Burn injury management refers to the course of treatment medical professionals take when treating a burn injury. Because burn injuries can vary widely in terms of severity and type, burn management plans change from patient to patient. This section will give a general overview of the steps medical professionals may take when treating a burn injury.
Stop the Burning
Although this is often completed before a patient arrives for medical care, the first step in burn injury management is to stop the burning process. For thermal burns, this involves flushing the burn with water for 10 minutes or more and covering the burn area in a way that it is not touched.
Chemical burns are also irrigated with water, generally for 20 minutes or more. If the chemical burn comes from a powder, doctors suggest brushing the powder off the patient before cleaning with water.
The ABCDEs of Assessment
Once the burning process is over, medical professionals will begin what is known as the ABCDEs burn injury assessment and treatment.
The first step is to check the patient’s Airway or upper respiratory tract. This is the part of the respiratory system above the trachea or windpipe. Some parts of the airway are more susceptible to burn injuries than other parts of the body. If the area has received burn injuries, medical professionals may elect to stabilize the airway before they stop the burning, if possible.
The next step is to assess the patient’s Breathing. This involves assessing the parts of the respiratory system below and including the trachea. Doctors will determine if any injury to the chest or lungs will affect the patient’s breathing.
Next, medical professionals will assess the patient’s Circulation. They will take blood samples to check for problems, and will ensure that the burns are not affecting how the blood circulates throughout the body.
After taking steps to protect the patient’s breathing and blood flow, medical professionals will next check for neurological Disabilities that may inform them that the patient has suffered from oxygen deprivation or significant blood loss.
Finally, medical professionals will look at the patient’s Exposure, also known as the percentage area of the burn. To do so, they may use the Rule of 9s, which assigns each part of the body a percentage of the total body surface area.
The percentage of the body burned, along with the depth of those burns, will determine future treatment.
At the end of assessment, it is common for medical professionals to begin fluid replacement. In many cases, a patient’s urine will be monitored. At this stage, painkillers will also be administered.
After assessment, the patient may be released, may be kept in the hospital, or may be transferred to a burn center. This depends on the severity of the burn. If the burns are severe enough, then the next step is to clean and dress the burn.
Cleaning the burn involves washing it with water and removing any loose skin. Dressing is generally done with gauze, unless the patient will go to a burn center. If this is the case, it will be dressed in cling film.
The American Burn Association established guidelines to determine if a patient should be transferred to a burn unit. Patients should be transferred if:
- They have partial thickness (second degree) burns on more than 10% of their body.
- They have any full thickness (third degree) burns.
- They have burns to the face, hands, feet, genitalia, or major joints.
- They have electrical, chemical, or inhalation burns.
- They have a pre-existing condition that may compromise recovery.
- They have an additional trauma that may affect recovery.
- They will require extensive rehabilitation support.
- They are children, and the treating professionals are not qualified or do not have the proper equipment.
Recovery greatly depends on the patient and the type of burn suffered.
Epidermal Burn Recovery
These are the most superficial burns. If they cover much of the body, painkillers and IV may be required, but they generally heal on their own within around one week.
Superficial Second Degree Burn Recovery
These burns only reach the upper dermis. They are often extremely painful because they can affect exposed nerves. They may heal in around two weeks. Treatment intends to prevent infection through dressings and antimicrobial creams. If they have not healed with two weeks, the depth has probably been misdiagnosed and that patient should be referred to a burn center.
Deep Second Degree Burn Recovery
These burns can be the most difficult to assess and treat because their depth is not quickly apparent. If the burned area is in a functional or cosmetic area, or if the burn is large, excising—removing the dead skin from—the wound and replacing with a skin graft is recommended. In other cases, if the wound environment is warm, moist, and free of infection, they can heal on their own. In these cases, modern dressings are used to encourage healing.
Third Degree Burn Recovery
Third degree burns destroy the skins’ regenerative elements. All injuries that are greater than 1 centimeter in diameter should be excised with skin grafted upon them. This process can be very lengthy, depending on the circumstances of the injury.