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Management of Burns and Scalds in Primary Care

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Management of Burns and Scalds in Primary Care ACC15029-1-Pr#6 5/17/07 12:15 PM Page 1 C M Y CM MY CY CMY K Composite ACC15029-1-Pr#6 5/17/07 12:15 PM Page 2 C M Y CM MY CY CMY K Composite Kua tawhiti ke to haerenga mai, kia kore haere tonu He tino nui rawa ou mahi Kia kore e mahi nui tonu sir james henare of ngati hine iwi from te tai tokerau We have come too far not to go further We have done too much not to do more 1 AACC15029-2CC15029-2 Pr#6.inddPr#6.indd 1 55/17/07/17/07 112:11:012:11:01 PPMM 2 AACC15029-2CC15029-2 Pr#6.inddPr#6.indd 2 55/17/07/17/07 112:11:032:11:03 PPMM Endorsements This guideline has been endorsed by the Australian and New Zealand Burn Association (until 2009), the Burn Support Group Charitable Trust, the Counties Manukau District Health Board (until 2009), the Royal New Zealand College of General Practitioners and St John. The Royal New Zealand College of General Practitioners 3 AACC15029-2CC15029-2 Pr#6.inddPr#6.indd 3 55/17/07/17/07 112:11:032:11:03 PPMM 4 AACC15029-2CC15029-2 Pr#6.inddPr#6.indd 4 55/17/07/17/07 112:11:052:11:05 PPMM Contents Endorsements ..................................................................................................................................................3 Purpose ............................................................................................................................................................9 About the guideline ........................................................................................................................................11 Summary ........................................................................................................................................................17 Chapters 1. Burn injuries and burns prevention in New Zealand ........................................................................27 2. First aid ..........................................................................................................................................31 3. Burn assessment ............................................................................................................................35 4. Referral...........................................................................................................................................45 5. Management of epidermal burns or scalds......................................................................................47 6. Management of superfi cial and mid dermal burns or scalds ........................................................... 49 7. Management of chemical injury ......................................................................................................59 8. Management of electrical injury ......................................................................................................63 9. Pain management...........................................................................................................................67 10. Psychological consequences of burn injury .....................................................................................71 11. Burn injuries in Ma¯ori .....................................................................................................................77 12. Burn injuries in Pacifi c peoples .......................................................................................................79 13. Complementary and alternative medicines .....................................................................................81 14. Implementation and evaluation ......................................................................................................83 Appendices A. Evidence and recommendation grading system ..............................................................................89 B. Wound care options ........................................................................................................................91 C. DSM-IV criteria for post-traumatic stress disorder ............................................................................95 D. Useful resources .............................................................................................................................97 Abbreviations and acronyms ...........................................................................................................................99 Glossary .......................................................................................................................................................101 References ....................................................................................................................................................103 Recommendations and good practice points Chapters 1. Burn injuries and burns prevention in New Zealand ........................................................................27 Opportunities for prevention ...........................................................................................................28 2. First aid .........................................................................................................................................31 Stopping the burning process and cooling ......................................................................................31 Gel pads .........................................................................................................................................32 Initial coverings: polyvinyl chloride fi lm (cling fi lm) .........................................................................33 5 AACC15029-2CC15029-2 Pr#6.inddPr#6.indd 5 55/17/07/17/07 112:11:052:11:05 PPMM 3. Burn assessment ...........................................................................................................................35 Emergency management .................................................................................................................35 Burn size: assessment and recording of total body surface area burn ..............................................38 Burn depth .....................................................................................................................................41 Non-accidental injury ......................................................................................................................42 Classifi cation of burns ....................................................................................................................43 4. Referral .........................................................................................................................................45 Emergency referral ..........................................................................................................................45 Referral between services ...............................................................................................................46 5. Management of epidermal burns or scalds .....................................................................................47 Dressings and creams (good practice points only)...........................................................................47 6. Management of superfi cial and mid dermal burns or scalds ...........................................................49 Preventing infection (good practice points only) .............................................................................49 Wound healing ...............................................................................................................................52 When to review (good practice point only) ......................................................................................54 Management of blisters (good practice points only) ........................................................................54 Scarring ..........................................................................................................................................55 7. Management of chemical injury .....................................................................................................59 First aid ..........................................................................................................................................59 Eye injury .......................................................................................................................................60 Specifi c substances: hydrofl uoric acid (good practice point only) ....................................................60 Specifi c substances: phosphorus (good practice point only) ...........................................................62 8. Management of electrical injury .....................................................................................................63 Management of electrical injury ......................................................................................................63 ECG monitoring ...............................................................................................................................64 9. Pain management ..........................................................................................................................67 Burn pain management ..................................................................................................................67 10. Psychological consequences of burn injury ....................................................................................71 Adverse psychological responses to trauma ....................................................................................71
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