Which of the following statements regarding burns is false: A. Low-temperature burns with prolonged contact cause mild injuries, B. Erythema occurs with intact epithelium, C. Every burned patient requires tetanus (Tetanus Toxoid) vaccination, or D. All facial burns should be referred to a burn unit?

From the Guidelines

The correct answer is C. Every burned patient must receive tetanus vaccination. This statement is false because not every burned patient requires tetanus vaccination. Tetanus prophylaxis in burn patients follows the same guidelines as for other wounds, as outlined in the most recent and highest quality study 1. According to this study, patients with burns who have completed their primary tetanus immunization series and received a booster within the last 5 years typically don't need additional tetanus vaccination. Those with incomplete immunization history or whose last booster was more than 5-10 years ago should receive tetanus prophylaxis according to their specific circumstances.

The other statements are true. Burns from low temperature but prolonged contact can indeed produce mild injuries, as seen in cases like heating pad burns or sunburns. In first-degree burns, the epithelium remains intact with erythema being the primary visible sign, as described in general medical knowledge. And burns affecting the face should be referred to a burn unit due to potential complications involving airways, risk of scarring in a cosmetically sensitive area, and possible associated inhalation injuries.

Key points to consider in tetanus prophylaxis for burn patients include:

• Completion of primary tetanus immunization series
• Time since last tetanus booster
• Type and severity of the burn
• Presence of contaminated wounds or other risk factors

The most recent guidelines from 1 provide a comprehensive approach to tetanus prophylaxis in wound management, including burns. This study supersedes earlier recommendations 1 and should be consulted for current best practices in tetanus vaccination for burn patients. Tetanus prophylaxis should be tailored to the individual patient's immunization history and wound characteristics, rather than a one-size-fits-all approach.

From the Research

Burn Injury and Treatment

• Burn of low temperature but long contact can produce mild injury, which is characterized by the epithelium being intact with erythema 2.
• The statement that every burned patient must receive tetanus vaccination is not entirely accurate. According to studies, tetanus prophylaxis is recommended for tetanus-prone wounds, such as severe crushing injuries, piercing wounds, blisters, and burns, particularly if contaminated with dirt, grass, or other debris 3, 4. However, the decision to administer tetanus vaccination should be based on the individual's immunization history and the severity of the burn.
• Any burn affecting the face should be referred to a burn unit, as facial burns can be complex and require specialized care.
• The correct answer is C, as not every burned patient requires tetanus vaccination, but rather those with tetanus-prone wounds or uncertain immunization history.

Tetanus Prophylaxis

• Tetanus prophylaxis is crucial in preventing tetanus infection, especially in individuals with tetanus-prone wounds 3, 4.
• The use of antibiotics, such as tetracycline, may have a prophylactic effect against tetanus if administered soon after injury 3.
• Tetanus immunoglobulin can be used to neutralize circulating toxin in individuals with tetanus infection 4.