Skin grafting should be pursued to facilitate recovery, minimize risk of infection, and prevent scarring. Fluid resuscitation must be considered in any patient with deep burns covering more than 20% TBSA. Pain control may require additional use of opiate medications. For deeper burns, drainage of blisters and debridement of non-viable skin is important as well as the application of topical antimicrobial agents and dressings to keep wounds clean and moist. Avoidance of sun exposure and tight clothing should be pursued as well as tetanus prophylaxis as indicated. Treatment #įor superficial burns, cooling, cleansing, emollients, and over the counter pain relievers may be utilized. TBSA can be determined by either using the Rule of Nines or the Lund and Bowder chart. A helpful guide for assessing depth of burn penetration is “dead tissue shrinks, damaged tissue swells”. If burns were caused by flame or explosion, signs of inhalation injury should also be assessed and include facial burns, singed facial hair, coughing, hoarseness, voice changes, and stridor. These steps are determining the mechanism/source of the burn (see differential above), the anatomical location/depth of the tissue damage, and the total body surface area (TBSA) affected. There are three essential steps in evaluation that once assessed will help guide treatment strategy. Deeper injury (4 th degree burns): some sources use the term “4 th degree burn” to refer to injuries that penetrate to and/or expose deep structures (e.g., bone, muscle, tendon). ![]() Sequela, such as contractures and hypertrophic scars, are common. They will not heal without surgical excision with skin grafting or tissue transposition. Frequently in shades of brown, white, gray, or black with overlying eschar.
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