Test Your Knowledge of Thermal Burns (Postscript 2 of 2)

Evidence-Based Urgent Care Postscript
Urgent Care Management of Patients With Thermal Burns | July 2022

A 26-year-old, previously healthy man presents the day after sustaining a burn to the dorsum of his foot during a camping trip. He was wearing flip-flops and stoking the campfire when a log rolled out and onto his right foot. There was only brief contact with the hot log, and he cooled the area with ice water and left it uncovered overnight. On examination, there is a 1% total body surface area (TBSA) superficial partial-thickness burn to the dorsum of the right foot. There is no circumferential involvement, and the foot is neurovascularly intact. The dorsal surface of toes 2, 3, and 4 show dry, blanching erythema only, and all burned tissue demonstrates pain to palpation. The patient is concerned about a large (4 cm x 3 cm) blister on the dorsal foot and wonders what he should do for wound care. Which of the following statements is MOST ACCURATE?

A. Burn blisters should never be opened or unroofed due to infection risk.

B. The patient needs immediate transfer to a burn center since the foot and toes are involved.

C. Larger blisters can be unroofed for pain relief/functional reasons; general wound care and topical bacitracin are indicated.

D. A newer-generation, biologic dressing should be applied to optimize patient outcome.

Answer: C. There is some controversy regarding the unroofing of blisters on burned skin. Most experts agree that larger blisters (>6 mm) can be unroofed for pain relief and functional reasons. Smaller blisters should be left intact. This patient has a 1% TBSA burn with no circumferential involvement, so immediate burn center evaluation is not necessary. There are no reliable data to suggest that any specific type of burn dressing is superior to others; cost, ease of use, and likelihood of compliance should strongly influence decision making when choosing dressings.

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Last Updated on January 26, 2023

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