Table of Contents
About This Course
Although some burn injuries will require transport to the ED or a burn center, many thermal burns can be treated in urgent care. Priorities for management of thermal burns in the urgent care setting include ruling out severe burn injury and/or inhalation injury, and providing fluid resuscitation (if needed), wound care, and pain control. In some cases, referral to specialized burn care may be needed to improve long-term outcomes. This article reviews thermal burn classification and evidence-based treatment strategies. In this issue, you will learn:
How to classify burns and quickly estimate the total body surface area affected.
The most effective dressings and topical therapies for burns.
When unroofing and/or debridement of burn blisters is indicated.
Evidence-based recommendations for pain control, including for sunburn.
The quality of evidence for nontraditional wound care strategies such as aloe vera or honey.
The physical examination findings that raise concern for nonaccidental burn injuries in pediatric patients.
The indications for transfer or referral to a burn center.
- About This Course
- Case Presentations
- Introduction
- Etiology and Pathophysiology
- Differential Diagnosis
- Urgent Care Evaluation
- History
- Physical Examination
- Diagnostic Studies
- Laboratory Testing
- Imaging
- Chest X-Ray
- Treatment
- Cooling
- Intravenous Fluid Resuscitation
- Wound Care
- Unroofing, Debridement, and Surgical Excision
- Escharotomy
- Antibiotics
- Pain Control
- Tetanus Prophylaxis
- Managing Sunburns
- Controversies and Cutting Edge
- Wound Care Controversies
- Disposition
- KidBits: Nonaccidental Burn Injuries in Pediatric Patients
- Risk Management Pitfalls for Management of Burn Patients in Urgent Care
- Summary
- Time- and Cost-Effective Strategies
- Critical Appraisal of the Literature
- Case Conclusions
- Clinical Pathway for Management of Burns in Urgent Care
- References
Case Presentations
- 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…
- 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…
- 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…
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Introduction
According to data from the American Burn Association, nearly half a million people suffer thermal burns each year in the United States. Burns are among the most common traumatic injuries presenting to urgent care clinics, and proper initial management of these injuries can reduce the risk of infection and preventable scarring. Urgent care clinicians must be equipped to accurately assess burn depth and extent, initiate appropriate wound care, manage pain effectively, and recognize when immediate transfer to a burn center is necessary. This review discusses the guidelines on assessment of thermal burns, the latest evidence on wound care and pain control for burn injuries, and the criteria for referral to specialized burn care.
Clinical Pathway for Management of Burns in Urgent Care
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Key References
Following are the most informative references cited in this paper, as determined by the authors.
2. * Rae L, Fidler P, Gibran N. The physiologic basis of burn shock and the need for aggressive fluid resuscitation. Crit Care Clin. 2016;32(4):491-505. (Review) DOI: 10.1016/j.ccc.2016.06.001
10. * Aziz Z, Abu SF, Chong NJ. A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds. Burns. 2012;38(3):307-318. (Systematic review; 14 randomized controlled trials, 877 participants) DOI: 10.1016/j.burns.2011.09.020
31. * Magnette J, Kienzler JL, Alekxandrova I, et al. The efficacy and safety of low-dose diclofenac sodium 0.1% gel for the symptomatic relief of pain and erythema associated with superficial natural sunburn. Eur J Dermatol. 2004;14(4):238-246. (Randomized double-blind single-center trial; 172 patients) PMID: 15319157
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Keywords: burn, thermal burn, superficial, first-degree burn, partial-thickness burn, second-degree burn, deep partial-thickness burn, full-thickness burn, third-degree burn, cooling, total body surface area, TBSA, silver sulfadiazine, escharotomy, scald, nonaccidental trauma, intentional injury, sunburn, topical NSAIDs, aloe vera, honey, referral criteria, burn center
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