Guidelines for the management
of partial thickness burns in a
general hospital or community
setting
Lieve De Cuyper, Antwerpen
Henk Hoeksema, Gent
Rudi Deleus, Leuven
André Magnette, Liège
Aims and recommendations
• Better patient outcomes
• Reducing the number of preventable late
referrals to specialists
• Few comprehensive step by step guidance
emphasising wound-healing principles
Indications for improvement
• Diagnosis and referral
• Wound preparation
• Wound covering
• Post wound care
The algorithm
• Examine cause, depth and surface
Initial referrals
• Prepare the wound
• Cover wound with appropriate dressing
Late referrals
• Post-wound care
Very late referrals
Treatment algorythm
Examine cause, depth and surface area
Indication for initial referral?
No
Prepare woundbed and apply bandage
Healed after two weeks?
Yes
Start after care
Scar souple and flat?
Yes
CONGRATULATIONS !!!
Yes
Refer to burncenter
No
Refer to burncenter
No
Refer to burncenter
First aid
WATER !!
Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
capillary refill
• Deep: wet or dry, less pain, grey/white, brownish, no
capillary refill, with decreased sensation
• Rule of nines (for area)
• Palm of hands + fingers victim (1%)
Superficial burn
Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
capillary refill
• Deep: wet or dry, less pain, grey/white, brownish, no
capillary refill, with decreased sensation
• Rule of nines (for area)
• Palm of hands + fingers victim (1%)
Deep burn
Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
capillary refill
• Deep: wet or dry, less pain, grey/white, brownish, no
capillary refill, with decreased sensation
• Rule of nines (for area)
• Palm of hands + fingers victim (1%)
Rule of 9%
Assesment of depth and place
• Superficial, partial thickness: red, wet, painful, with
capillary refill
• Deep: wet or dry, less pain, grey/white, brownish, no
capillary refill, with decreased sensation
• Rule of nines (for area)
• Palm of hands + fingers victim (1%)
Rule of the hand: 1%
Initial referrals
•
•
•
•
•
•
•
•
All full thickness burns
>15% TBSA in adults
>10% TBSA in children and elderly
Burns to face, neck, hands, feet, armpits, popliteal
region, genitals
Electrical and chemical burns
Circumferential burns
Burns associated with inhalation, trauma or disease
Non accidental burns
• Apply bandage with physiologic fluid
Wound preparation
•
•
•
•
Offer pain relief if required
Clean and disinfect wound
Puncture blisters/keep closed if<2%TBSA
Remove loose skin and blisters if>2% TBSA
• Tetanus prophylaxis if >5y. Ago
What is an ideal dressing ?
 Maintains moist wound environment
 Contours easily
 Non-adherent but retains close contact with
the wound
 Easy to apply and remove
 Painless on application and removal
 Cost-effective
 Protects against infection
 Lasts untill healing (one application)
 Waterproof to allow for washing and bathing
Best choice in primary care ?
 Ideal dressing= modern dressing
• BUT:
• Perfect diagnosis is necessary (LDI)
• Correct use of it requires high expertise
• SO:
• It is not the best choice in primary care
 Best dressing in primary care
= traditional ointment
Late referrals
• Not healed in 10 to 14 days
• Late presentation of pain, fever,
exudates, redness, odour, malaise
Very late referrals
•
•
•
•
•
Non healing wounds
Scar problems
Itch
psychological impact
…
Post-wound care
• Moisturise regularly with creams and/or ointments
• Prevent from sunlight for at least 1 year with high
protection sun cream or special clothing
• Take care of itching with cream and/or medication
• Discuss return to work
• Reconsult in case of problems (eg blisters, skin
defects,…)
• Think about psychological support
Conclusions
• Non-specialists play a pivotal role in the treatment of
superficial burns
• Communication is essential between specialists and
non-specialists
• Guidelines should be clear to informe non-specialists
and improve outcome
• Guidelines must be revised regularly
• National burn organisations should put forward the
recommendations to their members and develop
strategies to communicate with relevant healthcare
workers (www.burns.be)