Burn dressings

[Jarnhamar]

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.

 

[Blackadder1916]

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

Cooling of the burn using tap water is sensible as long as it does not delay in care and transfer to a hospital
facility. Cooling relieves pain and may reduce the depth of injury in evolving partial-thickness burns.
However, the exact method and length of cooling is still controversial. This course recommends that cooling
is appropriate by using tap water up to 30 minutes for burns %u2264 5% TBSA. In larger size injuries, the risk of
hypothermia and delay in care potentially outweighs the benefit of cooling.

B. Patients Who Meet Criteria for Referral to a Burn Center

Evaluation and treatment of life-threatening problems always takes precedence over the management of
the burn wound. The priorities for initial wound management differ from definitive wound management in
several ways. During initial stabilization, once the primary and secondary survey have been completed and
interventions planned, the provider should document the areas of second- and third-degree prior to transfer. To
avoid hypothermia, cover the patient with a dry clean dressing and keep the patient warm. There is no need to
cleanse extensive wounds in patients who are to undergo formal wound evaluation and cleansing once at the
burn center. The priority here is stabilization and rapid transfer. Elevate any extremity with a burn injury above
the level of the heart to minimize burn wound edema. Use pillows to ensure the extremity remains elevated
during transport.

C. Patients Who Do Not Meet ABA Referral Criteria, or Patients With Anticipated Delay in Transfer to a Burn Center

If the patient%u2019s injuries do not meet criteria for referral, or if transfer to a burn center will exceed 24 hours
because of mass casualty or other logistical reasons, this course recommends the following 2 steps:

1. Cleansing the wound with a cleansing agent (i.e., soap or chlorhexidine) and removing dirt and debris from
the wound area, if present. Perform wound care one body section at a time to limit the exposed areas
to a minimum. Prepare warm water or warm saline ahead of time. Prepare all dressings ahead of time to
apply immediately upon completion of wound care for that specific area of the body. Warm water with
dilute chlorhexidine gluconate to cleanse the burn wounds is optimal due to broad-spectrum antimicrobial
coverage. Do not use chlorhexidine gluconate in close proximity to the eyes. It is acceptable to use
baby shampoo mixed with warm water to clean the head and neck area along with the rest of the body if
chlorhexidine gluconate is not available. Pre-medicate the patient for pain and anxiety control and maintain
a warm environment.

2. Gently debride blisters >2cm in size using sterile gauze or scissors; apply a topical antimicrobial
medication. Consult with the burn center for the preferred topical antimicrobial medication. Common
topical ointments are silver sulfadiazine for full-thickness burns and bacitracin for partial- thickness burns.
If topical antimicrobial dressings are to be applied, the primary and secondary dressings method should be
used. A primary dressing makes direct contact with the burn wound surface. For instance, 1% SSD (silver
sulfadiazine) is commonly used. This cream can be applied directly to the burn wound or impregnated into
gauze and then applied to the wound. Other topical ointments can be used, either alone or in combination,
depending on the depth of the wound. Examples are bacitracin, double- or triple-antibiotic ointment,
and petrolatum. A secondary dressing provides a layer to absorb drainage and will provide mechanical
protection. All secondary dressings are loosely secured with size appropriate rolled gauze or surgical
netting if available. Do not secure dressings in a constrictive manner that may interfere with perfusion.

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.

 

[Jarnhamar]

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.

 

[BurnDoctor]

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.