4 Things Retail Clinicians Should Know About Treating Acute Burns

Because of the wide accessibility of retail clinics, nurse practitioners and physician assistants may be the first health care professionals patients turn to for acute burn treatment.

Patrick Dougherty, PharmD, BCPS, a clinical pharmacist from the Emergency Medicine Peninsula Regional Medical Center, and Meghan Sullivan, PharmD, BCACP, director of the Center for Medication Therapy Management at Creighton University School of Pharmacy and Health Professions, discussed some steps to take to help treat patients with burns at the 2015 American Society of Health-System Pharmacists Midyear meeting.

Dr. Dougherty toldContemporary Clinicthat nurse practitioners and physician assistants certainly play a part in managing patients’ acute burn treatments.

“Working in conjunction with pharmacists [and] physical therapists, and helping these patients try to get back to their normal lives they had prior to the injury—I think there’s definitely a role for nurse practitioners and physician assistants,” he said.

Drs. Dougherty and Sullivan discussed the 5 main types of burns, the most common of which is thermal burns that can stem from fires, flames, or hot liquids or surfaces.

The remaining 4 burn types are chemical, electrical, solar or radiation, and friction, the latter of which can occur when patients have accidents on treadmills, for example.

Some considerations for retail clinicians to stop the burn include protection of the airway, initiation of fluid resuscitation, pain management, and adequate circulation.

Here are 4 important facts to know about the acute treatment of burns:

1. The Parkland formula is a useful guide for fluid management.

One critical aspect of burn treatment is fluid management, since patients have experienced severe fluid loss because of their injury.

Dr. Dougherty highlighted the Parkland formula, which is most commonly used for fluid management.

For adults, health care providers should use 4 mL of Ringer’s lactated solution times the patient’s weight in kg times the percentage of burn surface area over the initial 24 hours.

The first half would be used for the first 8 hours from the time of the injury, and the second half would be used over the following 16 hours.

For children, multiply 3 mL of the solution by the weight and percentage of burn surface area over the initial 24 hours, plus maintain hourly maintenance fluids.

The urine output goal should be 0.5 mL/kg/hr to 1 mL/kg/hr.

2. Acute treatment for sunburns should include education, cleansing, and cooling.

Patients should return home from their retail clinic visit knowing how to cleanse and take care of blisters. (Blisters should be left intact or drained and debrided, depending on their size and location.)

Retail clinicians can also recommend topical anesthetics, systemic agents like pain relievers or antihistamines, aloe vera gel, non-greasy moisturizers, and cooling ice packs.

3. Patients with chemical burns will need decontamination and irrigation with water or saline.

To determine the length of the irrigation needed, pH paper may be used.

Other treatments may include topical antimicrobials and tetanus prophylaxis.

For chemical burns involving phenol, irrigation and a rinse with isoproponal is appropriate. For hydrofluoric acid burns, “copious” irrigation with water and co-administration with calcium gluconate is required.

Lime and water burns should be treated by wiping off dry particles and using a strong stream of water to stop the heat.

Molten metals should not be treated with water; instead, mineral oil should be used.

4. The goals for minor burn treatment include relieving symptoms, promoting health, and minimizing scarring.

Retail clinicians can clean minor burn wounds with mild soap and water or dilute an antiseptic.

Oral opioids or nonsteroidal anti-inflammatory drugs can relieve pain for these patients.

Topical antimicrobial may be applied to the burn in a thin layer, and then the burn can be covered with gauze. However, antimicrobials should not be used for the face or applied to patients with an allergy to sulfonamide.

Dr. Felton noted that gauze dressings can be great to treat new wounds in the short term, but they are not favorable for maintenance, since they can rip away new skin when removed.

Synthetic occlusive dressings may also be used for clean, flat partial-thickness burns. They should be changed twice a day to start, then once a day.