Urgent Care Management of Patients With Thermal Burns -
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Publication Date: July 2022 (Volume 1, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 07/01/2025.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional requirements.

Editor-in-Chief & Update Author

Keith A. Pochick, MD, FACEP

Attending Physician, Urgent Care, Charlotte, NC

Urgent Care Peer Reviewer

Steven S. Wright, MD, FACEP, MS

Optum Physician Partner, Prohealth Medical Management, LLC; Assistant Professor, Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY

Original Author

Juliana Tolles, MD, MHS

Assistant Professor of Emergency Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; Harbor UCLA Medical Center, Torrance, CA

Original Peer Reviewers

Boyd D. Burns, DO, FACEP

Professor and George Kaiser Family Foundation Chair in Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK

Christopher Palmer, MD

Assistant Professor, Department of Anesthesia, Division of Critical Care & Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO

Case Presentations

CASE 1

A 35-year-old woman who works as a chef presents to UC after burning her right hand on a cooking surface…

Her vital signs are normal and her hand is blistered over half of the palmar surface.
You have the patient immerse the burn in cool running water and order pain medication and a tetanus booster.
As you leave her room, you try to recall whether she should be referred to a burn center and whether there are any evidence-based guidelines to help you select a dressing…

CASE 2

A 20-year-old man presents with a complaint of severe sunburn...

He states that he returned from spring break in Florida the previous day and complains of painful sunburn to his upper torso, shoulders, and arms. He had been on the beach for 3 straight days prior to traveling back to college and admits that he forgot to apply sunblock on his second day of fun in the sun.
His vital signs are normal, but he appears uncomfortable, with intense erythema across the upper back and chest, shoulders, and arms. There is blistering in some discrete areas of the shoulders and upper back.
The patient phoned his mother for advice prior to the visit, and she recommended that he go to UC for a “shot of steroids and a prednisone prescription.” You wonder if the suggested management is appropriate…

CASE 3

A 3-year-old boy is brought in by his mother for scald burns to his feet…

The mother says that yesterday the child picked up a bowl of hot soup and accidentally spilled its contents.
The boy appears fussy and has symmetric, well-demarcated, full-thickness burns to both feet from the ankles down.
His vital signs are: temperature, 37°C (98.6°F); heart rate, 120 beats/min; respiratory rate, 22 breaths/min; and oxygen saturation, 98% on room air.
You are concerned about the delay in seeking care and wonder whether this might be more than an accidental burn…

Introduction

The American Burn Association (ABA) reports that nearly half a million people suffer thermal burns each year in the United States.¹ According to World Health Organization estimates, as many as 265,000 people worldwide die annually from thermal burns.² The economic burden of thermal burn injury is also substantial: In the United States in 2000, the annual direct-care cost of treating pediatric burns alone was $211 million.² This does not take into account the economic impact of rehabilitation and long-term disability. Although efforts to prevent thermal burns through regulation and public health initiatives have reduced the incidence in developed countries, burn injuries still account for approximately 0.5% of annual emergency department (ED) visits in the United States.³ This issue of Evidence-Based Urgent Care reviews the guidelines on assessment of burns, the latest evidence on burn wound care, pain control, and the criteria for referral to specialized care.

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.