This video is about Burn Dressings in the ED for patients that will be discharged to home.
Hey guys welcome back to another facility quick tips my name is frankie power and i’m the er educator here at the hospital my name is danielle and i’m the trauma resource nurse i’m michele i’m the physical therapist and certified wooden specialist today we have a special guest they’re gonna help us discuss the burn care in the emergency department as well as some
Of the additional topics that we can provide to our patients have to suffer oh burn so michele starting at the beginning when a burn patient arrives to the emergency department as an er nurse what should i be assessing for one of the most important things you need to remember about a burn patient is they are a patient just like all your other patients but you
Do want to incorporate a good skin assessment and based on that skin assessment you’ll be led into whether or not this is a first second or third degree burn so that you can determine which is the best treatment for them most of our patients that we are going to discharge to home which will be the ones that we are dressing will be either superficial or partial
Thickness first or second degree burns correct that’s correct unless they are a large total body surface area those then may require admission and further specialized care if i’m going to dress this burn as an er nurse how do i need to prepare the patient it depends on the patient and depends on the depth of injury first and foremost pain management so making
Sure that their pain is adequately controlled from this injury and for you to do that first dressing change second of all it depends on what the physician orders as far as your bacitracin or silvadene or what other topical medication so what areas of the body would you expect that bacitracin would be utilized and silvadene what is the preference for bacitracin
Versus silvadene when you are looking at the burn injury if it’s a superficial or first-degree sunburn face hands for instance your bacitracin is your best option it will still have enough of germ fighters in it to prevent infection but it’s not too astringent enough to cause damage to the eyes where the silver it’s a little more stringent it’s a little more
Broad-spectrum you’re gonna put that more on your chest your arms your legs back any other area where you’re not worried about rubbing the eyes or anything dripping into the eyes so definitely bacitracin for the face in the hand absolutely okay we’ve discussed what type of medication is that we might see the doctor order what type of supplies do i need to gather
To prepare for this dressing okay well let’s see we already have them gathered here wow that was fast it was fast however you’re usually not gonna have them laid out like this so let’s go over those you want a pair of scissors because we definitely need to be able to cut proper sizes that we need so we don’t overuse so we can send extras with our patient you’re
Gonna use tubular net bandage when we have these in different sizes this is a size six this is a size two forefingers the six i would probably use on a forearm you have eight size eight and that you can use on a leg or an arm and we also have a bigger size 11 that we can use to make a shirt now these are going to be used to secure and hold our dressing in place
After we have done the rest of the dressing depending on what the physician is ordered he may have ordered silvadene or she may have ordered bacitracin we actually michelle do have a tube of bacitracin in our a q dose so that’s going to be much easier for you to get access to to make this dressing go faster because we definitely don’t want our patients to get too
Cold then you’re going to use some vaseline gauze and this is your contact layer after you apply the medication and then you’ve got this thick brown gauze and well you’ll see how we do this when we do a dressing change because this is very thick and it’s used to absorb but you don’t want to you don’t want to apply too much or your patient won’t be able to move
They won’t be able to do range of motion you have curl x that we’re going to help secure the dressing and then we also have some four-by-fours and we can use those for fingers but we can also use these to clean and you have to make sure danielle that you clean these burn wounds what clean them with actually having your patient to get into the shower once they
Get home is the most important thing for them that shows in the literature to be the best way to clean a burn wound and we use non astringent so here at this hospital just because we don’t want to change the ph of our way and we have that in our pyxis as well so once you get this burn wound clean then we can go ahead and do the dressing so go ahead and show us
How to properly dress the burn just like you do up in the burn unit i’m gonna have you put your her arm up here and we’re only gonna say you have a burn that’s just on the dorsal aspect of her hand a couple fingers here and the forearm so i like to get everything ready and prepped that makes the dressing go faster mm-hmm so i will take the medicine whether it be
