Burns%20-%20initial%20management Treatment

Analgesics

• Pain control in children is done with the use of Paracetamol for out-patient & opioid analgesics (Morphine) for admitted patients
  
  • Opioid are still the analgesic of choice for moderate to severe pain in pediatric patients
  • Non-opioid analgesics (Paracetamol & Ibuprofen) are used for pediatric patients for minor pains or as an adjunct to opioid analgesics for severe pain

Emollients & Skin Protectives

• Superficial burns may be effectively treated with lotion & creams
  
  • The lipid contents of these treatments help accelerate repair of damaged skin

Surgical Dressings

• Dressings (eg silver coated, hydrocolloid, moisture-retentive) absorbs drainage, increase healing time, decreases pain, & helps control bacterial growth in burns
  
  • They also provide protection & isolation of wounds from the environment
• Application of dressings directly to large blisters is beneficial
•  Burn wounds heal best in moist environment, which can be provided by application of dressings
  • Closed dressing is recommended for raw areas, deep partial thickness, & full thickness burns

Biologic dressing

• Eg allogenic amnion
• Uses amniotic fetal membranes as wound dressing
• Has shown to be an effective protective dressing in partial-thickness burn wounds

Synthetic dressing

• Eg hydrocolloid dressings, Collagen/Silicone-coated nylon threads
• Has shown to be an effective protective dressing in superficial partial-thickness burn wounds
• Studies show that use of synthetic dressing causes less pain, increases healing time, has better patient compliance, & is cheaper as compared to other types of dressings
• Hydrocolloid dressings are recommended for small-area partial thickness burns & in the final stages of healing of small burn wounds

Skin Antiseptics

• Eg Povidone Iodine solution, Chlorhexidine
• Disinfectants may be used to prevent colonization of bacteria within wound beds but further studies are needed
• Scrubbing of burn wounds with antiseptics is not recommended

Topical Antibiotics

• Topical antibiotics are effective against most burn pathogen
• Prophylactic parenteral antibiotics are not indicated in the initial management of burn wounds

Sulfonamides

• Eg Silver sulfadiazine, Sulfathiazole silver
• Silver sulfadiazine is the recommended topical antibiotic for burn wounds
• Not to be used on infants <2 months of age
• Bacteriostatic, broad spectrum antibiotic
• Action: Interferes with the folic acid synthesis of susceptible organisms

Vaccine

• Eg Tetanus toxoid
  
  • Recommended for patients with more than 1st-degree burn
  • Should be considered for patients who received tetanus toxoid and immunoglobulin >10 years ago and those whose immune status is uncertain

Initial Therapy

• Wash burned skin with cool running water for 20 minutes
• Make sure to remove any debris, clothing, jewelry, etc from the affected area
• Keep the patient warm to avoid hypothermia: wrap the patient in clean sheets

Blisters

• Leave small blisters (<6 mm) intact in partial-thickness burns
• Remove thin walls of large blisters (>6 mm) especially near joints & those more likely to rupture spontaneously
  
  • Removing the extra wall will allow direct application of moist wet dressings & the affected area

Maintenance Treatments

• Lipid-rich topical treatments (eg lotion, moisturizers, aloe vera) are also recommended for healing lesions
  
  • Helps accelerate repair of damaged skin
• Oral rehydration schemes may be considered in patients whose access for fluid resuscitation is only orally
  • Salt-containing fluids (eg rice water w/ salt, Oral Rehydration Solution, Lassi) may be given in small amounts so that the equivalent amounts to 10% BSA

Wound Care

• Appropriate dressing depends upon burn degree, location, & wound exudate
• Occlusion dressing is preferred for patients with superficial partial thickness burns & donor sites of split-thickness skin grafts
• For burns with minimal to moderate exudate, polyurethane, hydrocolloids & hydrogels are recommended
• Foams & alginates are preferred for partial thickness burns with moderate-high exudate
• Biologic dressing is an option for burns with intact vesicles when modern dressing options cannot be applied
  • Snip-open technique coated with topical antibiotic and covered with bulky dressing is recommended

Skin Grafts

• Management option for coverage of second- or third-degree burns
• Split-thickness grafts are preferred for burns with large affected areas & less donor skin or donor sites
  • Self-regenerating ability allows this type of graft to be re-harvested once healing is complete
• Full-thickness grafts are better aesthetically but with limited availability of donor site & vascularity