The build-up of fluid under the intact blister (which becomes firm and jelly-like quite rapidly) can put pressure on the underlying dermis, which in turn can reduce perfusion and potentially deepen burns.The management of blister debridement is still controversial however, the authors’ burns service, in line with literature reviews of available evidence, 2 supports the practice of blister debridement for the following reasons: The overall aims of any burn wound dressing, irrespective of the size and depth of the burn, include: It follows, therefore, that different burns require different dressings.
#CHANGES TO FIRST AID 2017 SKIN#
When considering the choice of dressing for a burn injury, it is important to think of the size and depth of the burn, and also the aim of the dressing to be applied.Ī superficial epidermal burn (eg sunburn, minor scald, brief flash burn, where there is erythema of the skin but no break in the skin or blistering) does not require a dressing, and application of emollient or moisturiser to cool the intact but painful red skin is appropriate (Figure 2).Ī superficial dermal burn (eg hot water scald, where there is skin blistering over a wet, pink and painful dermis) requires a dressing to absorb fluid, avoid maceration and seal the wound from the outside environment to reduce pain and infection (Figure 3).Ī deep dermal or full-thickness burn (eg prolonged flame, contact burn, where skin under the broken or destroyed blister is less painful and a fixed red or pale white colour due to damaged blood vessels, proteins and nerve endings) will require a dressing to debride and lift the dead skin if it is a small area, or to temporise for surgery if it is larger area (Figure 4).įigure 4. However, good initial management, including dressings, can still prevent the burn from getting larger and deeper while the patient awaits review or transfer. If the zone of coagulation is large, it is likely that the patient will require specialist treatment and surgery. Reproduced with permission from Wound Healing Institute Australia. Jackson’s burn wound model. This model helps to explain the dynamic nature of burn injuries, and how an assessment of the burn at the time of injury can be different in terms of size and depth to an assessment of the same injury 48 hours later. Good first aid and wound management can significantly reduce the need for skin grafting, 1 simply by giving this middle zone the chance to recover, rather than deepen and become part of the zone of coagulation. The middle zone of the burn is called the zone of stasis, which is the target of good burns care, such as effective first aid and dressings. This is a reactive zone of inflammation in response to the injury, which can occur with non-burn injuries such as trauma, and will return to normal within hours of the injury. The outer zone of the burn is called the zone of hyperaemia. This area is dead and nothing any clinician can do will bring it back to life. The inner zone of a burn is the zone of coagulation. When considering burns dressings, it is useful to remember the theory of Jackson’s burn wound model (Figure 1). By managing all burn injuries effectively at every single step, we can reduce burn injury morbidity as a community. Every intervention in the journey of a patient with a burn injury affects their eventual outcome. This article provides a framework used by the State Burn Service of Western Australia, by which clinicians can understand the needs of a specific burn wound and apply these principles when choosing an appropriate burn dressing for their patient. This information includes the aims of burn wound dressings and indications for different types of dressings in different burn depths, advantages of blister debridement, and the reasoning behind advice given to patients after healing of the burn wound. The objective of this article is to provide healthcare professionals with information about the pathophysiology of burn wound progression. This can reduce the risk of the burn becoming deeper or infected, and can potentially reduce the requirement for specialist review or surgery. Management of smaller burn injuries in the community can be improved by appropriate first aid, good burn dressings and wound management. Burn injuries are common and costly each year, there are more than 200,000 cases, costing the Australian community $150 million.