Burn Management

Case Study: Your morning has been relatively quiet until shortly before noon when you get an urgent call from the daughter of a long-time patient, Mildred. Mildred is an 80-year-old woman who has been in good health except for elevated cholesterol and cataracts for as long as you have known her. In fact, you became her doctor when the practitioner who started your practice retired fifteen years ago. Mildred’s daughter tells you, “Mom was deep frying the turkey and got burned. She doesn’t want to go to the ER, but we think that she should go. Can you talk some sense into her?”

What do you want to do now?

You ask to talk with Mildred on the phone. When she picks up, you ask her if she is ok. She says that her arms hurt. You ask her what happened. Mildred tells you that she was deep frying the turkey, as she does every year. But as she was pulling out the turkey from the fryer, hot grease splattered on her arms. You ask her if she did anything afterwards, and she tells you that she ran cool water on both her arms for about 10 minutes while her children argued about whether or not she should go to the hospital. She does not seem to be in extreme pain while she is talking with you. However, she does tell you that the areas where the grease splattered are very painful and red. You ask her to send you a picture of her burns over the phone. She gives the phone to her daughter who gets your phone number, takes a picture of Mildred’s arms, and texts you the picture.

On the photographs, you see a few red areas with one or two blisters over Mildred’s forearms. The burns are not circumferential and they do not cross any flexures. You do not see any burns on her hands or face. The blistered areas appear red, and there is no evidence of white, deep partial or full-thickness burns. Based on the pictures her daughter sent, you do not think Mildred meets the criteria for being sent to a burn unit. The American Burn Association criteria for being sent to a burn unit are as follow: burns associated with other traumatic injuries; chemical burns; electrical burns; children with burns; burns with inhalation injuries; patients who will need rehabilitation; patients who have significant co-morbidities; third-degree burns; burns involving face, hands, feet, genitalia, or perineum; partial-thickness burns covering more than 10% surface area; or any third degree burns. Nevertheless, you call Mildred back and ask her to meet you in the clinic so you can get a better look and treat her burns.

In the clinic, you see that Mildred mostly has superficial first-degree burns that look like a bad sunburn. However, there are some areas that are blistered and look like superficial partial-thickness (second-degree) burns.

What do you want to do now?

You take pictures to document how the burns first appeared and put them in Mildred’s chart. You give Mildred some ibuprofen and ask her if she would like additional pain control before you treat the burns. She declines any additional pain control. You then wash the burned areas with sterile water, leaving the blisters intact. You decide to apply topical Bacitracin to the burned area and a nonstick dressing. The family should help the patient with dressing changes twice a day for the next week. When you discharge Mildred home, you arrange for close follow-up in the clinic the next day and on Monday. Lastly, you tell Mildred and her family that if she develops a fever or any sign of infection, they should call you immediately.

Additional Resource: American Burn Association – Burn Center Referral Criteria

Dr. V. Silverstein
Durham, NC

Published on 11/13/19