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HOW TO TREAT 23
CF
NEW
LEARN Events MORE ONLINE Calendar Visit our Therapy Update 4 AUGUST 2023
HOW TO TREAT 23
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2023
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Figure 5 xx . Rule . Percentage of nines . body surface area .
Head ( front and back ) = 9 %
Box 3 . Recommended dressings after optimal BFAT
• First aid : — Plastic wrap , clean sheet or tea towel .
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Right arm = 9 %
Right leg = 18 %
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Torso = 18 % front
+ 18 % back
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Left leg = 18 %
Left arm = 9 %
Perineum = 1 %
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Head ( front and back ) = 18 %
Right arm = 9 %
Right leg = 13.5 %
Torso = 18 % front
+ 18 % back
Left leg = 13.5 %
Left arm = 9 %
Perineum = 1 %
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• Primary care : — Local treatment only . — Paraffin tulle impregnated with chlorhexidine or a nanocrystalline silver-based dressing .
• Patients requiring transfer to ED and / or burns unit : — Plastic wrap if transfer time is less than four hours .
— Paraffin tulle impregnated with chlorhexidine if transfer time is greater than four hours .
Box 4 . Australian and New Zealand Burn Association referral criteria
• Ten per cent TBSA burn or 5 % TBSA full-thickness burn .
• Any burn with an associated inhalational injury .
• Burns to special areas : hands , feet , genitalia , perineum , crossing major joints .
• Electrical and chemical burns .
• Circumferential burns .
• Burns in children aged under 12 months or with significant preexisting illnesses .
• Any burn injury associated with non-burn trauma .
• Any suspected non-accidental injury .
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Adult |
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Child |
Source : Australian and New Zealand Burn
Association 10
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paracetamol ( 15mg / kg ) can be given ; morphine ( 0.1mg / kg ) may be indicated for those children with severe burns who have IV access .
The issue of deroofing blisters versus leaving them intact is highly controversial , with positives and negatives for both opinions . The author suggests that the GP leaves blisters intact unless they have a discussion with the burns unit that advises deroofing is indicated .
Dressings
Dressings and their use remain controversial , with limited objective data to clearly demonstrate the superior efficacy of one contemporary dressing type over another . While the goals of a burns dressing have been generally agreed ( see box 2 ), some variation over the recommended dressing exists . These depend on the body site concerned , the age and developmental status of the patient , the availability of the dressing and the local climatic environment . Many studies citing superior results with one type of dressing over another have often been compromised by comparison with outdated control dressings — classically , silver sulfadiazine or SSD — with subjective assessment of burn depth and burn wound healing . 9
No one dressing will generally suit all burn wounds ; however , a suggested approach has been outlined in box 3 . There is considerable evidence to support the use of antimicrobial
Box 2 . Ideal burn dressing features
• Antimicrobial .
• Contours easily and retains contact with wound .
• Simple and painless to apply and remove .
• Maximises healing potential of burn wound .
• Cost-effective .
• Available .
nanocrystalline silver-containing dressings . In many cases , these can be applied and left for up to seven days , reducing the need for frequent and painful burn wound dressings . The higher costs of these dressings may be offset against saved nursing time , reduced infection rates and improved burn wound healing . Recently , there has been increasing interest in the efficacy of topical negative pressure dressings for burns in children , with evidence of salvage of the zone of stasis ( the surrounding zone of decreased tissue perfusion that is potentially salvageable tissue ) coupled with benefits of local wound splinting and reduced wound infection rates . This has occurred , in part , because of a reduction in the size of pumps , making their use outside the hospital environment much easier for children and their families .
WHEN TO REFER
MINOR burns are common in
Figure 6 . Facial sunburn , 48 hours postexposure . Note the marked erythema with evidence of minor areas of blistering and serous exudate . This is extremely painful but is superficial and will heal with no risk of scarring .