How To Debride and Dress a Burn

Minor burn wounds

None

Wounds or other burn-related injuries that require transfer to a specialized burn unit (see treatment of burns Treatment Burns are injuries of skin or other tissue caused by thermal, radiation, chemical, or electrical contact. Burns are classified by depth (superficial and deep partial-thickness, and full-thickness)... read more )

Allergic reactions to topical antibiotics

Nonsterile gloves

Cleansing solution, such as 2% chlorhexidine

25- and 21-gauge needles

10-mL syringe

Local injectable anesthetic, such as 1% lidocaine

Sterile scissors, forceps

Nonadherent dressing

Specialized burn wound dressings, if available and warranted (eg, petrolatum gauze impregnated with 3% bismuth tribromophenate)

Absorptive bulk dressing (such as 4 × 4 gauze dressings and tape, flexible rolled gauze wrap for extremity burns)

Burns involving the hands, feet, face, genitals, perineum, or involving major joints or burns that are circumferential or extensive often require transfer to a burn center Hospitalization and referral Burns are injuries of skin or other tissue caused by thermal, radiation, chemical, or electrical contact. Burns are classified by depth (superficial and deep partial-thickness, and full-thickness)... read more .

Superficial (formerly 1st-degree burns): Involving the epidermis only

Partial-thickness (formerly 2nd-degree burns): Extending into the dermis

Full-thickness (formerly 3rd-degree burns): Destroying the entire skin

Patient comfort with excellent exposure of burned areas

Provide analgesics to take at home.

Instruct the patient to elevate an affected limb to prevent swelling, which may cause delayed healing or infection.

Follow up in about 24 hours. At the first follow-up visit, remove the dressing and reassess the burn for depth of injury and need for further debridement, then redress.

The type of dressing used: Some dressings are intended to be left on for a period of time and others are changed frequently.

Patient and family capability: Large burns, areas requiring awkward or complicated dressings, and patients with limited self-care skills, may need more frequent professional care and/or less frequent changes.

The amount of exudate produced by the wound: Drier burns need less frequent dressing changes.

Do not underestimate the need for procedural analgesia and sometimes sedation, particularly for complicated debridement or dressing changes. Inadequate analgesia deters thorough wound care.

For burns on the face and neck: Cleanse the wound with chlorhexidine and debride blisters and any loose skin, then apply a bland topical antibiotic such as bacitracin but leave the wound uncovered. The wound can be washed 2 or 3 times per day, followed by reapplication of the topical agent. Encourage patients to sleep with their head elevated to help minimize or decrease swelling.

Alternatives to IV opioids include regional or nerve block anesthesia; inhaled nitrous oxide; or IV ketamine.

For debridement of small burns, local anesthetic injection may be adequate analgesia.

Home burn care and dressing changes may be quite painful. An adequate supply of an oral opioid analgesic should be provided, and responsible analgesic use should be encouraged.