May Wound Blog – An overview of Burns
Hello again,
To recap last month we examined the need to establish protocols for wound management with your clinic. This month I'm touching on the subject of burns and appropriate dressings.
Etiology of Burns
Burns can be caused by a large variety of external factors. The most common types of burns are:
- Thermal: Caused by fire, hot objects, steam or hot liquids (scalding).
- Electrical: Caused by contact with electrical sources or, in much more rare circumstances, by lightning strike.
- Radiation: Caused by prolonged exposure to sources of UV radiation such as sunlight (sunburn), tanning booths, or sunlamps or by X-rays, radiation therapy or radioactive fallout.
- Chemical: Caused by contact with highly acidic or basic substances.
- Friction: Caused by friction between the skin and hard surfaces, such as roads, carpets or floors.
- Respiratory: Damage to the airways caused by inhaling smoke, steam, extremely hot air, or toxic fumes.
Classification of Burns
On the initial presentation of a patient with a burn, the injury is classified to determine how much damage there is, or it should be! This can be determined as either 1st, 2nd or 3rd degree. It is also considered more useful to classify them as to their depth. Deep partial or full-thickness burns require emergency treatment and often will require surgical intervention.
| Thickness | Degree | Depth | Characteristics |
| Superficial | First | Epidermis | Pain, Redness, mild swelling |
| Superficial Partial | Second | Dermis: Papillary region | Pain, Blisters, Splotchy skin, Severe Swelling |
| Deep Partial | Second
| Dermis: Reticular region | White, leathery, relatively painless |
| Full | Third | Hypodermis (Subcutaneous tissue) | Charred, insensate, escher formation |
Treatment of Burns
When the treatment plan is to heal the wound by second intention, it's vital the correct dressing is used. You will find increased amounts of fluid on the surface with burns, so it's crucial that this fluid loss is measured as accurately as possible as fluid losses will need to be replaced ideally via IV fluids (also required to treat hypovolemic shock in major and critical wounds). So ultimately you are also continuously assessing the patient's hydration status.
One example to help measure the fluid losses is to place a super absorbent dressing over the wound to protect the area. Being a super absorbent dressing, it will hold and lock away fluid, keeping it from the body's surface. This dressing is then weighed at the end of the day; you can then calculate how much fluid it's holding; you will need to weigh the dressing before placing it on the patient to determine the difference. The super absorbent dressing I recommend is Flivasorb, both available in adhesive and non-adhesive.
Another effective dressing for burn wounds is Actiform Cool. They are ideal for partial-thickness burns, balancing the need for moisture and exudate management. This dressing is an advanced hydrogel sheet, which also has a cooling effect on the area which offers pain relief too.
Unlike other wounds, burns (second-degree deep dermal and full-thickness) healing by secondary intention tend to have a prolonged "Remodelling Phase" and may take years to heal. Blisters and eschars (scabs) are also very common. Blisters can also be due to friction of slipped dressings and bandages. Blister fluid is plasma-rich protein and very good culture media for bacteria and other organisms and should not be left for long!
Nutrition
It is important to remember that the patient’s energy and protein requirements will be extremely high. The intense tissue trauma, heat loss, infection and demands of tissue regeneration will require good quality nutrition and it may even be necessary to feed the patient through a nasogastric tube to ensure an
adequate intake of energy.
Final thoughts
As a reminder, with any wound, whether it's following a burn, bite/puncture wound or a deep laceration, it's essential as part of the assessment to determine what stage of healing the wound is in and the risk of contamination.
Once you have assessed and determined what stage the wound is in, you can decide which dressing is best suited to enhance healing time. There are so many different dressings available as there are so many different situations! So it's important to understand that there is not one dressing that works all the time and for the entire wound healing process.
As it can be overwhelming, with all the different dressing choices I have completed a new wound-healing classification chart, which helps identify the stages of healing within the wound cycle and how it is best to manage each stage with certain dressings.
The images used in this chart have been from various cases I have assisted with over the five years of being with Pioneer.
Wound care charts are available in our resources area, become a platinum partner to unlock more support, resources and rebates!
Terminology
Etiology - The cause, set of causes, or manner of causation of a disease or condition
Hypovolemic shock - occurs when blood volume is decreased through haemorrhage, third space fluid distribution, or dehydration
Second intention - is the healing that occurs when a wound is left open to heal by granulation, contraction, and epithelialization