The silvadene or bacitracin and in this case since we have a hand we’re going to do bacitracin and a forearm we’re going to do the sylvie and i like to just go ahead and divvy out what i think i’m going to need to prevent cross-contamination back into the container so let’s take some silver dean and if you’re able to apply that directly to the burn injury the
Dosage on silvadene is 1/16 of an inch two millimeters thick so you want to try to apply that at that thickness not too much so that it’s so much that you have to clean off but just enough so that it’s kind of soothing so once you put that on there and you know if your wound was too wet for me to be able to put that on i would put it right on this vaseline gauze
Keep in mind that the vaseline gauze is whatever size you have this is a three by 18 we also have bigger through six by 36s they’re kind of accordions so don’t take this small piece and slap it right on there okay open it up try to cut to fit the best you can so michele why is it important that the silvadene not touch the the non burned areas it’s it’s not going
To damage the skin but it will macerate it or make it too wet which can mess with the integrity of the skin and cause an open a larger open wound so we’ve got the forearm covered with the silvadene and the vaseline gauze and now we’re gonna cover fingers so i have my bacitracin already out and i do put a fair amount a bacitracin on fingers because i need her to
Move her hand so i know i put a nice thick layer and again just trying to to the best of my ability cover the wounds themselves and sometimes if you need a pallet you might want to put the medicine on the back of your hand so that you don’t have to keep going back and forth as well so a question that is often asked is this a sterile procedure it is not a sterile
Procedure the only thing really sterile is in the o.r so it’s a clean procedure and we’re gonna do the same thing you’re gonna open up your vaseline gauze and again we’re going to cut and on the hand i do go a little bit beyond because your patients gonna you’re gonna ask them to continue to move make fists use that hand why is that so important with your burn
Patients that they increase their mobility when you have a burn injury regardless of size you’re gonna have local swelling local inflammation an active motion helps to decrease the swelling and on the hands you’ve got so many tendons that if you don’t move them that swelling and they will come thick and fibrotic under the tendons and they won’t be able to move so
We’re almost finished and to go along with that range of motion question i always after i wrap them or get the contact layer down i’ll ask your patient to the best of your ability try to make a fist for me and that way you can see and make sure nothing comes uncovered now that we have the contact layer in place we’re going to apply the gauze in order to absorb
Drainage so if your patients able you’re gonna ask them to straighten their fingers out and spread them apart as the fingers are spread we’re going to open the gauze and then you’re gonna kind of kind of couple the finger go around and crisscross and then i’m gonna use that size to netting to secure my dressing so it doesn’t fall off while i’m doing the rest of
My dressing now if i were to go around the fingers and just wrap all around she’s not gonna be able to move and that’s the most important part partial thickness burn injuries are gonna heal as long as there’s no infection within two to three weeks so that motion and getting all of that swelling out is the most important part of their recovery you get them back
To work so as the nurse or whoever’s dressing this wound is doing this is it important to incorporate family and anyone who is there so that they’re going home yes absolutely you want to make sure you’re educating the family members who whatever caregiver it is because they’re going to be doing these dressings once maybe twice a day depending on that order from
Whichever service they don’t know how to do it then the patient’s going to come back through the idi with a potential infection because we didn’t do our part with good family education question i’m often asked can i work usually the patients are not going to be going back to work until they follow up in the burn clinic we have a burn clinic here at this facility
On wednesday mornings so if the patient was burned on friday the physician in the er may say hey let’s have you off work until you follow up with a burn clinic and at that point based on whatever occupation that is we may let them go back light duty or just keep them off until they’re totally healed so we’ve got the fingers in the back of the hand covered and
That technique you see also gets that back of the hand cover so we don’t have to use as much of this thick bone gauze so we’re gonna wrap the forearm now and this is the burn gauze like i had mentioned earlier thick package and you don’t want to be putting this whole thing on there so you can peel this and whatever thickness you think you might need and all of
This that we don’t use we are going to have the families take home so they can use it for the next dressing so because it’s just the top of her arm i can take the burn galls and layer it just like that but it’s not going to stay on its own so then we’re going to use acrylics i like to go around the wrist once and then go around the thumb webspace once because
Otherwise it gets too tight and you can’t do your range of motion then you go up in a spiral pattern not circular these are not compressive dressings they are not meant to be extremely tight and since it’s just the forearm there’s no reason to go above if it went to the elbow i would go above because i don’t want it to slide down and expose so if we’re not using
All this you can cut and then to hold this in place we’re going to use a larger size so for your forum we can use a size six this is definitely easier with two people so if you’re able to have family help they would hold on one side and you would go up the forearm together and that’s important because these hurt so scraping is will sometimes cause more pain
Then you can either cut or poke a hole in this for the thumb because i definitely don’t want my dressing coming down and then we’re just about finished the last thing we want to do is because you’re going to be using this hand is we don’t want our dressings on the fingers to fall off so you can use whatever kind of tape trick tie yarn whatever the patient has
At home and you kind of poke a little hole through the netting poke a hole through the finger and then tie do you do both sides or just the the dorsal i usually just do the dorsal because sometimes the knot will get in the way and i never i’ve seen before where sometimes you’ll put a hole people put a hole here and then go through that but that can actually mess
With your mp joint and your finger your knuckle so try not to do that and then you can go through and do the rest of these so when sending supplies home for them to do their dressings should we send a couple two three days worth so so that they can get started and then there is a service that our case management can get involved with to set up further dressings
To be delivered yes we send about three to four days home because it takes about that long for this company to send the supplies to the home but yeah there will be a forum available by case management what you’ll need to do is have the the wound size and location so the forearm the hand fingers and then whatever you want you can get this vaseline goddess that
We use you can get burn gauze you can also get a bd pad you can get curl x the only thing that i’ve noticed is challenging is the netting so you might want to just go ahead through our central supply get a box of whatever supply of netting you want another burn that we may send home i see our nurses will be to either the back or the chest how am i supposed to
Secure that so we’re gonna have that contact layer that vaseline gauze you’re going to put the medicine on and we’re going to use the burn gauze as well so let’s say we’re gonna dress your chest you’re gonna cover it but to hold that in place we’re gonna use the netting we’re gonna use a bigger size netting usually measure the netting to whichever extremity this
Is the trunk so i’m kind of measured it out and then i’m gonna come down we’re gonna make a shirt and you make two cuts those your arm holes and this is going to stretch open now you can kind of see the vision we have two arm holes and then the head so put the arm in first as that was burned and then i’m going to come to the other side and help you you’re gonna
Put your other arm in here and i’m gonna help with your head and then we just kind of pull this down so the other thing is if this is if she’s burned up here and i don’t want the shoulder to get exposed you can take some more netting and just slide it up the arm and then use that tie to tie the shirt and the arm piece together that way none of this gets exposed
Patients who are going home with burns to the face we talked about bacitracin but should i cover those usually not they’re going home it’s usually probably scattered areas on the face so you’ll just put a little bacitracin a thin layer on those however if it’s on the forehead and it’s draining down they might want to use a little gauze to keep it from dripping
Into the eyes when discharging the patient home what are some of the things that the er nurse should educate the patient on for home care since the family member was already present for the dressing change you probably won’t need to go over that again however you do want to educate them on elevation to decrease the swelling you want to educate them on continued
Range of motion you want to explain to them the number of times a day they do the dressing that’s usually going to be once or twice a day depending on the service that was consulted on a face burn you want to make sure that they’re applying the bacitracin multiple times a day so it doesn’t dry out you also want to educate them to stay out of the sun most of the
Time your patients are not going to want to go out in the sun but the sun is going to cause them more damage and pain if they are exposed to the uv rays another thing to remember is for follow-up want to make sure you do that with whatever service was console today there’s a quick tips sheet at the secretary’s desk and to get the patient into proper follow-up
Thanks for watching this episode any quick tips as always if you have any questions we’re here to help oh
Transcribed from video
ED Quick Tips: Burn Dressings By Room9Rollout
