Burns 101 Treatment Video Lecture | Introduction to Burn Care: Medical Treatment - Health & Fitness

in this segment we'll discuss the
practical matters of de breeding and
dressing burns for outpatient treatment
now of course superficial burns are
treated with non narcotic pain
medications and moisturizer and full
thickness burns are admitted to the
hospital for evaluation and possible
operative management so this is really a
dissection on how to manage partial
thickness burns partial thickness
injuries are very painful especially
once to breed it because the underlying
dermis is sensitive to the circulating
air oxycodone and Tylenol are good
choices for pain control if you need IV
pain medications for initial wound care
it probably means the patient will
continue to require IV pain medication
and therefore admission remember that
most parents are ill prepared to take on
wound care range of motion and
administration of pain medications from
the get-go admitting kids overnight is
that often the right thing to do both
for the patient and the parents
debridement can usually be accomplished
with a pair of small scissors and a pair
of forceps both of which are available
in suture removal kits using sterile
scissors make a small cut in the blister
to drain the fluid remove as much of the
Dead and sloughing tissue as possible
picking up dead skin with your forceps
and cutting it as close as possible to
the skin with your scissors to expose
the viable skin underneath intact
blisters if small can be left alone the
perfect examples are blisters at the tip
of the fingers they're difficult to
dress and may actually hinder activity
if unroofed undressed we believe that
the biological dressing effect of
leaving blisters intact is probably
overrated more likely they'll just
rupture at home and then be in
adequately debride it for example a
patient with a blistered palm may not
use that hand or do a range of motion
exercises out of fear of damaging the
blister
only to have it debris did when they
come in to see us in clinic that's very
counterproductive the next step is a
gentle cleaning of the wound no
scrubbing is necessary this can be
easily accomplished with warm water non
perfumed soap and gentle cleansing with
a washcloth ask the patient to take a
deep breath and gently wipe loose
devitalized tissue with the wet
washcloth in a single motion in a single
direction
always reassessed the burn when it's
fully to breeded and cleaned to be sure
that it still seems appropriate for
outpatient management instruct patients
that they do not need to wear gloves at
home and can use regular warm tap water
for wound care it's now time to dress
the wound please keep it simple the
dressing should allow for a full range
of movement be loose enough to allow for
some swelling of the wound and be simple
enough that the patient or the patient's
caregivers can replicate it easily
dressings should not have to be changed
more than once a day
the purpose of a dressing is to prevent
gross contamination of the wound to
provide some antimicrobial activity and
to keep the tissue moist for healing and
range of motion
remember that topical antibiotics are
all that's necessary there is no role
for systemic antibiotics in these
patients primary bacteria that initially
colonize a burn our skin flora primarily
Staphylococcus streptococcus
later in the process gram-negative
bacteria colonize the wound as well so
the best antibiotics are the most
broad-spectrum shallow partial thickness
burns can be treated with bacitracin
alone since the chance for invasive
gram-negative infection is vanishingly
low most deep partial and full thickness
burns however are treated with silver
sulfadiazine which has the added benefit
of being soothing to the skin and
requiring once daily application most
patients with selfi allergies do not
have a reaction to silvadene you can
prove this using a test dose over a non
burned area applying silver sulfadiazine
has a lot in common with putting
frosting on a cake using a tongue
depressor scoop a generous amount of
silvadene from the container and spread
it thickly over the skin the other way
to accomplish this is to spread silver
sulfadiazine onto the inner dressing
layer then apply it to the patient then
wrap with sterile gauze and tape in
place we often advocate the use of multi
day silver impregnated dressings in
terms of activity encourage patients to
resume normal activities as best they're
able narcotic pain medications cause
drowsiness and should not be used during
the day or when patients are driving
in addition burns are not fractured
bones so you don't need crutches canes
or other assistive devices favoring or
not using an extremity only leads to
disuse and stiff non-functional
extremities perhaps the most important
part of any outpatient burn care is
making sure that patients have good
follow-up to be sure that they're
meeting all four domains of good burn
care remember those four domains are
wound care pain control physical and
occupational therapy and psychosocial
support our institution has developed a
fast-track program where discharge
eligible patients are transferred from
the emergency department to an acute
care ward
for wound care teaching and physical
therapy before being discharged home