Minor Burns

  Ask patient how burn occurred. How a burn occurred...

 This often indicates what treatment is most appropriate for that area.

Assessment

  1. For example, a chemical burn will be treated much differently from a burn caused by a thermal heat source.
  2. Determine what areas of skin were involved.
  3. Determine the BSA affected. Methods used to assess percentage of BSA involved with burn management   include the rule of nines and the Lund and Browder burn chart. When small or irregular burns are being         estimated, the patient's palmar surface is equal to about 1.25% BSA. BSA burned, depth of burn, and type of burn to determine what treatments are most appropriate.
  4. Assess for pain and medicate as prescribed. Burns, even minor, are very painful.
  5. Assess carefully to determine whether, for any reason, admission of the patient is warranted. Ascertain that the patient or family has the financial, mental, and physical capabilities to follow aftercare instructions. If not,other arrangements or admission is required.
  6. Perform hand hygiene and apply gloves.
  7. Remove jewelry from the affected extremity/area.
  8. Discard gloves.
  9. Perform hand hygiene and apply sterile gown, mask, and gloves.
  10. Apply a moist sterile dressing to the wound as soon as possible to stop the burning process. Omit this step if transferring patient to a burn unit.
  11. Consider using cool saline over the area initially to stop the burning process.
  12. If chemicals are involved, consult the Poison Control Center (1-800-222-1222) before initiating wound       debridement. Most chemicals require a minimum of 20 minutes of irrigation; additional therapy may be necessary.
  13. Administer tetanus prophylaxis as indicated.

Wound Debridement
  1. Arrange and organize on a sterile towel all supplies, instruments, and solutions before initiating wound care.
  2. Don a sterile gown, mask, and gloves.
  3. Using sterile saline and a cleansing solution, begin to wash the injured area gently. It may be less painful to begin in the center of the burn and work toward the margin. Use sterile gauze dressings or a soft, sterilesurgical brush. Maintain a circular motion and attempt to create a moderate amount of suds or foam.
  4. Rinse with sterile saline and repeat as often as necessary until the wound is thoroughly cleaned.
  5. If a blister is ruptured, debride the tissue. Initial management of intact blisters remains controversial, and     research is inconclusive. Intact blisters are associated with less pain than debrided blisters. Most recommend that blisters on the palms or soles be left intact. Consult with the attending physician regarding the  management of blisters.

 Blisters may be managed in several ways:
  • The blister may be left intact, allowing underlying wounds to heal spontaneously.
  • The blister fluid may be aspirated with a needle and syringe, leaving the overlying tissue (roof) in place.
  • Large blisters may be debrided, whereas small ones remain intact.
  • Do not shave the affected area.
  • Using fine-tipped scissors and forceps, elevate loose, devitalized tissue and remove it.
  • If the burn involves tar, cool the tar with cold water to limit tissue damage.4 Remove tar with mineral oil,        petroleum ointments, 2% to 3% lanolin, or a nonpolar solvent such as Medi-sol™. Additional agents include  sunflower oil, butter, and baby oil. Multiple applications and time frames of 30 minutes to 2 hours may be      expected.
 Continue the steps in this procedure until the area is clean, moist, and pink.

Wound Dressing

  • Open method: In cases such as the face, the topical agent may be applied in an open fashion, and no dressing is placed over the top.
  • Closed method: The closed method is one in which a dressing and bandage are placed over the topical agent. Dressings may include fine mesh followed by layers of 4 × 4 gauze.

Silver Sulfadiazine

  • Using a sterile-gloved hand or a sterile tongue blade, apply a thin (1/16-inch) smooth layer of cream over the area.
  • Fine-mesh gauze may also be impregnated with the silver sulfadiazine, which is then cut to the       appropriate size and placed over the wound. This may be less painful to the patient than rubbing the cream  directly on the wound.
  • If using the closed method, cover with a sterile gauze dressing and bandage. When bandaging the hand, wrap each digit individually or place a layer of dressing between adjacent skin surfaces. Anchor as necessary.

Silver Dressings

  1. Cut the dressing to the shape and size of the burn.
  2. Moisten the dressing with sterile water; do not use saline.
  3. Allow the dressing to drain on a sterile absorbent surface for at least 2 minutes.
  4. Apply the dressing to the wound surface, either side down. A transient stinging sensation is expected when the dressing is applied.
  5. Cover the dressing with a moist absorbent dressing created by saturating gauze with sterile water and wringing out the excess. Alternately, commercial gel pads are available to maintain a moist environment.
  6. Cover with a sterile gauze dressing and bandage, and anchor as necessary.
  7. Silver dressings can remain in place for 3 to 7 days. Consult the manufacturer's recommendations for the specific dressing.
  8. The dressing should be inspected periodically to ensure that it remains moist.
  9. Follow manufacturer's instructions; some silver dressings may not be used during Magnetic Resonance        Imaging (MRI) or while patient undergoes radiation therapy treatment.

Antibiotic Ointment

   1. Apply a thin layer of ointment to the wound and place a piece of nonadhering dressing over the area.
   2. Cover with a sterile gauze dressing and bandage, and anchor as necessary.
   3. Transparent Wound Dressing or Bismuth Tribromophenate Gauze
   4. Using sterile technique, apply the appropriate size of dressing directly to the burn.
   5. Leave a small, ½-inch margin that can adhere to the nonburned skin.
   6. Apply a gauze pressure dressing and bandage.
   7. Biobrane®
   8. Apply Biobrane® directly over the clean wound.
   9. Use surgical tape closures or a gauze bandage to hold the Biobrane® in place.

Post Procedure

    * Discard supplies; remove gown, mask, and gloves; and perform hand hygiene.
    * Document the procedure in the patient's record.




        
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