Clinical Update TEN TOP TIPS Management of burn wounds


Ten Top Tips... The management of burn wounds


M


Author: John McRobert


any people will experience a burn injury in


their lifetime. Burn injuries range from the most severe – requiring high levels of critical care and surgical intervention – to simple burns, for which self- treatment may suffice. Burn injuries pose a


considerable burden to heathcare resources across the globe.[1]


In the UK, the


Author: Krissie Stiles


figures are considerable, with 250 000 patients presenting in primary care, and a further 175 000 presenting to A&E annually. Approximately 40% of patients who require hospital admission are


admitted to non-specialist units.[2] Healthcare professionals with varying


degrees of experience in wound care manage a significant number of minor burns in the community. This article is aimed at healthcare professionals who do not regularly come into contact with burn wounds and highlights some of the key principles in burns assessment and management.


with untreated burns can cause progression of depth over 48 hours, so prompt first aid can limit the extent of the primary burn injury.[3] Cool the burn for a single block of 20 minutes under cool running water.[4]


1 If cooling is


commenced within 3 hours of injury, it can significantly reduce pain and oedema, decrease cell damage by slowing cell metabolism in hypoxic tissue, decrease inflammatory response, stabilise vasculature and ultimately improve wound healing and reduce scaring.[5] Cool running water dissipates heat better than a cold compress. Cold water or ice should


PROMPT FIRST AID IS ESSENTIAL The intense early inflammation associated


be avoided as they can cause vasoconstriction, deepening the burn or causing frostbite. Likewise, be wary of hypothermia while cooling burns by observing the maxim “cool the burn, warm the patient”. Prolonged cooling of extensive burn wounds (>20% total body surface area [TBSA] in adults; >10%TBSA in children) can cause hypothermia.[6]


Cooling should be suspended if hypothermia is suspected.


exceedingly painful. Analgesia will be required for the patient’s comfort, and during treatment to enable superficial debridement and accurate assessment. Ongoing analgesia may be required to ensure pain-free dressing change.[7] Furthermore, some evidence suggests that emotional stress may slow down wound healing and compliance with physiotherapy,[8]


2 therefore


good pain management is critical. Opioid analgesics are the backbone of analgesia for the burn patient, providing a range of potencies and administration options. The more simple analgesics, such as paracetamol, that have antipyretic and opioid-sparing properties should be considered for every patient. The dynamic evolution of the patient’s pain – from the initial burn injury to eventual healing – should be reflected by a similarly dynamic and flexible therapeutic plan that, when planned in conjunction with the patient, covers background, procedural, breakthrough, and postoperative pain.[9]


3


EFFECTIVE CLEANSING Maintaining a clean burn wound is


important. Remove debris and – for burn blisters greater than the size of the patient’s little fingernail – deroof blisters.[10]


This process


allows assessment of the burn wound bed and prevents uncontrolled rupture of the blister, decreases the risk of blister infection, relieves pain in tense blisters, and reduces restriction of movement of joints.[11] In cases where the patient has scalp burns, or if the affected area is very hairy, shave


Wounds International Vol 5 | Issue 1 | ©Wounds International 2014 | www.woundsinternational.com


Author details John McRobert is the lead Wound Care Specialist Nurse for Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. Krissie Stiles is Burns Specialist Nurse and Burns Care advisor working for the London and South East Burns Network, London, UK.


REMEMBER ANALGESIA Depending on depth, burns can be


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Ten Top Tips


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