MINOR BURN

Question 1

MANAGEMENT

Answer 1

INITIAL ED MANAGEMENT

1. COMFORT: analgesics before burn care and for outpatient use - NSAIDS, Acetaminophen
2. COOL: Run cool tap water over the burn for minimum 20 min.
3. CLEAN: burn with mild soap and water or chlorhexidine or NS
4. CUT: Debride blisters >2cm with sterile gauze or scissors
5. COVER:

SUPERFICIAL:
No need for dressing

SUPERFICIAL PARTIAL THICKNESS

Bacitracin
AND
Xeroform, Bactigras, Jelonet, or Adaptic, or a silver-containing dressing like Aquacel Ag or Acticoat
OR
topical antimicrobial
direct to wound or impregnated into gauze

THEN

Dry Gauze

THEN

Kerlix

FULL THICKNESS
1% silver sulfadiazine cream for full thickness burns (c/i on face or in patients with sulfa or G6PD allergy)

OR

Bacitracin ointment for partial-thickness burns

OR

Triple-antibiotic ointment (neomycin, polymyxin B, bacitracin zinc) , triple-antibiotic ointment (neomycin, polymyxin B, bacitracin zinc)

Secondary Dressing: loosely secured with size appropriate rolled gauze or surgical netting

6. CARE INSTRUCTIONS:
   Dressing Change Twice daily, gently removing residual ointment
   Continue so long as wounds weep
   THEN
   daily until healing is complete
   Follow up within 24-48 hrs
7. DISPOSITION
   Home

Question 2

DOCUMENTATION

Answer 2

HISTORY
Time of injury
Mechanism of burn:
Burning agents
Chemicals
Duration of exposure
Open or closed space
Inhalation injury
Concomitant injuries
First aid Provided

Ask about:
headache
loss of consciousness
nausea
altered mental status

PHYSICAL EXAM
1. BURN SIZE
Rule of Nines (Adult)
head = 9%
Torso = 18% (front), 18% (back)
Arm = 9% (each)
Leg = 18% (each)
Genital = 1%

Do not include superficial burns

Rule of Nines (Pediatric)
Head = 18%
Torso = 18 % (front), 18% (back)
Arm = 9 % (each)
Legs = 14% (each leg)
OR
Area of patient’s back of hand ~ 1% of TBSA

2. BURN DEPTH
   SUPERFICIAL: (1st degree)
   Like a sunburn
   Red
   Painful
   No blisters
   Area blanches
   Heals in 7 d

SUPERFICIAL PARTIAL THICKNESS: (superficial second degree)
Epidermis and superficial dermis (papillary layer)
Red
very painful
Blisters
Exposed dermal layer is red and moist
Area blanches
14-21 d, no scar

DEEP PARTIAL THICKNESS: (deep second degree)
Epidermis and deep dermis (reticular layer)
sweat glands, and hair follicles damaged
Exposed dermis
Red to pale white and yellow
Blisters, very painful
Burned area does not blanch 0 cap refill
3-8 wk, permanent scar

FULL-THICKNESS: (third degree)
Entire epidermis and dermis
charred, pale, leathery; no pain
Months, severe scarring, skin grafts necessary

3. CURCUMFERENTIAL BURN
   Neurovascular status distal to the burn
4. SPECIFIC BODY PARTS:
   hands
   face
   genitalia
   major joints
5. NEUROVASCULAR STATUS
6. CONCOMITANT INJURIES