From the Guidelines
Management of nasal thermal burn injuries requires immediate cooling with cold tap water, careful cleaning, and application of topical treatments to promote healing and prevent complications, as recommended by the most recent guidelines 1. The initial step in managing nasal thermal burn injuries involves cooling the affected area with cold tap water to reduce pain, edema, and depth of injury, as well as to speed up the healing process 1. It is essential to avoid applying ice directly to the burn, as it can cause tissue ischemia.
Key Considerations
- Nasal burn injuries can be classified into different degrees, including first-degree (superficial), second-degree (partial thickness), and third-degree (full thickness) burns.
- For first-degree burns, applying petroleum jelly or bacitracin ointment 2-3 times daily can help maintain moisture and create a protective barrier.
- For second-degree burns, gentle cleansing followed by the application of silver sulfadiazine cream (1%) or mafenide acetate (5%) twice daily, covering with a non-adherent dressing if possible, is recommended.
- Pain management typically includes acetaminophen 650mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed, as supported by recent guidelines 1.
- Severe or third-degree burns require immediate medical attention and may necessitate surgical intervention.
Additional Recommendations
- Throughout the healing process, it is crucial to maintain nasal patency to preserve respiratory function and consider humidification to prevent mucosal drying.
- Tetanus prophylaxis should be administered if the immunization status is uncertain.
- Monitoring for signs of infection, such as increased pain, redness, purulent discharge, or fever, is essential, and antibiotic therapy with cephalexin 500mg four times daily for 7-10 days may be necessary 1.
- The nasal mucosa has an excellent blood supply, which facilitates healing, but proper wound care is essential to minimize scarring and functional impairment.
Special Considerations
- Burns involving the face, hands, feet, and genitals may require surgical intervention to prevent permanent disability, and those with a large surface area can lead to significant fluid loss and multisystem organ failure 1.
- Inhalation injury from hot smoke can rapidly lead to loss of the airway due to airway swelling, and evidence of inhalation injury can also be indicative of carbon monoxide poisoning 1.
From the Research
Management of Nasal Thermal Burn Injury
There are no specific research papers provided that directly address the management of nasal thermal burn injury. However, the following information can be gathered from the available studies:
- The management of burn injuries, in general, involves stopping the burn process, evaluating the depth and percentage of total body surface area involved, and providing appropriate wound care 2.
- Topical antimicrobial agents, such as silver-based antiseptics, honey, and iodine-based treatments, can be used to prevent infection and promote healing of burn wounds 3, 4.
- Cool running water (CRW) first aid within three hours of thermal burn injury can decrease the odds of patients requiring skin grafting and surgical intervention for wound management 5.
- Local wound care, excision, and grafting are important parts of managing the functional, cosmetic, and physiologic derangements caused by burn injuries 6.
Key Considerations
- Burn depth and percentage of total body surface area involved are key determinants of the need for referral to a burn center 2.
- Prophylactic antibiotics are not indicated for outpatient management and may increase bacterial resistance 2.
- Patient education during primary care visits may be an effective prevention strategy for burn injuries 2.