A 65-year-old woman comes to the emergency department due to a burn on her left hand. She lost her grip when pouring a large pot into the kitchen sink, spilling boiling water onto her hand. Medical history includes obesity, hypertension, and well-controlled type 2 diabetes mellitus. The patient is up to date on vaccinations. Blood pressure is 136/84 mm Hg and pulse is 82/min. There is erythema of the skin on the palmar surface of the left hand and distal forearm; the area is dry, has no blisters, and has good capillary refill but is painful when touched. Following cleansing of the area, ointment and a clean dressing are applied. Which of the following is the best next step in management of this patient?

Question

A 65-year-old woman comes to the emergency department due to a burn on her left hand.  She lost her grip when pouring a large pot into the kitchen sink, spilling boiling water onto her hand.  Medical history includes obesity, hypertension, and well-controlled type 2 diabetes mellitus.  The patient is up to date on vaccinations.  Blood pressure is 136/84 mm Hg and pulse is 82/min.  There is erythema of the skin on the palmar surface of the left hand and distal forearm; the area is dry, has no blisters, and has good capillary refill but is painful when touched.  Following cleansing of the area, ointment and a clean dressing are applied.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d196_cad7_bc81_95f2b2f95d0a_MD0003_00 This patient who spilled boiling water onto her left hand now has a superficial (ie, first-degree) burn. Superficial burns involve only the epidermis and are characterized by erythema, intact capillary refill and pain sensation, and lack of blistering or weeping (ie, dry). Because the epidermis remains in continuity in superficial burns, the skin's protective barrier against microbial invasion remains intact; therefore, topical antimicrobial ointments are not required. After gentle cleansing of the affected area, a basic ointment or perfume-free moisturizer (eg, petroleum jelly, aloe vera) is sufficient to provide a moist wound-healing environment. A dressing may be applied for protection of the area and/or patient comfort. Debridement is not required, and superficial burns generally heal within a week without scarring. Patients with superficial burns may be discharged with simple wound care instructions (eg, wash daily, apply moisturizer). Even if the affected area involves joint creases (eg, hand and finger joints), normal joint range of motion is encouraged. Follow-up within a few days of the injury is advised to confirm that the affected area is healing and that the patient is resuming normal use of the affected area. (Choice A) Superficial burns do not require debridement because the epidermis remains intact. In contrast, partial-thickness burns, which have blistering and/or sloughing of the epidermis, typically require at least gentle debridement (eg, abrasion with saline-moistened gauze) to remove the devitalized tissue. Full-thickness burns require complete surgical excision, followed by skin grafting. (Choices B and C) Prophylactic systemic (eg, IV, oral) antibiotics are not used in the management of burns. Even for deeper (eg, partial- or full-thickness) burns, prophylactic antibiotics do not prevent burn sepsis (ie, invasive infection) but instead may select for more aggressive, antibiotic-resistant bacteria. Topical antibiotic ointments are not required for superficial burns but are regularly used for deeper burns. (Choice D) Topical steroids are contraindicated in the initial treatment of superficial burns because decreasing the local inflammatory response may impair healing and increase the risk of infection. Educational objective: Superficial burns involve only the epidermis and are characterized by erythema, pain, intact capillary refill, and lack of blistering or weeping. They do not require debridement and can be managed with simple wound care (eg, cleansing, moisturization). References: Outpatient burn care: prevention and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/32293848) Antibiotic prophylaxis for preventing burn wound infection. (http://www.ncbi.nlm.nih.gov/pubmed/23740764)

A 65-Year-Old Woman Comes to the Emergency Department Due to a Burn