Burns

Burn Management Tips

Caring for a wound is based on the severity of the wound.

Our skin is the first line of defense against microorganisms that can invade the body and cause infection. Once the skin is damaged, microorganisms can enter the body. The goal of treating wounds is to prevent shock, relieve pain and reduce the risk of infection.

First-degree Burns

First-degree burns (also called superficial burns) do not cause a break in the skin. They present with redness, swelling, tenderness, itching, and dryness. These burns affect the outer skin layer (epidermis) only. There is no blister formation.

The causes include:

• Sunburn or radiation
• Scalding/thermal – usually caused by hot liquids or steam, common in children under the age of 4
• Electricity – common in children by sticking items into an electrical socket, biting on cords or playing with an appliance that is plugged in
• Chemical - contact with acidic substances (cleaners, detergents)

Treatment

• The burned area should be placed under cool running water for about 10 minutes. Never use cold water or ice.
• Cover the burn with a sterile, non-stick dressing. Gentell Bordered NonAdherent Gauze Dressing or ReliaMed Sterile Bordered Gauze are good choices. Do not apply topicals that contain oil, gel, ointment, or grease. These products can trap heat at the injury site and cause further damage.
• You can take over-the-counter analgesics for discomfort (Tylenol or Ibuprofen). These burns may take 1-2 weeks to heal.

Second-degree Burns

Also known as superficial partial-thickness burns affect the epidermis and extend into the dermis layer of the skin. The skin becomes very red, wet and shiny, and painful with blister formation.

The blister is filled with plasma and proteins for healing. This increases the risk of infection. It is important to keep the injury clean and bandaged to prevent infection. Healing takes about 2-3 weeks, longer for larger areas of blistering.

Treatment

If the burn injury is less than 3 inches in diameter and the blister is intact,

• The area should be placed under cool running water for about 10 minutes. Never use cold water or ice. This can damage the skin further
• Remove jewelry and do not remove clothing from the area.
• Do not break the blister
• If the blister has broken, do not run under cool water and do not remove clothing that has stuck to the burn for it can cause more damage.
• Dressings- Use non-adherent foam dressing such as Meline Sterile Bordered Gauze Adhesive Island Wound Dressing, Allevyn Life Foam Dressing, or Derma Sciences Medihoney Hydrogel Adhesive Dressing.

If the burns cover more than 15% of the body make sure the victim is not in contact with a burning or smoldering material.

• Call EMS
• Do not remove clothing
• If possible, elevate the burn area above the level of the heart to reduce swelling
• Cover the area with sterile non-adherent dressings, a clean cloth, or a clean sheet depending on the size of the injury.
• Wait for EMS

Third-degree Burns

Also called deep partial-thickness burns to extend through the epidermis and dermis. The depth reaches the reticular region (lowest level of the dermis) which contains hair follicles, sebaceous and sweat glands, cutaneous sensory receptors (nerve), and blood vessels.

These burns cause significant scaring but cause little pain. These burns will appear waxy and white in color. They will look wet but not blister. Skin will look char, dark brown, and leathery. These burns require medical management. Never try to treat these at home.

Treatment

• Call 911 immediately
• While waiting for help to arrive, raise the burn site above the heart
• Do not undress but be sure no clothing is stuck to the burn
• Significant scarring and contracture will occur if not surgically treated

Complications The risk for complications in this type of burn is much higher and includes:

• Infection
• Blood loss
• Shock
• Hypothermia - The body temperature is below 95 degrees. The body has difficulty maintaining temperature with the loss of tissue and blood
• Hypovolemia - Low blood volume. Loss of 15% of blood or fluid volume. This causes impaired heart function. Shock occurs o Leads to organ failure

Dressing choices

The dressing should be chosen to protect and maintain the appropriate environment to reduce the risk of infection.

• Molnlycke Mepilex Transfer Ag Antimicrobial Soft Silicone Dressing is a good choice

The dressing should create an optimal moisture level.

• Medline Optifoam Gentle Antimicrobial Silicone Face Non-Border Dressing is a good choice.
• If the wound is too wet, there is a risk for bacterial growth and biofilm development. It can also macerate or break down the surrounding skin.
• If too dry, the healing is impeded or slows

Manage peri-wound skin

• Edema
• Wound edges
• Level of pain
• Use skin barrier on surrounding skin –Coloplast Baza Clear Moisture Barrier Ointment

Compression

Reduces scar formation and swelling

• 3M Coban Self-Adherent Wrap Sterile is a good choice

Reduces tension on wound edges, promoting healing

Pain Management

Use a non-adhesive dressing to protect new granulation tissue

• Molnlycke Mepitel One Wound Contact Layer with Safetac is a good choice

Reduces pain with removal

Fourth-degree burns

Also called full-thickness burns extend beyond both the epidermis and dermis layers into the subcutaneous tissue which includes fat, muscle, and bones. Nerve endings are destroyed, these burns are usually painless but along the edges of the burn, the site is burned at various degrees. The surrounding burns are what causes pain.

Best Burn Dressing - Plurogel Wound Gel

Again, these wounds need medical burn management and surgical intervention. Calling 911 is appropriate. Treatment of these wounds will be similar to that of third-degree wounds.

Heal time of third- and fourth-degree burns cannot be estimated. Healing is dependent on severity, depth of the burn, and the amount of surface area affected.

 

Author Profile: Christine Kijek, Registered Colorectal Nurse

Related Articles