Management of clean 2nd degree burn

gwenith, BSN, RN · Apr 15, 2005

Being Aussie I have to say no but I would have opted for something a bit different in relation to management anyway. How big was the burn and do you need grafting?

gwenith, BSN, RN · Apr 15, 2005

We don't use hydrogen peroxide anymore so I went online to see if I could find a reason why and I think this might explain it.

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Hydrogen peroxide 3% solution is commonly used as a wound cleanser; it provides effervescent cleansing action through its release of oxygen. The limited studies available indicate that hydrogen peroxide is cytotoxic at 3% concentrations. Dilution of hydrogen peroxide to 0.3% concentrations provided no bactericidal activity against Staphylococcus aureus; however it still remained moderately toxic to cells. It was not until the 3% solution was diluted to 1:1,000 (0.003%) that it did not demonstrate toxicity to cells. Current data indicate that hydrogen peroxide's cytotoxicity properties outweigh its limited bactericidal effects as an antiseptic.37,47

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After cleaning the injury, apply an antimicrobial cream, ointment, or spray as an additional safeguard against infection. Don't use hydrogen peroxide, iodine, or alcohol directly in a wound because they may damage or irritate tissue; however, they are safe for cleaning wound edges and the skin around the injury.

http://jaxmed.com/articles/wellness/wounds.htm

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Hydrogen peroxide is less used now as a debriding agent than in the past. When hydrogen peroxide is applied to a wound it combines with catalase produced in the tissues and decomposes into oxygen and water, producing effervescence (Potter and Perry, 1993). The rationale was that this helps to loosen materials that might hinder wound recovery and enables them to be washed off more readily. Six-percent w/v hydrogen peroxide (known as ' 20 volume' solution) liberates twenty times its own volume of oxygen upon decomposition (Thomas, 1990a), and is generally diluted 1 in 3 for the irrigation of wounds. The release of oxygen also kills some anaerobic bacteria such as the tetorifice bacillus or Escherichia coli that might otherwise infect the wound. This anti-microbial action of hydrogen peroxide can be amplified 100-fold by the addition of L-cysteine (Berglin et al, 1982).
The problem with hydrogen peroxide and some other traditional debriding agents is that they also damage the healthy cells (keratinocytes and fibroblasts) that are needed for wound healing and inhibit their necessary migration into the damaged area (Tatnall, Leigh, and Gibson, 1990; Tatnall, Leigh, and Gibson, 1991; O'Toole, Goel, and Woodley, 1996). In current practice the emphasis has moved away from the use of cytotoxic materials to those which promote healing, including the use of natural signalling molecules such as platelet-derived growth factor (Higgins and Ashry, 1995). In the British National Formulary (1996) hydrogen peroxide is now listed under "Astringents, oxidisers and dyes", and not as a desloughing agent.
The application of hydrogen peroxide has been replaced with the use of saline wash, substances such as Debrisan and Intrasite Gel for the removal of necrotic tissue, and the application of hydrogel dressings such as Granuflex. Varidase is a desloughing agent with wound cleansing properties, and contains streptokinase and streptodornase (Thomas, 1990b).

JEEMA · Apr 15, 2005

It's not that big- the most damaged part is just more than the size of a quarter dollar. That's the area where hydrogen peroxide is used which I think contributed to its slow healing (?)

It doesn't need grafting, just conservative treatment. It just hurts so bad esp if i'm on duty (though I'm in light duty) because I seal it with opposite (over the gauze) which might contribute to the heat /stinging sensation that i feel after a few hours.

Thanks for the articles about hydrogen peroxide...

**canoehead, BSN, RN** · Apr 17, 2005

I've never heard of MEBO cream, we use Silvadene on burns in our ER. Having had a 2nd degree I would recommend just keeping it moist with any antibiotic cream (like Silvadene) and covered. What about a biooclusive that won't rub, and will come off easily if you use lots of cream first?

Ashera, LPN · Jul 13, 2005

Had a second degree burn across my foot earlier this year. Treated with silvadene cream, covered then with a piece of xeroderm (the vaseline impregnated gause) then clean gauze and medfast tape. Removed the dressing bid and rinsed with NS, reapplying silvadene, vaseline gauze, clean gauze and medfast. Hurt like h### for about a week but then healed in about 2 enough that the pain was gone. Scar was dark but lightened considerably with Mederma.

Lesson? DO NOT freak out when your butter in the skillet catches fire and you don't want your pretty little apartment to fill with that nasty smoke. Do not then pick up the skillet and try to walk out the front door with it to throw it outside. It will: Melt your foot, melt your nice white carpet, set your outside grass on fire .....

And then...do not work at some stupid hospital that tells you that you have to get a DOCTORS excuse to not come to work the next day (cause you can't wear a shoe). Went to a clilnic, saw another nurse, who shook her head and asked upon filling out the 'excuse' if I wanted to be excused from recess too??

michellejenson · Sep 30, 2010

Dear jeema

There is a nice article that you should check

http://asktheburnsurgeon.blogspot.com/2010/01/management-of-2nd-degree-superficial.html