How are burn wounds treated?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Answer

Most burns are small; patients with small burns are appropriately treated in an outpatient setting if the burns do not involve critical areas such as the face, hands, genitals, or feet. [9, 11] The outpatient setting is the primary focus of this section. Outpatient burn management can be taxing and, when poorly performed, can cause unnecessary suffering and compromise long-term results. In some situations, the best plan is to coordinate outpatient management with the burn unit's team of doctors, nurses, and therapists because their expertise may facilitate attaining optimal outpatient results. However, most small burns can be properly managed by community-based providers with burn center consultation as needed. [11]

Selection for outpatient care

Several factors are relevant to the decision regarding the location of burn care. Airways must not be compromised. The wound must be small enough so that fluid resuscitation is unnecessary, which generally precludes outpatient care for burns over 10-15% of TBSA. The patient must be able to ingest adequate fluid orally. Typically, serious burns to the face, ears, hands, genitals, or feet should initially be managed in an inpatient setting.

The patient and family must be able to support an outpatient care plan. An adult caregiver should be available who can be with a child treated in an outpatient setting. A family member or visiting nurse must be available who can perform the necessary wound cleansing, inspection, and dressing applications because most patients cannot do this themselves. The family must have adequate transportation to return for clinic visits and unexpected emergency visits. If abuse is suspected, outpatient management is contraindicated. Finally, if the initial examination findings indicate that surgery is needed for a full-thickness wound area, the patient should be promptly admitted for surgery. [38] Despite all of these qualifications, most patients with smaller burns can be successfully treated in an outpatient setting.


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