# Burn dressings



## Jarnhamar (7 Jun 2020)

For burns are gel soaked burn dressings (like Water.jel https://www.waterjel.com/professional-products/ ) more effective than a Petrolatum dressing that come in a fine mesh gauze ?

I recently had a discussion with someone in the health care field that said the mesh burn dressings can be bad to use because they end up sticking to the wound and the emergency room sometimes takes a grinder type thing to grind the dressing off of wounds.


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## Blackadder1916 (11 Jun 2020)

Since you mention "emergency room", my first thought is "why the interest".  Are you seeking a recommendation as to the most appropriate burn dressing for a personal first aid kit or similar "non-professional" set-up?

In the decades since I was last required to care for a serious burn patient, there has obviously been considerable advances in burn dressings.  What I do remember clearly though is that the simplest, easiest and most non-intrusive dressing to use on a burn is a dry, clean (preferably sterile, non-adherent) dressing.

I dug through most of my (now well dated) reference books, including the ABLS provider manual from the course I audited* in the late 1990s and most provide relatively the same guidelines as that currently available online.

This from a more recent Advanced Burn Life Support manual.

http://ameriburn.org/wp-content/uploads/2019/08/2018-abls-providermanual.pdf


> IV. WOUND CARE
> 
> A. Pre-Hospital Wound Care: Cooling
> 
> ...



That may be more advanced than required by a lay-person.  If you are looking for a recommended burn dressing to include in a FAK, I suggest that you ask a firefighter what they have in their kit and what the protocol is for use.


*  _There's a story as to why I "audited" the course._


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## Jarnhamar (11 Jun 2020)

Mix between setting up my personal/work kit and instructing.

Thanks for the link and write up. Never even considered asking what firefighters use. 

I thought the idea of burn dressings having to be grind off the wound pretty interesting, it was the first time I've heard anything of the sort but the guy talking about it really seemed to know his stuff.


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## BurnDoctor (12 Jun 2020)

Saran Wrap is an excellent field expedient dressing for relatively short term/pre-hospital - doesn't stick, keeps it clean, and you can evaluate the wound without removing it. Learned that from CF med techs upon joining the army - by which point I'd already been in the burn realm for >10 years 

Blackadder's suggestion to speak to a firefighter is an excellent one; re; field care.

Beyond that, there's a saying in burn care that it matters less what you put on the wound and more what you take off of it; the implication being that wound hygiene, cleaning it of dead tissue/debris/bacterial load regularly takes precedence over the type of dressing. A dressing never healed a wound - that's up to either a) biology, if the wound is shallow enough to heal on it's own, or b) surgery, if the burn wound is too deep to heal on its own and needs to be excised and skin-grafted.

Basic principles in selecting a dressing are what's available, what you know how to use, ease of application, and ease of removal (i.e. not getting stuck to the wound). Most fine mesh gauze products (of which there are a ton) will stick if worn long enough, so are probably best combined with a cream or ointment.  Most newer advanced care burn dressings incorporate an antimicrobial right into the material and are designed to be more comfortable and with longer wear times.

The fact that there are a bajillion products marketed for burn dressings is a great clue that there is no one single best dressing. Keep it clean, use a dressing the patient can tolerated comfort-wise, and re-evaluate regularly. A good rule of thumb is that if it hasn't managed to heal on its own by ~ 3 weeks-ish, consultation with a surgeon is warranted.


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