Clinical Update TEN TOP TIPS Management of burn wounds
“Burn wounds, like all other
types of wound that clinicians
come across in daily practice, need accurate assessment,
effective analgesia and effective
treatment, with
specialist referral when required
with appropriate follow-up.”
Figure 3. A non-accidental burn in an adult. The history of injury was inconsistent with the clinical presentation.
Figure 2. A non-accidental burn in a young child. Note the well demarcated nature of the burn and the lack of splash marks.
polyethylene wrap (cling film) as it will contain the chemical, causing further tissue damage.
• Alkalis cause deep, penetrating burns and will require prolonged irrigation. The aim of water irrigation is to achieve a pH of 7.
• Certain chemicals may cause systemic effects or have a definitive antidote – contact TOXBASE (
www.npis.org/toxbase. html) for guidance on management.
• The extent of chemical burn injuries can be limited by prompt and copious irrigation guided by pH testing strips.[36]
necrosis puts the patient at risk of rhabdomyolysis, leading to acute kidney injury. These patients are at higher risk of compartment syndrome and the irreversible damage to tissues may lead to limb amputation.
• Look for “entry” and “exit” sites (may not always have both), as these are associated with severe deep-tissue damage.
• Assess the patient's electrocardiography (ECG) rhythm. If the initial ECG is normal and there is no history of loss of consciousness, then no further ECG monitoring is needed. Otherwise, 24-hour ECG monitoring is required.[35]
Chemical burns • Chemical burns continue to cause cutaneous damage until completely removed.
• Copious irrigation with water, away from healthy tissue to avoid further contamination. Adequacy of irrigation is guided by regular pH testing of the wound. Special attention must be paid to ocular chemical burns ensuring immediate irrigation with water (or if not available, normal saline), remembering to flip the lids and irrigating the fornices to remove any material that may be retaining chemicals. • Do not wrap chemical burn wounds in
14
CONCLUSION Burns can be complex, life-threatening wounds. Even relatively minor burns can have significant physical effects and require prolonged specialist treatment from specialist burn teams. Burns services are equipped not only to care for patients but also to provide help, guidance, and expertise to clinical staff looking after patients outside specialist environments. With good communication and information sharing, patients with non-complex burn wounds can be cared for in a more general environment with positive outcomes. Burn wounds, like all other types of wound
that clinicians encounter in daily practice, need accurate assessment, effective analgesia and treatment, and – if required – specialist referral and appropriate follow-up. n
REFERENCES cont.
32. Jackson DM (1953) The diagnosis of the depth of burning. Br J Surg 40(164): 588–96
33. Edwards J (2011) Managing wound pain in patients with burns using soft silicone. Wounds UK 7(4): 122–6
34. Selig HF et al (2012) The properties of an "ideal" burn wound dressing--what do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists. Burns 38(7): 960–6
35. Hettiaratchy S, Dziewulski P (2004) ABC of burns: pathophysiology and types of burns. BMJ 328(7453): 1427–9
36. Palao R et al (2010) Chemical burns: pathophysiology and treatment. Burns 36(3): 295–304
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