Burns 201: Initial Care and Debridement of Outpatient Burn Wounds Video Lecture | Introduction to Burn Care: Medical Treatment - Health & Fitness

over 400,000 burns presented the
emergency departments in the United
States every
and many more present to their primary
care providers offices this video
reviews the steps for initial wound care
of burns in an outpatient setting first
degree burns is typically a sunburn no
blisters only require a moisturiser and
pain relief second-degree burns also
known as partial thickness blisters are
present and they need proper wound care
and analgesia to facilitate healing and
minimize functional and psychological
complications burns over large surface
areas deep burns and third-degree burns
are best managed by referral to a burn
center with specialty medical surgical
nursing and therapy care treatment of
third-degree burns is beyond the scope
of this video
initial wound care and debridement of
dead skin and blisters are necessary to
adequately assess the depth of injury
and urgency of subsequent referral
cleansing the wound is critical in the
following example removal of soot and
divide alight skin by simply wiping with
a washcloth reveal the full thickness
burn around the wrist an indication for
immediate referral to a burn center most
but not all blisters require debridement
generally we recommend to leave alone or
deflate the small non bulging blisters
on a two centimeters and to completely
unrepresentable outpatient course we use
four criteria for that assessment burns
can be very painful at all hours of the
day and night requiring scheduled
medication for pain management the
patient will also need additional dosing
for wound care should daily wound care
be necessary for many children parents
often need several sessions to acquire
the skills and confidence necessary to
perform wound care adults with burns may
also benefit from a helper who can set
up and apply ointment sand dressings as
necessary use of silver impregnated
dressings for appropriate burns may
simplify wound care non-english speaking
patients and caretakers should verbalize
and demonstrate good understand
the wound care as well we encourage
burned patients to mobilize as much as
possible to avoid disuse and extremity
edema in particular lower extremity
burns benefit from both elevation and
walking not for standing in place use of
crutches or other assistive devices
promote dependent disuse edema and pain
and such increases the risk of
complications rolling hands or feet are
high risk for infection providers must
ensure that the patient has an
environment to heal their injuries the
circumstances of burns are also
important as any suspicions about
neglect or views mandates a thorough
workup rather than returning the victim
to the same environment remember that
not only children but also adults with
physical or mental conditions are
vulnerable to abuse reassuring the
patient about upcoming Lune care
procedures and describing the steps in
wound care will help alleviate anxiety
using an age-appropriate scale to assess
pain prior to during and after the
procedure to ensure adequate pain
control the patient should premedicate
with an oral narcotic medication
approximately 20 to 30 minutes prior to
the wound care and oral benzodiazepine
can also alleviate procedural anxiety
and reduce problems with subsequent
dressing changes but may require post
procedure observation for more severe
pain and anxiety it is appropriate to
administer intravenous or oral at forms
of narcotic and anxiety medications in
some instances a deeper level of
sedation and increased monitoring may be
necessary however the same level
analgesia and angio lysis cannot be
provided at home when additional daily
wound care is expected we advise
hospitalization of the patient who
requires anything more than oral
analgesics until they are able to
perform their own wound care with an
oral pain regimen that can be replicated
at home prepare the procedure room by
ensuring that it is sufficiently warm
lay out and prepare all necessary
supplies prior to wound care to expedite
the steps and decrease the duration the
wound is exposed to the air
wound cleansing at home requires hand
hygiene soap and water and a washcloth
whereas medical and nursing providers
must also wear gloves mask and sometimes
a gown because of standard infection
control practices if the wound was
previously dressed use a generous amount
of tap water to soak remove and discard
all dressings gently wash the wound with
wet soapy washcloth and remove loose
debris with forceps or clean scissors do
not scrub the wound to cause bleeding
for heavy hair-bearing areas such as the
scalp face or forearm shaving the wound
surface prevents accumulation of cream
and ointment that becomes harder and
harder to remove over time not shaving a
bearded area will cause the hair to grow
into the wound exudate and increase the
risk of bacterial overgrowth the patient
might be tempted to simply add oil
rather than face the discomfort of
Shaving over the next few days do not
show eyebrows as they may not grow back
once cleanse the wound is ready for
dressings
the application of dressings that
contain a topical antibacterial agent
that can be left in place for seven days
avoids daily wound care and decreases
discomfort this child sustained a
superficial second-degree scald and was
treated with a silver impregnated
dressing once secured in place he was
only removed at clinic follow-up at
which point the burn was healed secure
silver impregnated dressings with
adhesive tape and a light wrapping of
gauze
we recommend applying silver impregnated
dressings only to superficial burns
deeper second-degree burns may progress
to a third degree in eschar formation
trapping devitalized tissue underneath
an extended dressing may promote severe
infection note that these dressings
cannot be wet so patients are advised to
perform sponge baths until their
follow-up visit
prefabricated silver containing gloves
and finger sleeves are commercially
available but issues with proper sizing
flexibility for hand motion and costs
are limiting their widespread use so far
so we recommend treating mobile areas
such as hands fingers and feet with
daily dressing changes it's also
difficult to keep extended dressings on
the neck face and scalp for multiple
days we recommend daily dressing changes
in those areas also superficial
second-degree burns should epithelial
eyes quickly and are appropriate for
bacitracin pointment we recommend silver
sulfadiazine for deeper second-degree
burns at least initially as some of
these wounds may progress to full
thickness over the next few days for
bacitracin apply a thin pointment layer
over 0 form gauze and then applied the
zero form to the patient's wound for
silver sulfadiazine use a tongue
depressor or gloved hand to apply a thin
layer to dry gauze then apply to the
patient's wound good secondary dressings
to hold the gauze in place include dry
curl ex cling stretchy net tuba Crip or
ISOTONER gloves
although daily wound care may seem
inconvenient the patient will be able to
shower over those areas wash hands and
change soiled dressings as necessary
always dress the fingers individually
this promotes use of the hand and
fingers do not mummy wrap the hand ask
the patient to apply part of their
dressings themselves and to perform
range of motion exercise as a test of
their readiness for outpatient care
small blisters at the fingertips in a
toddler who has touched a hot surface
and roofing the blisters entails daily
wound care for parents and caretakers
for the next several days an unnecessary
discomfort for the patient
since hand dressings are difficult to
keep in place in young children
we recommend either leaving the blisters
alone or deflating them using a sterile
needle this avoids the burden of daily
wound care
instruct the patient to alternate
elevation with use of the affected
extremity as much as possible discharge
the patient with instructional sheets
for wound care activities range of
motion exercises and potential
complications such as a wound infection
schedule a follow-up appointment in five
to seven days to reevaluate for wound
healing insufficient supply and pain
medication may cause patients to avoid
performing their wound care and to
reduce their daily activities only a few
patients with very small wounds do
tolerate wound care without narcotics in
the subsequent days do not prescribe
prophylactic oral antibiotics initial
wound care and debridement for
second-degree burns is a common
procedure for emergency departments and
primary care offices nationwide with
appropriate pain control and patient
counseling this procedure lays the
foundation for successful outpatient
management and healing