Burns for Beginners: How the “Experts” Manage Burns and …...1. Partial thickness burns greater...

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www.mghcme.org Burns for Beginners: How the “Experts” Manage Burns and Wounds Jonathan Friedstat, MD, MPH, FACS Assistant Professor of Surgery, Harvard Medical School Massachusetts General Hospital

Transcript of Burns for Beginners: How the “Experts” Manage Burns and …...1. Partial thickness burns greater...

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Burns for Beginners: How the “Experts” Manage Burns and Wounds

Jonathan Friedstat, MD, MPH, FACSAssistant Professor of Surgery, Harvard Medical School

Massachusetts General Hospital

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Disclosures

I do not have a relevant financial relationship with a commercial interest to disclose.

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Overview

• Evaluation of Burn Wounds

• Estimating Burn Size

• Wound Care

• Referral Criteria

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BURN INJURY ASSESSMENT

Depth

1. Superficial (1st Degree)

2. Partial Thickness (2nd Degree)

- Superficial

- Deep

3. Full Thickness (3rd Degree)

4. 4th Degree

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1ST Degree Burn

• Epidermis is intact

• Painful

• Heals on its own

• Does NOT count toward TBSA

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Example: First Degree Burn (0% TBSA)

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Partial Thickness Burns (2nd Degree)

• Epidermis is destroyed

• Dermis is involved

2 Categories of 2nd Degree Burns

• Superficial – Minimal dermal injury

• Deep – May be equivalent to a full thickness burn

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Superficial Partial Thickness Burns

• Upper 1/3 dermis

• Painful

• Blisters

• Pink / Blanching / Moist

• Healing Time: 6-10 days

• Scarring: Minimal

• Treatment: Dressings

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Example: Superficial Second Degree Burn

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Deep Partial Thickness Burns

• Lower third of dermis

• Hypoalgesia

• Blisters / Matte / Non-Blanching

• Lobster Red / Cherry Red

• Healing Time: typically > 21 days

• Results: ↑ hypertrophic scarring

• Treatment: Operative / Non Op

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Example Deep Second Degree

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Full Thickness Burn (3rd Degree)

• Completely through the Dermis

• Insensate

• Opaque, white, black, leathery

• Healing: Via contracture & re-epithelialization

at wound margins

• Treatment: Excise and Graft

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Examples Full Thickness Burns

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4th Degree Burn

• Much less common than 1st, 2nd, and 3rd

degree burns

• Extremely prolonged contact with a hot surface

• Extends into the muscle, tendon, bone or deeper organs

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Measuring Burn Size

• Several approaches

• Best overall and easiest is a Lund Brower Diagram (color in areas of second degree or higher burns and use columns

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Burn Treatment

• There is NO single good treatment

• Even among burn centers there is disagreement about optimal treatment

• If ever in doubt call your regional burn center

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American Burn Association Referral Criteria

1. Partial thickness burns greater than 10% total body surface area (TBSA).

2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints.

3. Third degree burns in any age group.

4. Electrical burns, including lightning injury.

5. Chemical burns.

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American Burn Association Referral Criteria

6. Inhalation injury. 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality. 8. Any patient with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. 9. Burned children in hospitals without qualified personnel or equipment for the care of children. 10. Burn injury in patients who will require special social, emotional, or rehabilitative intervention.

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Find your Regional Burn Center:http://ameriburn.org/public-resources/burn-center-

regional-map/

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Treatment with Plans for Transfer for Follow-up

For small burns,

• First stop the burning process

• Run under clean, cool water for 10-15 min

• Cover with antibiotic ointment, Vaseline gauze/adaptic and kerlex.

• Contact burn center for follow up or transfer

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Small burns not transferring

For small burns,• First stop the burning process• Run under clean, cool water for 10-15 min• Cover with antibiotic ointment, non-stick dressing

and gauze• This should be changed daily and cleaned with

soap and water• Patients should follow up weekly until healed• If not healed in 3 weeks, should refer to a burn

center

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Choices of Ointment

• Bacitracin– Can use for nearly any simple wound– Can cause a rash when used for longer

periods of time

• Bactroban– Use for MRSA and some gram negative

coverage

• Sulfamylon cream– Use for broad antimicrobial coverage– Not readily available at many pharmacies

• Silvadene– Commonly used– MUST clean off completely


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