A burning question...

[mommatrauma, RN]

We have had multiple burn patients recently...mostly 2nd degree burns...90% of our burns get transferred out to our nearby burn center...we have gotten conflicting reports on whether or not to apply silvidene to the burns...some say yes, others say don't put it on, because they will just have to scrub it off when they get there, possibly being more painful for the patient in the long run...any views on this??

[Nancy2]

We have had multiple burn patients recently...mostly 2nd degree burns...90% of our burns get transferred out to our nearby burn center...we have gotten conflicting reports on whether or not to apply silvidene to the burns...some say yes, others say don't put it on, because they will just have to scrub it off when they get there, possibly being more painful for the patient in the long run...any views on this??

I was a burn Nurse in the 1990's, silvadine was only used on some kinds of burns then and since then, there have been several schools of thought. I would check with the burn center that you usually transfer to and ask them what their protocol is. I'm sure this would add value to your relationship as well. They will respect you seeking their input. What they use probably depends on the medical director, the depth of the would, what caused the burn and the location on the body.

Hope this helped.

[Medic14]

When in doubt follow the guidelines from the American Burn Association's course of Advanced Burn Life Support (ABLS). Which states that leave all blisters intact, cover all wounds with a WARM DRY Sheet, I say again DRY Sheet. Also, acceptable are dry dressings like Kerlex, Don't worry about the dressing sticking to the wound bed or bullea. The dressings will be moisten and cut away, also during transport all partial thickness wounds will weep w/ serous fluid, another way to keep dressings from sticking.

The rationale behind this is very important for burn patient, KEEP THEM WARM AT ALL COST. These patients will loose body heat through evapouration, convection, conduction, radiation, and also the skin is damaged and will not retain heat. The worst thing someone can do is to wrap a wound with wet dressings, does nothing for pain, that is what Morphine and Fentanyl are for. One last point, if this is a partial thickness burn that is inspected after debridement and cleansing, it could possibly be covered with a synthetic dressing such as biobrane or transcyte. If any pertrolum product or cream has been placed on the wound, non of these synthetic dressings will adheare to the wound bed, therefore allowing serous fluid between the wound bed and the synthetic dressing, bad for wound healing.

It is always good to have a protocol set up with your nearest burn center. They would be happy to work with you.

FYI:

http://www.ameriburn.org

Medic14

Burn Nurse

[redwinggirlie]

I would ask the burn center what their protocol is first. Yes, if you do send them there, they will just have to scrape the silvadene off. Plus, if the patient is being airlifted, having silvadene or any moist dressing on them will hinder their already compromised thermal system. It's cold up there! Dry sheets and dry dressings are best for transport...

[clgmezzo]

Well, all burns get cleaned when they come in, regardless of whats on them under normal curcumstances, even tubed pts. So whether its a big burn that gets tubbed, or a little burn that just gets cleaned it all comes off for examination because, no offense, report is wrong as to the extent and depth of the burn 75% of the time, and for infection control, debridement, etc.... Talk to your regional center as to their guidlines, they should have outreach staff and educators who would probably even be able to come talk to some of your staff.

[Burnnurse63]

Ahhh, probably the most common question I get asked as I do work in a burn center. The answer really depends on the patient, type and size of burn, etc. Our protocal for larger burns: no dressings, CLEAN DRY SHEETS AND WARM blankets. Protect against heat loss as much as possible. If the burn is small: cool compress is okay, but no ointments or creams.

Major reason we do not like ointments or creams:

• Upon arrival to burn center, it allows us a faster assessment of the patient and injury and therefore quicker adjustment in fluid management.

Until you get to know your local burn center's preferences and protocals, I would defintely encourage direct communication with the burn center.

[RazorbackRN, BSN, RN]

We have had multiple burn patients recently...mostly 2nd degree burns...90% of our burns get transferred out to our nearby burn center...we have gotten conflicting reports on whether or not to apply silvidene to the burns...some say yes, others say don't put it on, because they will just have to scrub it off when they get there, possibly being more painful for the patient in the long run...any views on this??

Our burn unit does not use silvadene at all (we cringe when we see it come through the door). We use a silver impregnated dressings when applicable (Acticoat).

For us, we prefer that the wound has just been washed with Hibiclens or Dial soap and wrapped in kerlix.

[rn/writer, RN]

I understand the rationale behind using dry dressings and warm blankets to prevent hypothermia. But one question that I have always had regarding burn patients is this: when I was an EMT (up until earlier this year), we would sometimes come up a burn patient (especially chemical burns) who seemed to have a tremendous amount of heat in the wounded areas. Is damage still being created by this trapped thermal energy? Is there any merit to doing some kind of rapid cool-down in the affected area and then keeping the patient warm overall?

In the burn center, you probably aren't seeing the patient until an hour or more after the injury is inflicted. Out in the field, we sometimes saw people within 4-5 minutes and it seemed like the burn was still being created or expanded. I wanted to stop that process and then do the dry dressing/warm blanket protocol.

Any input?

[babynurselsa, RN]

CHeck with your local burn center and see of they will send someone to come and do an inservice. Most of them would be happy to do so.

[neneRN, BSN, RN]

Its funny that I'm seeing this thread now; I'm in a Level II Trauma Center- but we don't do burns; we send them out. Just last week, I had a pt with second and third degree burns over entire chest/neck/arms that I had to transer out. What I have always done with burn pts is cover the burns with wet sterile towels, and then tons of warm blankets. I was surprised when I called the burn center to give report and the receiving nurse told me to take off all the wet towels, and just do dry drsgs-obviously I recognise that that nurse knows far more about burns and I did as she said..but this was the first time I had heard to do it that way, and when I asked all my coworkers about it, they all said that they have always done the wet towels as well. I know in nursing school, I was taught to use the wet; but that obviously has changed. If anyone knows of a resource telling about the benefits of just using dry, let me know; I would like to pass it on to my staff. Thanks.

[Burn_Nurse_in_Ga]

in fact with many chemical burns, the chemical continues to destroy tissue well after the initial contact, when dealing with a burn such as this as a first responder, clothing should be removed and discarded ( remember, protect yourself!) then large quantity's of water should be used to irrigate the area, never immerse a chemical burn due to the chemical binding with the water and causing a larger affected area. hope this helps:thankya: