What is the management plan for a patient presenting with chemical burns to the dorsal feet, 3 days post-exposure, with symptoms of swelling and pain, requiring wound care and pain management with acetaminophen (Tylenol) or ibuprofen (Advil)?

From the Guidelines

For chemical burns on the dorsal feet presenting 3 days after exposure with swelling and pain, the most effective treatment involves wound cleansing and debridement followed by application of silver sulfadiazine cream USP 1% under sterile conditions once to twice daily, as this approach provides antimicrobial protection and promotes a moist healing environment, although it's crucial to note that prolonged use of silver sulfadiazine on superficial burns may be associated with prolonged healing 1. Pain management is also critical and can be achieved with acetaminophen 650mg every 6 hours or ibuprofen 400mg every 6 hours with food, if not contraindicated, and considering the use of multimodal analgesia as suggested by experts for severe burn-induced pain, which may include titrated intravenous ketamine combined with other analgesics 1. The feet should be elevated above heart level to reduce swelling by improving venous return and decreasing fluid accumulation in the tissues. Key aspects of care include:

• Keeping the burn area clean and covered with sterile dressings to prevent infection and promote healing.
• Follow-up in 2-3 days to assess wound healing progress and check for signs of infection.
• Immediate medical attention if symptoms worsen, including increased pain, swelling, purulent drainage, or fever, as these could indicate infection or other complications requiring prompt intervention. It's also important to consider the general principles of burn wound care, which should be performed in a clean environment and may require deep analgesia or general anesthesia, with the type of dressing depending on the extent and appearance of the wound, as well as the patient’s general condition 1.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The burn areas should be covered with silver sulfadiazine cream, USP 1% at all times The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch.

The patient's treatment plan for chemical burns to the dorsal feet is appropriate, including wound cleansing and debridement, application of silver sulfadiazine cream USP 1% once to twice daily under sterile conditions, and pain management with acetaminophen or ibuprofen.

• Elevation of the feet above heart level is recommended to reduce swelling.
• The patient should be educated on burn care, including keeping the area clean and covered with sterile dressings.
• Follow-up in 2-3 days is necessary to reassess wound healing and evaluate for signs of infection 2.

From the Research

Treatment of Chemical Burns

• The patient's treatment plan includes wound cleansing and debridement, followed by the application of silver sulfadiazine cream USP 1% under sterile conditions once to twice daily 3, 4.
• Pain management is achieved with acetaminophen 650mg q6h or ibuprofen 400mg q6h with food if no contraindications, which is consistent with the recommended treatment for minor acute pain in burn patients 5.
• Elevation of the feet above heart level is recommended to reduce swelling, and the patient is educated on burn care, including keeping the area clean and covered with sterile dressings.

Wound Care and Follow-up

• The patient is advised to follow up in 2-3 days to reassess wound healing and evaluate for signs of infection, such as worsening pain, increased swelling, purulent drainage, or fever 6, 7.
• The use of silver sulfadiazine as a topical therapy is a standard treatment for partial-thickness burns, and its effectiveness in wound infection control and healing has been extensively studied 3, 4.

Management of Chemical Burns

• Chemical burns require rapid assessment and early management to reduce the period of resulting morbidity, and copious irrigation with water remains the mainstay of early management 6.
• The assessment of the patient should be rapid and occur in conjunction with early emergency management, and referral to a centre of higher acuity may be required for expert evaluation 6, 7.