Transcript Outpatient Burns: Prevention and Care

Outpatient Burns:
Prevention and Care
Jade Hennings
R1
American Family Physician 01.0.1.12
Objectives
 Differentiating 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 Burns
 Thermal
 Electric
 Radiation (sun)
 Cold (frost bite)
 Inhalation
 Chemical
Minor Burn
 Isolated injury (ie, no suspicion of inhalation or highvoltage 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
Pain
Control
Rapid
Healing
Return of
full
function
GOALS
OF
BURN
CARE
Good
Aesthetic
Results
Initial Management
1) Primary survey
*Airway: Burns to the face and neck,
regardless of size, should be promptly
assessed as risk of asphyxiation is
possible.
2) Secondary Survey
 Size (TBSA), depth and circumference of burn evaluated
 Abuse?
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
Management
Superficial
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 Blisters
Controversial???
 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 Management
 Cellulitis: 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???