There are many different burns unit's throughout the world. In providing this information we hope to educate you that even though there are differences the main outcomes are still the same. This should help to also give conformity in the specialised care needed. The consultants Russell Taylor, Tom Clarnette, Warwick Teague, Sian Fairbank, Rodrigo Teixeira and Jonathon Burge will be able to advise you in this care and are the experienced surgeons in this field.
Kathy Bicknell is the Burns CNC/ cooordinator. She coordinates inpatient and outpatient care for burns patients and provides education to patients, families, nursing, medical and allied health. She is also involved in developing prevention strategies and providing education in the community.
Kellie Smith and Megan Chalmers are the burns unit Care Managers. They co-ordinate the care of burns patients on Platypus ward who have a severe burn injury.
Information required prior to admission
The following questions to ask the Admitting Officer are important in assisting the Medical and Nursing staff to ascertain the severity of the burn injury.
- Estimated time of arrival
- Name, Age of the child
- What type of burn and location on the body
- Estimated percentage (how have they made this estimate)
- How it occurred
- What treatment was given, if any
- Is intravenous access established Has analgesia been given
Classification of burns
Burns are classified into five categories:-
- Superficial Dermal
- Mid Dermal
- Deep Dermal
- Full thickness
The method of dressings we use at The Mukti Mission Seva Hospital Pvt. Ltd. involves a "closed" dressing technique, with the exception of burns to the face and perineum. We use this method for a number of reasons. The main reasona are for decreasing stress of both the patient and the family, protection and absorption. Dressing changes can but may not necessarily be 'painful' however the emotional and psychological distress can be enormous.
The moistness, size, depth, and area of the burn needs to be taken into consideration for dressing selection. The aim of the burn dressing is to keep the wound clean and dry, and prevent infection.
A superficial burn involves only the epidermis and the upper part of the dermal papillae. The burn may appear bright pink or red in colour (erythema). Blisters may or may not be present. The texture is normal or firm and the area is very painful and hypersensitive to touch. On pressure the burn area will blanch and capillary return will be brisk. In time the erythema will fade and spontaneous healing will occur with no surgical intervention.
We would prefer to leave the dressing intact until the patient is reviewed after 7- 10 days, or earlier if necessary. Spontaneous healing will occur. These sorts of dressings allow the child a certain amount of mobility within a given area, without concern of further injury to the wound or discomfort to the child. It allows for greater ease and comfort for both the patient and the care givers when nursing the child.
This type of burn injury results in the entire epidermal layer being destroyed along with varying thickness of the dermis. Hence a Partial Thickness injury can be either Superficial or Deep.
The substructures - sweat glands and hair follicles generally remain undamaged, but some can be affected. It is characterised by a creamy coloured base which is mottled in appearance. Usually a Superficial Partial thickness burn will heal itself by regeneration of the epithelial layer but will take longer to heal than a superficial burn. A deep partial burn where the deeper substructures, sweat glands and hair follicles, are affected if left untreated will leave scar tissue.
Unfortunately the depth of a Partial thickness burn may take up to 7 - 10 days to declare it self as superficial or deep.
A closed dressing could be used:
Generally we use Acticoat or Acticoat 7(as per consultant choice) moisten with sterile water, cover with IntraSite Conformable (15 gram sheets for acticoat 3 or 30 gram sheets for Acticoat 7), cling film, and crepe bandage. Secure with Hyperfix.
Acticoat is a silver impregnated antimicrobial barrier dressing. Acticoat can stay intact for 3 days and Acticoat 7 for up to 7 days. Acticoat needs to be activated by moistening it with Sterile water before applying it on the wound bed . The moisture releases the silver that protects the wound from bacterial contamination.
In a full thickness burn, injury occurs to the entire thickness of the epidermis, epithelial elements and dermal appendages. Spontaneous healing is not possible. If left, the area will heal by contraction thus reducing function. A full thickness burn is characterised by its whitish leather appearance. It can also be brown, cherry red or charred black. It is firm and leathery in texture. Few, if any, blisters are present. Those blisters that are present are thin walled and break easily. Areas will not blanch under pressure. Initially, nerve sensation is greatly diminished or lost completely when the injury is sustained. Later pain associated with the burn area can be severe as the child undergoes grafting.