Be aware of misconceptions
It’s necessary to be aware of current thinking on burn treatment, stresses Teresa Merk, RN, BSN, transport coordinator at Shriners Burns Hospital for Children in Cincinnati, OH. Here are some common misconceptions about management of burns:
Myth 1: If the patient has pulses to all extremities, the patient’s circulation must be good. "We were all taught in nursing school the importance of checking and documenting pulses," says Merk. "However, in burns, even if a pulse is present, there can still be inadequate blood flow and damage to nerves in the extremity, enough to cause death of the muscle or impairment of neurological function."
The long-term consequences of inadequate circulation sometimes leads to amputation being required, says Merk. "This is a problem that must be addressed in the ED or during the initial hours following the burn injury. Every nurse working the ED must be aware of this."
Compartment pressures should be measured, and escharotomies performed as needed. "It’s frustrating when a nurse reassures me the patient still has a dopplerable pulse, and I know the burn is circumferential, and the extremity is as hard as a rock. A simple escharotomy in the ED can prevent many long-term complications," Merk stresses.
Myth 2: Burn patients should be started on antibiotics. "Burned patients should not be started on antibiotics prophalactically, because they will build up a resistance to them. Then when the patient does need them, we will not be able to use them," says Merk. "Also, if you keep the wounds clean, they will not usually become infected."
Patients also do not become instantly infected with a burn injury. "Probably the only time we start antibiotics in the early phase of treatment is for your typical ear infections," Merk notes.
Myth 3: Topical antimicrobial agents should be applied immediately. Application of antimicrobial agents in the ED is unnecessary, says Merk. "ED staff should not be applying topicals, as the burn unit will want to evaluate the wounds upon admission," says Merk. "Dry dressings and blankets are basically all you need."
Myth 4: Sterility is essential. "You do not need to be sterile at the scene. This would also include the ED," says Merk. "When we do dressing changes, we use clean techniques. Only after the patient has been grafted do we use sterile techniques."
Infection in the burn patient can be prevented by routine cleansing of the burn wound and frequent hand/ forearm washing, says Merk. "Remove wrist watches to ensure proper hand/forearm washing," she recommends. "Many nurses are aware of the importance of hand washing, but very few wash their forearms. This can be a major source of contamination."
Use gloves at the patient bedside, and eliminate cross contamination by the use of equipment used on other patients without proper decontamination (i.e., stethoscopes), Merk advises.
Myth 5: C-spine clearing isn’t necessary. "C-spine clearing is sometimes not considered necessary for burn patients, but often times should be," says Merk. "Any patient suspected of being abused, even if they only appear to be abused by burning, could have a C-spine injury."
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