Guidelines for the management of partial thickness burns in

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					  Guidelines for the management
  of partial thickness burns in a
  general hospital or community
  setting




Lieve De Cuyper, Antwerpen   Rudi Deleus, Leuven
Henk Hoeksema, Gent          André Magnette, Liège
   Aims and recommendations
• Better patient outcomes

• Reducing the number of preventable late
  referrals to specialists

• Few comprehensive step by step guidance
  emphasising wound-healing principles
  Indications for improvement
• Diagnosis and referral

• Wound preparation

• Wound covering

• Post wound care
                 The algorithm
• Examine cause, depth and surface

            Initial referrals

• Prepare the wound

• Cover wound with appropriate dressing

            Late referrals

• Post-wound care

            Very late referrals
     Treatment algorythm
Examine cause, depth and surface area                Yes
     Indication for initial referral?           Refer to burncenter


               No
                                                      No
    Prepare woundbed and apply bandage
                                                Refer to burncenter
          Healed after two weeks?

                 Yes
           Start after care
                                                      No
         Scar souple and flat?                  Refer to burncenter


                              Yes
                          CONGRATULATIONS !!!
First aid



      WATER !!
 Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
  capillary refill

• Deep: wet or dry, less pain, grey/white, brownish, no
  capillary refill, with decreased sensation

• Rule of nines (for area)

• Palm of hands + fingers victim (1%)
Superficial burn
 Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
  capillary refill

• Deep: wet or dry, less pain, grey/white, brownish, no
  capillary refill, with decreased sensation

• Rule of nines (for area)

• Palm of hands + fingers victim (1%)
Deep burn
 Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
  capillary refill

• Deep: wet or dry, less pain, grey/white, brownish, no
  capillary refill, with decreased sensation

• Rule of nines (for area)

• Palm of hands + fingers victim (1%)
Rule of 9%
 Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
  capillary refill

• Deep: wet or dry, less pain, grey/white, brownish, no
  capillary refill, with decreased sensation

• Rule of nines (for area)

• Palm of hands + fingers victim (1%)
Rule of the hand: 1%
                 Initial referrals
•   All full thickness burns
•   >15% TBSA in adults
•   >10% TBSA in children and elderly
•   Burns to face, neck, hands, feet, armpits, popliteal
    region, genitals
•   Electrical and chemical burns
•   Circumferential burns
•   Burns associated with inhalation, trauma or disease
•   Non accidental burns
        • Apply bandage with physiologic fluid
          Wound preparation
•   Offer pain relief if required
•   Clean and disinfect wound
•   Puncture blisters/keep closed if<2%TBSA
•   Remove loose skin and blisters if>2% TBSA

• Tetanus prophylaxis if >5y. Ago
 What is an ideal dressing ?
 Maintains moist wound environment
 Contours easily
 Non-adherent but retains close contact with
  the wound
 Easy to apply and remove
 Painless on application and removal
 Cost-effective
 Protects against infection
 Lasts untill healing (one application)
 Waterproof to allow for washing and bathing
Best choice in primary care ?
 Ideal dressing= modern dressing
  • BUT:
           • Perfect diagnosis is necessary (LDI)
           • Correct use of it requires high expertise
  • SO:
           • It is not the best choice in primary care


 Best dressing in primary care
         = traditional ointment
            Late referrals

• Not healed in 10 to 14 days


• Late presentation of pain, fever,
  exudates, redness, odour, malaise
           Very late referrals
•   Non healing wounds
•   Scar problems
•   Itch
•   psychological impact
•   …
             Post-wound care
• Moisturise regularly with creams and/or ointments
• Prevent from sunlight for at least 1 year with high
  protection sun cream or special clothing
• Take care of itching with cream and/or medication
• Discuss return to work
• Reconsult in case of problems (eg blisters, skin
  defects,…)
• Think about psychological support
                   Conclusions
• Non-specialists play a pivotal role in the treatment of
  superficial burns
• Communication is essential between specialists and
  non-specialists
• Guidelines should be clear to informe non-specialists
  and improve outcome
• Guidelines must be revised regularly
• National burn organisations should put forward the
  recommendations to their members and develop
  strategies to communicate with relevant healthcare
  workers (www.burns.be)