Answer
Two of these, burn wound cellulitis and invasive burn wound infection, are seen with some regularity by clinicians outside a burn center environment.
Burn wound cellulitis (see the image below) usually manifests with progressive erythema, swelling, and pain in the uninjured skin around a wound. Usually, this is seen in the first few days after the burn occurred and is typically caused by S pyogenes. Infection can progress rapidly, but it is generally sensitive to penicillin. Excision of associated deep eschar can be essential to the successful treatment of cellulitis. Elevation to reduce edema is an important adjunct.
Initial evaluation and management of the burn patient. Burn wound cellulitis manifests with increasing erythema, swelling, and pain in uninjured skin around the periphery of a wound.
Invasive burn wound infection (see the image below) is a rapid proliferation of bacteria in burn eschar that invades underlying viable tissues. A change in color, new drainage, and, occasionally, a foul or sickly sweet odor are clinical findings. Pseudomonal and other gram-negative species are common causes. This infection can be life-threatening and usually requires combined treatment with surgery and antibiotics.
Initial evaluation and management of the burn patient. Invasive burn wound infection implies that bacteria or fungi are proliferating in eschar and invading underlying viable tissues. These wounds display a change in color, new drainage, and often a foul odor. These infections are life-threatening.
Fever and systemic toxicity commonly accompany both infections. Inspect burn wounds frequently to identify infection early. This is an important consideration in outpatient burn care. Someone must inspect the wounds managed in the outpatient environment to promptly detect infections. Errors in initial depth assessment are routine. Infections occur and must be treated in a timely manner. A wound monitoring plan is an essential part of burn care.
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Initial evaluation and management of the burn patient. Burn size is best estimated using a chart that corrects for changes in body proportion with aging.
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Initial evaluation and management of the burn patient. Second-degree burns are often red, wet, and very painful. Their depth, ability to heal, and tendency to result in hypertrophic scar formation vary enormously.
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Initial evaluation and management of the burn patient. Third-degree burns are usually leathery in consistency, dry, and insensate. These wounds do not heal.
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Initial evaluation and management of the burn patient. Management of burn blisters is controversial. Burn blisters occasionally obscure the presence of full-thickness wounds.
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Initial evaluation and management of the burn patient. Burn wound cellulitis manifests with increasing erythema, swelling, and pain in uninjured skin around the periphery of a wound.
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Initial evaluation and management of the burn patient. Invasive burn wound infection implies that bacteria or fungi are proliferating in eschar and invading underlying viable tissues. These wounds display a change in color, new drainage, and often a foul odor. These infections are life-threatening.
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Initial evaluation and management of the burn patient. If hand positioning and therapy are ignored while overlying burns heal, poor long-term function may result.
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Initial evaluation and management of the burn patient. Estimating the burn area in an adult patient.
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Initial evaluation and management of the burn patient. Estimating the burn area in a child.
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Initial evaluation and management of the burn patient. Escharotomy incisions.
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Partial-thickness burn.
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A 2-year-old child with a scald burn to the hand.
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Proper functional positioning for splinting of serious hand burns is the metacarpophalangeal joints are at 70-90° of flexion, the interphalangeal joints are in extension, the wrist is at 20° of extension, and the first web space is open.
