What is the treatment for a patient with a second-degree burn on the mid-back, presenting with a blister, covered with a Duoderm (hydrocolloid dressing) patch, and no fever, that occurred within the last 48 hours?

From the Guidelines

For a second-degree burn on the mid back from a heating pad, I recommend continuing the Duoderm patch for 3-5 days as it provides an appropriate moist healing environment, as supported by the most recent guidelines 1. The patient should clean the area gently with mild soap and water before applying a new dressing if the current one becomes saturated or loosens. Take over-the-counter pain medication such as acetaminophen 500-1000mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed for pain, considering the patient's pain management needs as outlined in 1. Apply a thin layer of antibiotic ointment like bacitracin if the Duoderm is discontinued. The burn should be kept clean and protected from further trauma. Seek immediate medical attention if signs of infection develop (increased pain, redness extending beyond the burn area, purulent drainage, or fever). Second-degree burns involve damage to both the epidermis and part of the dermis, causing blistering, but maintaining the Duoderm provides protection while allowing the body's natural healing processes to work, as burn wound dressings can reduce pain and protect the wound from external contamination 1. Most second-degree burns heal within 2-3 weeks with proper care, though deeper burns may take longer and could potentially leave scarring. Key considerations in burn care include:

• Keeping the burn clean and protected
• Managing pain effectively
• Monitoring for signs of infection
• Following up with a healthcare professional for further evaluation and guidance, as the initial dressing should be assessed by a healthcare professional 1.

From the Research

Treatment of Second-Degree Burn

• The patient has a second-degree burn on her mid back from a heating pad, with a blister present and no fever.
• The burn is currently covered with a Duoderm patch, which is a type of hydrocolloid dressing.

Management of Partial-Thickness Burns

• According to a study published in 2010 2, hydrocolloid dressings like Duoderm can provide an occlusive moist environment to optimize healing and are associated with less frequent dressing changes.
• The same study found that the use of hydrocolloid dressings can decrease operative intervention rates in pediatric burns.
• A systematic overview published in 2015 3 evaluated the effects of various treatments for partial-thickness burns, including hydrocolloid dressings, and found that they can be effective in promoting healing.

Pain Management During Dressing Changes

• A study published in 2017 4 found that pain and sedation management for burn dressing changes can be challenging, and variations exist in the selection of medications.
• Another study published in 2010 5 found that a combination of ketamine, tramadol, and dexmedetomidine can be an effective treatment option for preventing procedural pain during dressing changes in adult patients.

Current Treatment

• The patient's current treatment with a Duoderm patch is consistent with the recommendations for managing partial-thickness burns.
• However, the patient's pain management during dressing changes may need to be reassessed, and alternative treatments like ketamine, tramadol, and dexmedetomidine could be considered if necessary, as suggested by studies 4, 5.