ®, Eucerin ®, Nivea ® can be applied until natural lubricating mechanisms return. Avoid lanolin
Lanolin is a greasy yellow substance secreted by the sebaceous glands of wool-bearing animals, with the vast majority of it used by humans coming from domestic sheep.
-Basic dressing:NON-adherent dressing (adaptic, etc) after antibiotic ointment, Second layer of fluffed gauze
Third layer of elastic gauze, Must individually wrap fingers/toes to prevent adherence/maceration, When to change dressing?, No clear recommendation
Once daily, Whenever soaked with exudates or fluids, whenever dirty .
Follow-up: Surveillance for infection, contracture, scarring, pain control
F/u in 24hrs, then, if pt reliable, up to a week later.
Sooner if ANY concerns for compliance, infection, etc.
How to tell if a wound is infected?
Burn is already red, swollen, painful.
Watch for lymphangitis, fever, malaise, anorexia.
Burn infections should be treated aggressively with admission and IV abx.
Non-superficial burns have higher risk of infection 2/2 decreased neutrophil activity, impaired T lymphocyte activity and cytokine imbalance