Burns & Wound Management (Dr. Yamaki)

• superficial-thickness burns

• injury to the superficial cells of the epidermis, does not form blisters, but it does become erythematous and mildly painful

• heal within 3-7 days without scarring

• Example: sunburn

first degree

• superficial partial-thickness, depending on the depth of dermal involvement

• superficial second degree burns involve the epidermis and upper layer of the dermis

• deep second degree burns

second degree

• full thickness deep burn

• full thickness of the skin

• appear pearly white, gray or brown and dry

• pain sonly sensed when deep pressure is applied

• excision and grafting

third degree

great risk of infection

appear blackened, dry, painless because of destruction of nerve endings

similar to third degree burns except the devitalized tissue extends into SQ tissue

fourth degree

causes of burns are what

heat

electrical discharge

chemicals

friction

radiation

• dry and red appearance

• blanches with pressure

• sensation of pain

• healing time: 3-7 days

superficial epidermal burn

• blisters

• moist, red, weeping

• blanches with pressure

• painful to temperature and air

• healing time: 7-21 days

superficial partial thickness burn

• bisters

• wet or waxy

• variable color

• does not blanch with pressure

• healing time: >21 days

deep partial thickness burn

• blisters

• waxy white, leather gray, charred, black

• dry and elastic

• healing: months

full thickness burn

• blisters

• extends through fascia and/or muscle. even through bones

• deep pressure

• healing: never; unless surgical treatment

deep burn injury

do not apply ice or iced water directly on wound due to risk of increasing burn

true

•Cool running water or still water applied for no longer than 5 minutes to avoid wound maceration

true

non-adherent, sterile, wound dressing

• gauze with 3% bismuth tribromophenate petroleum

xeroform dressing

• non adherent dressing

• knitted cellulose acetate fabric

• impregnated with petrolatum emulsion

adapted dressing

• does not adhere to moist wound

meptitel dressing

• maintain a moist environment

• covered with dressings that assist with the healing process and promote repithelialization

• topical antimicrobial agent to consider only if infection

• non-adhesive dressing

treatment of superficial burn wounds

• microbial colonization is likely for all wound sites

• microbial colonization does NOT mean infection

• prophylaxis of infection not necessary

• reserve antibiotic use for clinically infected wounds

antibiotics for burns

antimicrobial ointment are what

polysporin (OTC)

Muprirocin

siler sulfadiazine (SSD 1% cream) is what

antimicrobial action and possibly anti-inflammatory properties

bismuth with petroleum is what

preferred for skin graft donor sites

• applied as single layer with gauze over burn sites

• 1st line cleaner

• used as cleanser at wound sites

• can be used in combination with SSD

• dose not prevent re-epithelization of wound

chlorhexadine

antimicrobial properties and ointment preparation provides a moist environment for would healing

• not first line due to cytotoxicity

• increase pain, decrease adherence

povidone-iodine

• efficacy has been shown anecdotally for resistant bacterial infection such as MRSA and vancomycin resistant

• sodium hydrochloride 0.025

dakin’s solution

• systematic review has noted increased efficacy in regard to wound healing time in combination with SSD

honey

can be managed outpatient most cases is what burn

minor burn

requires hospital admission, but may not need burn center is what burn

moderate burn

require referral to burn center and often intensive care is what burn

major burn

• appropriate dressing

• polysporin if no resistant organics

• mupirocin if MRSA or suspicious of resistance

management of superficial partial thickness burns

• requires continuous reevaluation of burn site as initial depth of injury may increase over first 72 hours

management of full thickness & deep burns

• antibiotics not indicated initially until removal of eschar

• RCT and meta-analyses have demonstrated improved healing and decreased length of hospital stay with early eschar removal

early excision of deep burns

management of itching with burns (what is the first line)

antihistamine

• if antihistamine fails, topical low potency glucocorticoids

non-pharm therapy for pruritic associated with burns

• aloe vera

• antihistamines

• avoids products containing lanolin

Occlusive dressings that are non-adherent are preferred for covering burn wounds. (t/f).

true

If blanching upon pressure occurs at the burn site, this is generally considered a good sign indicating less severity. (t/f)

true

While there is lack of large randomized clinical trials, there is evidence that manuka honey can aid in burn wound healing and infection prevention. (t/f)

true

If an eschar has developed, surgical removal is recommended in order to ensure adequate penetration of antibiotic therapy. (t/f)

true

Deep burn wounds penetrate all layers of the dermis, down to the muscle and sometimes bone. (t/f)

true

Deep burn injuries will heal without intervention over months, as long as the wound does not get infected. (t/f)

false

Prophylactic antimicrobial therapy should be started on all burn wound patients to prevent infectious complications. (t/f)

false

when to use polysporin?

if no resistant organism suspected

• good for partial thickness burns

when to use mupirocin ?

if MRSA or suspicious of resistance or colonization with resistance organism

which two dressings are occulsive properties

adaptic, xeroform

which dressing does not adhere to moist wound

mepitel