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Burns (102.147)

Burns (102.147) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Wound and Skin

102.147

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: BURNS

Effective Date: October, 2002 Approval: See Authorization
Contact: Clinical Staff Education

Reviewed April, 2005 May, 2008 May 2009


PURPOSE: To provide guidelines for the assessment and treatment of burns at UWMF
clinics.

DEFINITION: Burns cause damage to the skin that may vary greatly in depth, size and
severity.

The treatment of burns depends on the depth, area and location of the burn. Burn depth is
categorized as first, second or third degree. Burns that cover more than 15% of the total
body surface can lead to shock and require hospitalization for intravenous fluid
resuscitation and skin care.

 A first-degree burn is superficial and has similar characteristics of typical
sunburn. The skin is red in color and sensation is intact. In fact, it is usually
somewhat painful.
 Second-degree burns look similar to the first-degree burns; however, the damage
is now severe enough to cause blistering of the skin and the pain is usually
somewhat more intense.
 In third degree burns, the damage has progressed to the point of skin death. The
skin is white and without sensation.

TYPES OF BURNS

I. Thermal Burns - Most thermal burns are caused in one of the following ways:

Flames: Burns are often deep, causing partial to full thickness injury, especially
when a person’s clothing has been ignited.

Hot Liquids: Scalds from hot liquids are usually not as deep as flame burns but
can produce serious burns. Hot water or coffee may produce deep partial
thickness injuries. Grease may produce deep partial, and occasionally, full
thickness injuries.

Hot Objects: Touching a hot object such as a stove, skillet or grill, causes contact
burns. Contact burns vary in depth since a person’s reflexes may cause them to
react quickly and protect them from prolonged exposure to the hot object.

2
Flash Injuries: Explosions produce flash burn injuries. These injuries vary in
depth according to the proximity of the flash and the intensity. Flash injuries
involve exposed parts of the skin such as face and hands.

Sunburn: Superficial burns but can be extremely painful. By early cooling, the
pain is relieved as the wound is soothed and the progress of the injury is stopped.

II. Chemical Burns: Chemical burns are a reaction that occurs when the skin comes in
contact with strong acids, alkalis, or other corrosive materials.

III. Electrical Burns: Electrical injuries occur when an electric current travels from the
contact site into the body, arcing from one body point to the other. As the electrical
current goes into the body, it is converted to heat.

IV. Mechanical Burns: Mechanical burn injuries are caused by friction such as from
ropes, carpet, or sports activities.

POLICY: The clinical staff will utilize the following guidelines to assess and stabilize a
patient with a burn at a UWMF clinic.

SUPPLIES: Chlorhexidine solution or prescribed solution
Silver Sulfadiazine (Silvadene) 1% or prescribed cream
PPE (gloves, gown, goggles, mask), Provider’s order, Patient’s record

EMERGENCY CARE FOR BURNS

Monitor vitals signs and consider immediate transporting to the hospital if:

 The patient has symptoms of shock, or breathing difficulties.

 The burn has penetrated through the first layer of skin and the resulting second-
degree burn covers more than 4 inches in diameter (2 to 3 inches in diameter for
chemical burns).

 The burn occurred on the eye, hands, feet, face, groin or buttocks or over a major
joint.

GENERAL PROCEDURE FOR ALL BURNS:
1. Wash hands and gather equipment
NOTE: equipment may vary depending on type of burn. See burn table at end of
document.

2. Introduce yourself to the patient and identify the patient.

3

3. Put on gloves.

4. Explain procedure to the patient.

5. Check with patient or the patient’s record for allergies.

6. Provide good light and provide privacy by closing curtains or door.

7. Remove any constricting clothing or jewelry (such as rings).

8. Review cleaning and dressing instructions from attached table.

9. Document in the patient's record
 The type of burn
 Care given
 Discharge instructions
 Follow-up appointment (if needed)
 Patient's response to the treatment

WRITTEN BY:

Ronnie Peterson, R.N., M.S., Clinical Staff Educator

REVIEWED BY:

LaVay Morrison, RN, BSN, Clinical Staff Educator
Danielle Varnell, RN Clinical Staff Educator

REFERENCES:

1. Basic Skills and Procedures: Perry & Potter, 4
th
Ed., 1998, Mosby, St. Louis.
2. Clinical Nursing Skills & Techniques, 5
th
Ed. Perry & Potter, 2002, Mosby, St. Louis.
3. Just the Facts: A Pocket Guide to Basic Nursing, Peterson, 3rd ed. 2002, Mosby.
4. Burn Care Advisory; http://www.burnremedies.com/
5. Lippincott Williams & Wilkins. Procedure Checklists Fundaments of Nursing of
Nursing: The Art and Science of Nursing Care, 4
th
ed. Lillis, LeMone and LeBon.


AUTHORIZATION:



Medical Director Date


4
UWMF Guidelines for Cleaning and Dressing Instructor for Minor Burns


Chemical burns Thermal Burns Electrical burns Mechanical Burns
Put on PPE (personal protective
equipment). Remove the cause of
the burn by flushing the chemicals
off the skin surface with cool,
running water for 20 minutes or
more, (unless otherwise ordered by
provider).
Cleanse area with
chlorhexidine solution, unless
otherwise ordered by
provider.
Wash with soap and water,
and then soak in cold water
for 10 minutes.
Cover any burned areas with
a sterile gauze bandage
cloth.
Rinse the burn for several more
minutes under cool tap water.

Remove clothing or jewelry that has
been contaminated by the chemical,
after the 20 minute flush has been
completed.
For 2
nd
or 3
rd
degree burns
apply 1/16 inch of Silvadene
cream around burn – unless
otherwise ordered by
provider.
If burn on arm or leg, elevate
for 24 hrs to decrease
swelling.
Consider using a prescribed
lotion, such as one containing
aloe vera, to prevent drying and
to make the skin feel more
comfortable.
Rinse the burn again for several
more minutes if the patient
complains of increased burning
after the initial washing.
Wrap the burned area with a
dry, sterile dressing.
Assess vital signs and
potential need for hospital
transport.
Burn can remain open to air or
wrapped with a dry, clean
dressing.
Consider using a prescribed lotion,
such as one containing aloe vera, to
prevent drying and to make the skin
feel more comfortable.
A tetanus booster should be
considered if patient has not
had tetanus booster within the
last 5 years.

Wrap the burned area with a dry,
sterile dressing.