aims of burn management
- avoid infection
- reduce pain
- promote effective wound healing
- minimise scarring and psychological trauma
- restore or replace damaged skin and normal movement
superficial burn
- involves only epidermis (UV rad)
- dry snd red/ bright pink
- no blisters
- painful
- blanches with pressure
- 1 week heal, minimal scarring
superficial partial thickness burn
- involves damage to epidermis to upper dermis
- deep pink to bright red
- painful blisters
- moist and weeping
- blanches with pressure
- 3 week to heal, with minimal scarring + occasional pigmentation
deep partial thickness burn
- involved damage to epidermis and deeper dermis
- variable color (dark red to patchy white)
- blisters
- wet or waxy dry
- do not blanch readily- reduction in skin prick sensation, able to feel some pain with little nerve receptors
- > 3 weeks to heal, with scarring, may have contracture
full thickness burn
- extends through dermis into tissues beneath adipose tissue, muscle or bone may be exposed
- whitish leathery appearance
- can be brown, cherry red, charred or black
- dry and inelastic
- do not blanch with pressure
- nerve sensation is greatly diminished
- extensive scarring
time-surface temperature for full thickness burn
50 deg: 2-3 min
45 deg: 5h
patient assessment for burns
- age
- cause
- timing
- size
- underlying conditions if any
indication for burn referral
- > 2% of TBSA
- face, joints, genitalia, perineum
- deep partial thickness or full thickness
- electrical/chemical burns
- inhalation injury
- preexisting medical disorder that could complicate management, prolong recovery or affect mortality
- concomitant trauma
- require special social, emotional or rehab intervention (eg. children)
- elderly
- immunocompromised
first aid for minor burn
cool the burn surface with COOL water, or COOL compress (8-25deg) for 10-30min
DO NOT USE ICE!!!
what to avoid using/doing in minor burns
- ice
- alcohol-containing prep (can dry the skin)
- hydrogen peroxide
- not to pull at loss skin or peel off burned skin
treatment options for minor burns (intact skin)
- hydrogels (eg. intrasite gel)
- burned gel
- burned gel dressing
treatment options for small superficial partial thickness burns
cover with a low-adherent dressing (foam, hydrocolloid, silicone coated, newer/older tulle)
note: jelonet can adhere to wound if kept for too long
treatment options for larger superficial partial thickness burns with a high risk of infection
Topical antimicrobial dressing
1. silver dressing
2. bactigras (fishnet dressing; need cover area with low-adherent dressing; can also adhere to wound if kept for too long)
other treatment options for minor burns
- antiseptic prep (chlorhexidine)
- painkillers (paracet)
- perfume and color free moisturising lotion or cream after healing PRN
general patient education for minor burns
- instruct patients on first aid procedure and dressing use
- avoid rupturing blisters if possible
- use mild analgesics (PRN)
- refer dr if any redness, swelling extend beyond boundaries of original injury
- refer dr if burn worsen or has not healed significantly with 7d
