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???