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Burns Treatment

Procedures Procedure

Authors: Rami Mossad Ibrahim, MD, Elisabeth Lauritzen, MD, Frederik Gulmark, Hansen Med. Stud., Anne Mosebo, Med. Stud., Magnus Balslev Avnstorp, MD and Rikke Holmgaard, MD, PhD

This treatment is applied as soon as the wound is cooled and washed. Dressings increase wound healing, decrease pain and facilitate mobilization for the patient.

First place a non-adherent dressing on the wound. Secondly cover with a thick layer of fixating gauze.

Face

Do not use bandages on burns in the face. Otherwise treat these burns as any other.

Instructions to the patient:

  • Move the muscles of the face as much as possible
  • Apply fatty perfume-free creme on dry skin
  • When in sunlight use suntan lotion (SPF ≥ 25) for 6-12 months after injury

Arm

Use the standard dressing for a burn on the arm:

  • Mepilex Transfer or 2 layers of Jelonet
  • A large amount of absorbent gauze
  • Fixating bandage

Hands

Minor burns

Use the standard dressing for a minor burn on the hand:

  • Mepilex Transfer or 2 layers of Jelonet
  • A large amount of absorbent gauze
  • Fixating bandage

Generally, the bandage has to allow movement of the fingers/joints to avoid stiffness and to maintain function. Though this is not crucial in minor burns since they usually heal within 14 days.  

Large burns, deep injuries or extensive involvement of the joints

A suitable dressing is identical as for small burns on the hand.

Change dressings 3-4 days after injury.

  • Change to a Mepilex transfer Ag dressing and a thinner layer of gauze as the wound produce less fluid than in the first 2-3 days post-injury
  • Another option is to change the outer thick layer of gauze while leaving the inner non-adherent layer

Remove the dressing again 10-12 days after the injury

  • Assess the need for debridement of the wound

Children

Since small fingers/joints are difficult to bandage individually, a ”boxing glove” dressing is a useful alternative.

Instructions to the patient

Mobilize the fingers/joints as much as possible i.e. clasp and elevate the hand.

Check for clinical symptoms such as:

  • Change in color
  • Decreased mobility or sensibility
  • Pain that worsens with movement

These symptoms suggest a risk of compromised perfusion and should result in a clinical examination including:

  • Assessment of skin color and temperature
  • Measurement of the saturation in fingers
  • Palpating pulse

Thorax

Use the standard dressing for a burn on the thorax:

  • Mepilex Transfer or 2 layers of Jelonet
  • A large amount of absorbent gauze
  • Fixating bandage

Leg

Use the standard dressing for a burn on the leg:

  • Mepilex Transfer or 2 layers of Jelonet
  • A large amount of absorbent gauze
  • Fixating bandage

Foot

Often requires admission because of decreased mobility. 

A suitable dressing for a burn on the foot could be:

  • Mepilex Transfer or 2 layers of jelonet
  • Gauze
  • Elastic bandage (or a product containing silver + elastic bandage)

The foot must be elevated during healing to facilitate decreased swelling.

Pain relief treatment

  • Regular over-the-counter medication eg. paracetamol 1 g x 4 daily +  ibuprofen 400 mg x 3 daily
  • Administration for children according to weight
  • Alternatively morphine can be ordinated

Flamazine/Silverderma and Jelonet

  • Flamazine and Silverderma contains silver
  • Is used for infected burns

Procedure

  • Wash the wound with water and soap
  • Apply Flamazine, Jelonet and a dry fixating bandage
  • Daily change is needed

Procedure and cases

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Cleaning the burn

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Surgical debridement

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Changing the bandage

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Skin grafting


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