Editing Burns (section)

=== '''Initial treatment of burn''' ===

** Remove clothing and debris (don't peel off adherent clothing)
** Cooling
*** Cool/room temp water
*** Alternatively cover with wet gauze
*** Avoid ice or very cold water
*** Avoid macerating wound - max five minutes
** Simple cleansing
*** Gently clean with gauze and normal saline, or 0.1% aqueous chlorhexidine
*** Remove loose skin/debris
*** A clean flannel can be substituted if gauze is unavailable
*** Shave burns to a 2cm border at initial cleaning, and with subsequent dressing changes
** Debride
*** Remove sloughed or necrotic skin, ruptured blisters
*** Management of intact blisters is controversial. Indications for debriding them:
**** Thick-walled blisters
**** Blisters over joints or dependent areas
**** >2cm in diameter
** Appropriate dressing
*** Superficial and superficial partial thickness do not need chemoprophylaxis - use moisturiser cream
*** Deep partial or full thickness should have a topical antibiotic
*** Do not use systemic antibiotics prophylactically 
*** No role for topical steroids
*** If transferring, dry gauze is appropriate
*** For longer-term dressings, use gauze with a non-stick layer or hydrocolloid eg duoderm
** Pain management
*** Simple stuff
*** Elevation may help
*** Itching - use antihistamines
** Tetanus prophylaxis