First aid and treatment of minor burns
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7454.1487 (Published 17 June 2004) Cite this as: BMJ 2004;328:1487
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Dear editor,
the use of dressings in burned patients is a complex matter. The
article cited is not precise and, most of all, without clear general
guidelines that can help the medical audience in the decision process. In
the outpatient setting of our hospital we usually classify burns according
to the thickness (superficial vs. deep partial thickness) and the presence
/ absence of exudates. We use Jelonet paraffine gauzes in superficial
partial thickness without excessive exudates, Aquacel Ag (Sodium
carboxymethylcellulose with 1.2% silver – Convatec) for those with
exudates. In deep partial thickness burns we use Acticoat (Nanocrystalline
silver – Smith and Nephew) in burns without excessive exudates and Aquacel
Ag in those with exudates (both Acticoat and Aquacel Ag have silver for
the prevention of infections). With this protocol we usually heal
superficial partial thickness burns in 5.9 days (± 5.2) and deep partial
thickness in 19.3 days (±17.4). Furthermore, we recorded a 34.4.% decrease
in the healing time of deep partial thickness burns compared to the year
2004-2005 when we treated all these burns with Sofargen cream (1% silver
sulfadiazine).
E-mail for correspondence: ggravante@hotmail.com
Competing interests:
Burn Surgery
Competing interests: No competing interests
Toxic shock syndrome is a rare but recognised complication of
burns.It tends to occur in children as they have not acquired immunity
against the toxins causing this condition. It can occur in small
percentage burns eg 5% ref1.
The incidence of toxic shock syndrome is static despite declining rates of
menstrual toxic shock. With this in mind some advocate the use of
flucoxacillin as prophylaxis against toxic shock syndrome.
1. WC. Egan,WR.Clark;the toxic shock syndrome in a burn victim.Burns
Incl Therm Inj.1988 Apr;14(2):135-8
Competing interests:
None declared
Competing interests: No competing interests
The burn’s dressings represents one of the most controversial topic
in the field of the cutaneous wounds.
The Authors (Hudspith J, Rayatt S. 2004) suggest the use of a simple
paraffined gauze; it must be emphasized that this type of dressing is
easily bridled with the burn’s exudate when it dries up, tending to cause
pain and difficulty in the movement. An Author (Cole E. 2003) suggests to
use up to four overlapped layers of paraffined gauze to obviate to this
drawback.
Regarding the use of Silver Sulfadiazine, it is uneniable that this
ointment is widely used in the burn’s field. In the few RCTs on the use of
Silver Sulfadiazine in the burns treatment, it has always shown worse
results compared to the biosynthetic dressings (Gerdin RL 1990), as well
as to the hydrocolloid (Wyatt D, 1990). Despite all the use of Silver
Sulfadiazine is still proposed. Some Authors (J.Y. Chung et al. 2001) have
dedicated to this type of treatment an article with an explicit title!
Bibliografia
·American Burn Association. Practice Guidelines for Burn Care. 2001
·Barret J.P, MD et al. Biobrane versus Silver Sulfadiazine in Second-
Degree Pediaric Burns. Plastic and Reconstructive Surgery 2000; 105:62-65
·Chung J.Y, Mel E. Hebert. Myth: sulfadiazine is best treatment of
minor burns. Western Journal of Medicine 2001;175:205-206
·Cole E. Wound management in the A&E department. Nursing
Standard. 2003; 17(46):45-52
·Gerdin RL, Emerman CL, Effron D, Lukens T, Imbembo A.L, Fratianne
RB. Outpatients management of partial-thickness burns: Biobrane vs 1%
silver sulfadiazina. Annal of Emergency Medicine 1990; 19:121-124
·Hudspith J, Rayatt S. First aid and treatment of minor burns. BMJ
2004; 328: 1487-89
·Wyatt D, McGowan DN, Najarian MP. Comparision of hydrocolloid
dressing and Silver sulfadiazine cream in the outpatient management of
second – degree burns. Journal of Trauma 1990; 30: 857-865.
