Burns%20-%20initial%20management Treatment

Analgesics

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

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 pathogens
• Prophylactic parenteral antibiotics are not indicated in the initial management of burn wounds

Sulfonamides

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

Vaccine

• Eg tetanus toxoid
  
  • Recommended for patients with more than first-degree burn and burns >10% BSA
  • 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 and those more likely to rupture spontaneously
  
  • Removing the extra wall will allow direct application of moist wet dressings on the affected area

Maintenance Treatments

• Oral rehydration schemes may be considered in patients whose access for fluid resuscitation is only orally
  • Salt-containing fluids (eg rice water with salt, oral rehydration solution, Lassi) may be given in small amounts so that the equivalent amounts to 10% BSA

Emollients and Skin Protectives

• Lipid-rich topical treatments (eg lotion, moisturizers, aloe vera) are also recommended for healing lesions
  • The lipid contents of these treatments help accelerate repair of damaged skin 
  • Superficial burns may be effectively treated with lotion and creams

Wound Care

• Appropriate dressing depends upon burn degree, location, and wound exudate
• Occlusion dressing is preferred for patients with superficial partial-thickness burns and donor sites of split-thickness skin grafts
• For burns with minimal to moderate exudate, polyurethane, hydrocolloids and hydrogels are recommended
• Foams and 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

Surgical Dressings

• Dressings (eg silver-coated, hydrocolloid, moisture-retentive) absorb drainage, increase healing time, decrease pain, and help control bacterial growth in burns
  
  • They also provide protection and 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, and 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, and is cheaper as compared to other types of dressings
    • Hydrocolloid dressings are recommended for small-area partial-thickness burns and in the final stages of healing of small burn wounds

• Management option for coverage of second- or third-degree burns
• Split-thickness grafts are preferred for burns with large affected areas and 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 and vascularity