1. Outpatient Burns: Prevention and Care Jade Hennings R1 American Family Physician 01.0.1.12

2. Objectives Differentiating between classification of burns Current evaluation and management of minor burns in the outpatient setting Indications for referral to specialty care or for transfer to a burn unit.

3. Types of Burns Thermal Electric Radiation (sun) Cold (frost bite) Inhalation Chemical

4. Minor Burn Isolated injury (ie, no suspicion of inhalation or high- voltage injury) May not involve face, hands (fingers), perineum, or feet May not cross major joints May not be circumferential

6. Classification of Burns By Depth of Injury

7. Superficial Burn

8. Superficial Partial Thickness Deep Partial Thickness Full Thickness

9. Percentage of Total Body Surface Area Burnt

10. Management of Burns: Initial & Long Term GOALS OF BURN CARE Rapid Healing Pain Control Return of full function Good Aesthetic Results

11. Initial Management 1) Primary survey 2) Secondary Survey Size (TBSA), depth and circumference of burn evaluated Abuse? *Airway: Burns to the face and neck, regardless of size, should be promptly assessed as risk of asphyxiation is possible.

12. 3) Pain Control: Running cool water vs Ice water Cool water is an acceptable home txt for minor burns but ice water immersion is not because it can lead to further injury and hypothermia. Recommended judicious use of narcotic analgesics 4) Wound Cleaning Clean with Sterile water Do NOT clean with iodine/chlorhexidine

13. 5) Wound Dressing ClassificationManagement SuperficialAloe vera, lotion, honey, Abx ointment. Topical steroids NOT recommended Partial ThicknessHeal best in Moist, not wet environments best created by applying topical Abx ointment or absorptive occlusive dressing. Full ThicknessSurgically treated Fourth DegreeSurgically treated- debride with skin grafts ** Prophylactic oral antibiotics did not improve mortality and therefore generally not recommended

14. Management of Blisters Controversial??? However, extensive evidence recommend that small blisters <6mm should be left alone. Large blisters with thin walls should be debrided from a pressure and infection standpoint so that dressings can be applied directly to the wound bed. Blisters that prevent proper movement of a joint or that are likely to rupture should be debrided

15. Long Term Management Cellulitis: Staph aureus, Strep pyogenes, Pseudomonas, Acinetobacter, Klebsiella Pruritus: txt with Zyrtec Neuropathic pain: Recent retrospective study found that Lyrica reduced neuropathic pain in 69% of patients

16. When to Refer…

17. Stages of Healing 1 Week 1 Month 10 Months

18. Blistering burns that blanch with pressure characterize… They are also typically moist and weep.

19. Easily unroofed blisters that do not blanch with pressure and have a waxy appearance typify…

20. Burn areas that are waxy white or leathery gray and insensate characterize...

21. Extends through the skin to the underlying tissue such as fascia, muscle, and/or bone…

22. Red burns that blanch are typical of…

23. Be Vigilant… Child abuse burns have characteristic markings.

24. Questions???