Competing interests:
None declared
Competing interests: No competing interests
How can you publish an article that provides no evidence for current
practice? I stopped using jelonet when I saw a video demonstrating what
damage it did when removed, it took the healthy skin with it! What
happened to the warm moist environment for wound healing? Where is the
evidence for using chlorahexidine?
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir
Just a few comments on the article by Hudspith and Rayatt on the
treatment of minor burns(1).
Firstly, there is now no need for anyone's burn dressing to become
painfully adherent. Mepitel (silicone impregnated gauze) is expensive, but
this should not be a reason for confining its use to children.
Secondly, not all facial burns need to be referred to a burns unit,
and this is just as well for those of us whose nearest such unit is 40
miles down the congested M6. Most superficial facial burns heal well with
watchful neglect, and personally I would not promote twice daily cleansing
with chlorohexideine solution for fear of this getting into eyes.
Finally, the authors make no mention of tetanus prophylaxis. This
should be considered wherever there is tissue damage, and particularly in
the elderly.
Alan M Leaman
Consultant in emergency medicine
(1)Hudspith J, Rayatt S. First aid and treatment of minor burns. BMJ
2004; 328: 1487-89
Competing interests:
None declared
Competing interests: No competing interests
Dr. William Johnson's comments notwithstanding, I found the
presentation on burns management very useful.It gives sufficient
'technical' information and caters to the dummies and daydreamers among us
(it stresses the point that in electrical burns the patient ought to be
disconnected from the source of electricity before commencing treatment).
Actually, I bet that a lot of people would agree with me (on THIS item)
and some of us would have learned some things.
BMJ needs to bring more of these 'hands-on' articles to us and I wouldn't
worry about the generics or non-generics of things.
I think perhaps Dr. Johnson was having a stressful day.
Competing interests:
None declared
Competing interests: No competing interests
It's nice to see that the use of generic descriptors has reached plastic surgery.
Apologies for the sarcasm, but this should have been caught in the editing process, and it is embarrassing to have a journal like the BMJ using non-generic woundcare product names.
In addition, the lack of evidence base for much of this area of medicine should be acknowledged.
This is a half-baked article, and I expect better from the BMJ.
Competing interests:
None declared
Competing interests: No competing interests
Re: Treatment of minor burns
Dear Sir
We manage most of minor burns in our general surgey unit,most
patients are treated as out-patients or in the day case surgery ward.We
adopt the following protocol:
Treatment of Minor Burns
Classification of Burns
1.First Degree-Superficial burns that only involve the epidermis with
swelling, redness, and pain. Doesn't blister and heals quickly without
scarring.
2.Second Degree -the entire epidermis is involved and usually blisters.
Very painful and healing will take 7-14 days.
3.Third Degree- these are full thickness burns with the entire epidermis
and dermis involved. The nerves endings are destroyed and usually there is
no pain. Because of the inability to epithelialize, grafting is necessary.
First Aid for Burns
1.Cooling as soon as possible. This can limit the inflammation and thermal
damage. Best to use cool water or ice pack wrap. Ice application has been
associated with frostbite and should be avoided.
2.Pain Control- Opiates such as codeine.
3.Check immunization status and update tetanus if necessary.
4.Debridement of Bulla- there are some differences of opinion regarding
breaking of blisters.
a.Some suggest leaving intact because the blister acts as a barrier to
infection and others debride all blisters.
b.Most agree that after blister ruptures necrotic skin skin should be
removed.
5.Application of Antibiotics
6.Cleaning the Wound- use of plain water or soap and water. May use water
on cotton swab to remove crusted material.
7.Dressing- should use a non-adherent dressing
Vaseline gauze
May want to inspect the wound frequently but not necessarily take off the
entire dressing. Can inspect for warmth, redness, and drainage without
removing all the layers.
Most minor burns that occur can usually be treated as outpatients.
Guidelines are that if it covers less than 10% of the body surface area,
inpatient treatment not necessary
Competing interests:
None declared
Competing interests: No competing interests