injuries poisoning
How To Debride and Dress a Burn
Step by Step Description of Debriding and Dressing a Burn
Stabilize patient as per trauma protocol. Irrigate chemical burns involving the Etiology or During the first 30 minutes after injury, use room temperature (20 to 25° C) or cold tap-water irrigation, immersion, or compresses to limit the extent of the burn and provide significant pain relief. Add ice chips to water or saline to lower the temperature as needed. However, avoid immersing burned tissue in ice or ice water because ice immersion increases pain and burn depth and increases the risk of Frostbite and, if the burn surface is large, systemic Treat pain before doing anything to the burn wound. The best analgesics for severe pain are usually IV opioids in titrated doses, such asfentanyl1 mcg/kg, ormorphine0.1 mg/kg. For minor burns, nonsteroidal anti-inflammatory drugs (NSAIDs) andacetaminophenalso may be effective. Remove all clothing and gross debris from the burned area. Remove any jewelry from the burn and distally, such as rings or piercings. Cover the burn with a moist, sterile dressing soaked in room temperature water or saline. The dressing should be kept cool and moist to provide continued pain relief. Give Indications (eg, Td, Tdap) depending on patient's vaccination history (see table Transfer stable patients with major burns to a burn center. For other patients, complete burn wound care. Cleanse the burned area gently with a clean cloth or gauze and soap and water or a mild antibacterial wound cleanser such aschlorhexidine. Irrigate the wound with saline or water. Some physicians recommend leaving unruptured blisters intact, and others recommend opening them with scissors and forceps. Regardless, loose skin and broken blisters are devitalized tissue that should be debrided by peeling from the wound and snipping with scissors close to the border with viable, attached epidermis. Apply a sterile burn dressing, with or without a topical agent. There are several options for burn dressings. Some are impregnated with antimicrobials (eg, silver). Most are a form of gauze, but there are biosynthetic dressings with some of the characteristics of skin that adhere to the wound and can be left in place for extended periods of time. Some are typically used over a layer of antimicrobial cream or ointment, whereas those containing an antimicrobial are not. In all cases, dressings should be sterile and have an absorptive layer sufficient for the amount of exudate expected. , once a mainstay of topical burn treatment, is no longer recommended because it is no better than other topical antibiotic preparations and may impair wound healing. However, it is sometimes still used for partial thickness burns ( Reference ). Cover the wound surface. There are many commercial dressings available but a fine-mesh gauze or commercial nonadherent gauze is appropriate. Cover and pad the wound with loose gauze fluffs. If fingers and toes are involved, pad the web spaces and the digits individually and separate them with strips of gauze. Wrap the entire dressing with an absorbent, slightly elastic material. 