What is the management plan for burns and wounds?

Management Plan for Burns and Wounds

Burns and wounds should be managed with appropriate cleaning, cooling for recent burns, proper dressing selection, and avoidance of routine antibiotic prophylaxis to optimize healing and prevent infection. 1

Initial Assessment and Management

Burn Cooling

• For burns in adults with total burned body surface area (TBSA) <20% and children with TBSA <10%, cool the burn with cold tap water (15° to 25°C) as soon as possible for up to 40 minutes to limit burn depth and reduce pain 1
• Avoid cooling large burns (>20% TBSA in adults, >10% in children) or using ice directly on burns as this can cause tissue ischemia and hypothermia 1
• Remove all jewelry near the burn site before swelling occurs to prevent constriction 2

Wound Cleaning

• Clean burn wounds in a clean environment with tap water, isotonic saline solution, or an antiseptic solution 1
• Thorough irrigation is essential for superficial wounds and abrasions to remove foreign matter 1
• Wound care should be performed only after proper resuscitation in severe burns 1

Pain Management

• Provide adequate pain control during wound care, which may require deep analgesia or general anesthesia for severe burns 1
• Short-acting opioids and ketamine are effective for managing burn-induced pain 1
• Inhaled nitrous oxide can be useful when intravenous access is unavailable 1
• Non-pharmacological treatments such as cooling limited burned surfaces and covering burns with appropriate dressings may improve pain control 1

Wound Dressing

Dressing Selection

• Choose dressing type based on TBSA, local wound appearance, and patient's general condition 1
• Cover wounds with antibiotic ointment or cream and a clean occlusive dressing for superficial wounds 1
• For burn wounds, apply appropriate dressings that can reduce pain, protect from external contamination, and limit heat loss 1
• Silver sulfadiazine should be applied to a thickness of approximately 1/16 inch once to twice daily, but avoid prolonged use on superficial burns as it may delay healing 1, 3

Dressing Application Technique

• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1
• Reapply dressings immediately after hydrotherapy 3
• Leave burn blisters intact and cover loosely with a sterile dressing to improve healing and reduce pain 1

Infection Prevention and Management

• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 1, 4
• Systemic antibiotic prophylaxis should not be administered routinely to burns patients 1
• Monitor for signs of infection including increasing pain, redness, swelling, or purulent discharge 2, 5
• For infected burns, consider appropriate topical antimicrobial treatment after proper wound cleansing 4, 5

Special Considerations

Circular Burns

• Monitor closely for compartment syndrome, especially on extremities 2
• Surgical debridement of eschar may be necessary for circular burns with dead tissue to prevent infection and promote healing 2

Severe Burns

• Initiate nutritional support within 12 hours after burn injury, preferably via oral or enteral routes 1
• Routinely prescribe thromboprophylaxis for severe burns patients in the initial phase 1
• Consider supplementation with trace elements (copper, zinc, selenium) and vitamins (B, C, D, E) 1

Referral Criteria

• Burns involving the face, hands, feet, or genitals require specialized burn center treatment 2
• Burns covering >10% TBSA in adults or >5% in children should be referred to a burn center 2
• Any full-thickness burns or those with significant eschar formation should be evaluated by burn specialists 2, 6

Follow-up Care

• Reassess dressings daily when possible 1
• Continue treatment with appropriate dressings until satisfactory healing has occurred or until the burn site is ready for grafting 3
• Be aware that burn scars may take years to mature, requiring prolonged remodeling phase compared to other wounds 6

Common Pitfalls to Avoid

• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 1
• Avoid applying ice directly to burns as it can cause tissue damage 1
• Do not use elevation or pressure points to control bleeding as they are ineffective and may compromise direct pressure, which is more effective 1
• Avoid routine use of topical antibiotics for uninfected wounds to prevent antimicrobial resistance 1, 4
• Do not delay appropriate treatment for severe burns; early specialist consultation is crucial for optimal outcomes 2, 7