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Burn

On July 4th I received a call about a child who was burned by a sparkler and the level of his parents’ concern got me typing. Very few medical problems cause more pain. And when the patient is a child, often times there is a parent along feeling exquisite guilt. As a kid I grabbed the hot end of a soldering iron, which made my father feel terrible. But I’m certain I learned more about burns that day than any time in medical school.

In general, if you’re reading this page for guidance and if you wonder whether or not a trip to the ER may be warranted, it almost certainly isn’t. Pain with a serious burn is usually the driving force. If junior is back to watching fireworks, then there’s definitely time to think. I say this not to be cavalier, but because the large majority of patients I see in ERs are destined to heal well no matter what we may do.

Red Flags:

• Pain that can’t be controlled by ibuprofen and cool wet soaks
• Signs of infection – fevers, pus, cellulitis
• Circumferential burns (around entire limb)
• … Not many red flags really because pain is the main driver. Of course you’ll seek help for charred skin, exposed bone, lost vision etc.

Happy Words

• No pain now and back to playing
• Small blisters not really causing any problems
• Full range of movement of any affected joints

(We also examine burns looking for signs of abuse, but that’s a different animal.)

Burn treatment has 3 general objectives – pain control, infection prevention, contraction/scar prevention.

To control pain, ibuprofen (always with a little food), wrap in a damp cloth and elevate. If that’s not enough then we move to narcotics. If you’re going to slather in butter, mayo, tooth paste, egg whites, hummus, etc. then please stay home, because it’s just more to clean up in the ER.

To prevent infection, much depends on burn depth and blister status. If blisters are intact, we typically leave those as “physiologic dressings.” If ruptured, then we debride the blisters to limit infection risk and then apply bacitracin. I’m not sure how much bacitracin stops infection, but it does limit skin cracking and stuck dressings. Deeper burns are often treated with a product called Silvadene. But beware that this contains sulfa in case you are allergic. We also update people on their tetanus vaccinations.

To limit scaring and contractions, avoid direct sun, continue to use bacitracin, aloe, or any other ointments of your choosing, and try to maintain range of motion. This could require physical therapy.

You’ll read about first, second, third degree burns and you’ll see other descriptors like superficial, partial, full thickness, etc. Basically, these are meant to convey how many layers of skin seem to be affected. Rule of thumb – if sensation is present throughout the burn that’s a good sign (glass half full) in the sense that sensory nerves have not been destroyed.

If you’re on the fence, give Pre-R a call (570) 507-7737. A simple text image may be all we need.

P.S. Do NOT Google “burns images.”

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