Burn Injury/Thermal Burn — Wound Care — Clinical Pathway: Inpatient

Burn Injury Clinical Pathway — Inpatient

Wound Care

Debridement
  • To be completed during the initial assessment of the burn, preferably in the ED if sedation will be needed
  • Moist gauze application by RN
  • Conservative sharp debridement by APP/MD
  • Consider debridement of blisters if:
    • Causing significant pain from pressure
    • Limiting joint ROM
    • Concern for full-thickness burn
Re-evaluation of the Burn
Dressings
Monitor for Infection
  • Fever, foul smelling drainage from the burn, severe edema, increased pain, spreading erythema
  • If suspected, consider:
    • Further wound debridement
    • Systemic (oral or IV) antibiotics
    • ID consult
    • Plastic Surgery Consult
  • Keep tetanus booster up to date

Burn Location and Care

Location Face/Head with no Dressing Face/Head with Dressing Perineal, with Diaper Perineal, NO Diaper Fingers/Toes with Ingestion Risk Fingers/Toes without Ingestion Risk Other Body Parts
Topical/
Anti-microbial		 Bacitracin-polymyxin b OPHTH ointment Bacitracin-polymyxin b OPHTH ointment Bacitracin-polymyxin b ointment Bacitracin-polymyxin b ointment Bacitracin-polymyxin b ointment Bacitracin-polymyxin b ointment Bacitracin-polymyxin b ointment or Mepilex Ag
Primary Dressing None Adaptic Adaptic Adaptic Adaptic, wrap each finger/toe individually Adaptic, wrap each finger/toe individually Adaptic (none with Mepilex Ag)
Secondary Dressing None Stretch gauze (Kling) or Bulky gauze (Kerlix) None Stretch gauze (Kling) or Bulky gauze (Kerlix) Stretch gauze (Kling) Stretch gauze (Kling) Stretch gauze (Kling) or Bulky gauze (Kerlix)
Secure with: None ElastoNET Diaper ElastoNET ElastoNET ElastoNET ElastoNET
Frequency of Dressing Changes TID, or apply if Bacitracin-polymyxin b ointment rubs off BID With each diaper change BID BID BID BID for Bacitracin-polymyxin b ointment. Minimum Q 7 days or prn Mepilex Ag.