How do you manage a scald burn child presenting 5 days post-injury in a general practice (GP) setting?

From the Guidelines

Management of a scald burn child presenting 5 days post-injury in a general practice setting should prioritize wound assessment, infection control, and promotion of a moist healing environment. The primary goal is to assess the burn for depth, size, signs of infection, and healing progress, considering the child's overall condition and the time elapsed since the injury [@\1@].

Key Considerations:

• Gently cleanse the wound with warmed sterile water or saline, or an antimicrobial agent like chlorhexidine (1/5000) to prevent infection [@\1@].
• Apply a greasy emollient, such as 50% white soft paraffin with 50% liquid paraffin, over the whole epidermis, including denuded areas, to maintain moisture and promote healing [@\1@].
• Consider applying a topical antimicrobial agent to sloughy areas, guided by local microbiological advice, and use silver-containing products or dressings judiciously due to the risk of absorption [@\1@].
• Use nonadherent dressings on denuded dermis, such as Mepitel™ or Telfa™, and apply a secondary foam or burn dressing to collect exudate [@\1@].

Monitoring and Referral:

• Monitor the child closely for signs of infection, such as increased redness, purulence, odor, or surrounding cellulitis, and manage pain appropriately.
• Consider referral to a burn center if the burn covers a significant body surface area (>5%), shows signs of infection, or if there are concerns about healing or the child's overall condition.
• Ensure tetanus prophylaxis is up to date and provide guidance on wound care and signs of complications that require immediate medical attention.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Management of Scald Burn Child in a GP Setting

• The management of a scald burn child presenting 5 days post-injury in a general practice (GP) setting requires careful consideration of the risk of infection and the need for timely intervention 1.
• The child's burn wound should be assessed for signs of infection, such as increased redness, swelling, and purulent discharge, and the GP should be aware of the risk factors for infection, including the mechanism of burn, extent, and depth of the burn 1.
• Topical antimicrobial agents, such as silver nanoparticles, may be effective in preventing infection and promoting wound healing, but their use should be guided by the severity of the burn and the presence of any signs of infection 2, 3.
• The GP should also be aware of the importance of early inflammation in burn wound healing and the potential benefits of allowing some degree of early inflammation to occur, while also preventing prolonged inflammation 3.

Prevention of Infection

• The GP should take precautions to prevent infection, including meticulous hand-washing and the use of gloves when handling the wound site, and prophylactic application of a topical antibacterial agent such as SSD cream 4.
• Surveillance wound cultures should be done weekly to determine the emergence of colonization and aid in the selection of empiric antimicrobial regimens when these are appropriate 4.
• The GP should also be aware of the common organisms that colonize burn wounds, including Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans, and the importance of choosing effective empirical therapy to prevent infection and its complications 5.

Antibiotic Prescription Protocol

• The GP should be aware of the importance of institution-specific studies to guide the choice of empirical antibiotics for burn patients, and the need to consider the patterns of burn wound bacterial colonization and antimicrobial resistance profiles in their local area 5.
• The GP should also be aware of the potential for antibiotic resistance and the need to choose antibiotics that are effective against the most common organisms that colonize burn wounds, such as Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) 5.