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Guidelines for the management of partial thickness burns in a general hospital or community setting

Guidelines for the management of partial thickness burns in a general hospital or community setting. Lieve De Cuyper, Antwerpen Rudi Deleus, Leuven Henk Hoeksema, Gent André Magnette, Liège. Aims and recommendations. Better patient outcomes

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Guidelines for the management of partial thickness burns in a general hospital or community setting

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  1. Guidelines for the management of partial thickness burns in a general hospital or community setting Lieve De Cuyper, Antwerpen Rudi Deleus, Leuven Henk Hoeksema, Gent André Magnette, Liège

  2. Aims and recommendations • Better patient outcomes • Reducing the number of preventable late referrals to specialists • Few comprehensive step by step guidance emphasising wound-healing principles

  3. Indications for improvement • Diagnosis and referral • Wound preparation • Wound covering • Post wound care

  4. The algorithm • Examine cause, depth and surface Initial referrals • Prepare the wound • Cover wound with appropriate dressing Late referrals • Post-wound care Very late referrals

  5. Treatment algorythm • Examinecause, depth and surfacearea • Indicationforinitialreferral? • Yes • Refer to burncenter No Prepare woundbed and apply bandage Healed after two weeks? No Refer to burncenter • Yes • Start after care • Scarsouple and flat? • No • Refer to burncenter Yes CONGRATULATIONS !!!

  6. First aid WATER !!

  7. Assesment of depth and place • Superficial, partial thickness: red, wet, painful, with capillary refill • Deep: wet or dry, less pain, grey/white, brownish, no capillary refill, with decreased sensation • Rule of nines (for area) • Palm of hands + fingers victim (1%)

  8. Superficialburn

  9. Assesment of depth and place • Superficial, partial thickness: red, wet, painful, with capillary refill • Deep: wet or dry, less pain, grey/white, brownish, no capillary refill, with decreased sensation • Rule of nines (for area) • Palm of hands + fingers victim (1%)

  10. Deep burn

  11. Assesment of depth and place • Superficial, partial thickness: red, wet, painful, with capillary refill • Deep: wet or dry, less pain, grey/white, brownish, no capillary refill, with decreased sensation • Rule of nines (for area) • Palm of hands + fingers victim (1%)

  12. Rule of 9%

  13. Assesment of depth and place • Superficial, partial thickness: red, wet, painful, with capillary refill • Deep: wet or dry, less pain, grey/white, brownish, no capillary refill, with decreased sensation • Rule of nines (for area) • Palm of hands + fingers victim (1%)

  14. Rule of the hand: 1%

  15. Initial referrals • All full thickness burns • >15% TBSA in adults • >10% TBSA in children and elderly • Burns to face, neck, hands, feet, armpits, popliteal region, genitals • Electrical and chemical burns • Circumferential burns • Burns associated with inhalation, trauma or disease • Non accidental burns • Apply bandage with physiologic fluid

  16. Wound preparation • Offer pain relief if required • Clean and disinfect wound • Puncture blisters/keep closed if<2%TBSA • Remove loose skin and blisters if>2% TBSA • Tetanus prophylaxis if >5y. Ago

  17. What is an ideal dressing ? • Maintains moist wound environment • Contours easily • Non-adherent but retains close contact with the wound • Easy to apply and remove • Painless on application and removal • Cost-effective • Protects against infection • Lasts untill healing (one application) • Waterproof to allow for washing and bathing

  18. Best choice in primary care ? • Ideal dressing= modern dressing • BUT: • Perfect diagnosis is necessary (LDI) • Correct use of it requires high expertise • SO: • It is not the best choice in primary care • Best dressing in primary care = traditional ointment

  19. Late referrals • Not healed in 10 to 14 days • Late presentation of pain, fever, exudates, redness, odour, malaise

  20. Very late referrals • Non healing wounds • Scar problems • Itch • psychological impact • …

  21. Post-wound care • Moisturise regularly with creams and/or ointments • Prevent from sunlight for at least 1 year with high protection sun cream or special clothing • Take care of itching with cream and/or medication • Discuss return to work • Reconsult in case of problems (eg blisters, skin defects,…) • Think about psychological support

  22. Conclusions • Non-specialists play a pivotal role in the treatment of superficial burns • Communication is essential between specialists and non-specialists • Guidelines should be clear to informe non-specialists and improve outcome • Guidelines must be revised regularly • National burn organisations should put forward the recommendations to their members and develop strategies to communicate with relevant healthcare workers (www.burns.be)

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