BURNSSurgical Emergencies 25510 Give tetanus prophylaxis and oral analgesics such as paracetamol 500 mg
and codeine phosphate 8 mg two tablets q.d.s. to take home.
11 Remember that burns of the perineum, feet or hands in children may be due
to non-accidental injury.
(i) Suspect this when there has been a delay in seeking treatment and
the explanation is tenuous, or there is absence of any evidence of
splashing.
(ii) Refer the child to the paediatric team for admission if non-
accidental injury is possible, however trivial the burn (see p. 372).
FOLLOW-UP MANAGEMENT1 Review the patient after 24–48 h to clean the affected site, to reassess the
condition of the burn, and to ensure that no evidence of secondary infection
is present. Re-dress the site, but omit the silver sulfadiazine.
2 Thereafter, change the dressing every 5 days, unless the wound becomes
painful, or smells, or the bandage becomes soaked (‘strike through’), when
the dressing should be renewed immediately.
(i) Leave the paraffin-impregnated gauze in place when changing
the dressing, if it has become adherent to the skin, to avoid
destroying the delicate new epithelium forming underneath.
(ii) Otherwise, replace the paraffin-impregnated gauze, the gauze and
cotton-wool absorbent layer, and the crêpe bandage.
3 When the wound is healing and has become epithelialized, leave it exposed
or cover it wit h a dr y, non-adherent dressing.
4 Refer burns that have not healed in 10–12 days to a plastic surgery unit for
review and consideration for skin grafting.
5 Warn the patient that healed burns will initially be both hypersensitive and
photosensitive, will have dry scaly skin, and that there may be depigmenta-
tion in dark-sk inned races.
MINOR BURNS OF THE HAND
DIAGNOSIS AND MANAGEMENTThese are difficult to dress.
1 Cover the hand with silver sulfadiazine cream and place the hand inside a
sterile polythene bag, bandaged over a gauze ring as a seal at the wrist.
2 Elevate the hand and encourage the patient to move the fingers regularly.
3 Give tetanus prophylaxis and analgesia.
4 Replace the silver sulfadiazine cream and bag daily, as turbid f luid collects in
the bag.