Hydrogel burn dressings

[Melbourne MICA]

Interested to hear any thoughts on the clinical value of these types of burn dressings beyond "soothing" wounds. Cost effective? Proven efficacy based on quality evidence? Effect on burn management approach by EMS - ie are staff now approaching a burn this way.....Burn=Burnaid/Waterjel/Burnshield etc. If so is hypothermia now a bigger issue proportional to larger BSA.
Do you use 20min cool running water then cover with clingfilm and dry dress + IV analgesia for pain. If not why not? Other approaches to burn management? (Interested in the "cooling" and pain relief issues in particular not the ALS, airway burns, fluid resus stuff)

Cheers
MM

 

[Smash]

Interested to hear any thoughts on the clinical value of these types of burn dressings beyond "soothing" wounds. Cost effective? Proven efficacy based on quality evidence? Effect on burn management approach by EMS - ie are staff now approaching a burn this way.....Burn=Burnaid/Waterjel/Burnshield etc. If so is hypothermia now a bigger issue proportional to larger BSA.
Do you use 20min cool running water then cover with clingfilm and dry dress + IV analgesia for pain. If not why not? Other approaches to burn management? (Interested in the "cooling" and pain relief issues in particular not the ALS, airway burns, fluid resus stuff)

Cheers
MM

Don't like the gel impregnated dressings for larger/serious burns, I find that the goo gets absolutely everywhere and makes it very difficult to hold on to things and secure IV's and the like as no adhesive will stick. I had a patient recently in whom I had to just about hold a cannula in the entire time, despite trying with clean towels, wet towels and isowipes to clean around the area to get the op-site to stick.

Most times cooling has been done prior to me arriving, I then prefer clingfilm, analgesia and managing whatever other problems that arise.

For smaller superficial and partial burns the goo stuff seems fine.

That is purely my uneducated, unscientific bias.

 

[Melbourne MICA]

Goo stuff

Are Hydrogels in widespread use around your neck of the woods smash?

MM

 

[abckidsmom]

Don't like the gel impregnated dressings for larger/serious burns, I find that the goo gets absolutely everywhere and makes it very difficult to hold on to things and secure IV's and the like as no adhesive will stick. I had a patient recently in whom I had to just about hold a cannula in the entire time, despite trying with clean towels, wet towels and isowipes to clean around the area to get the op-site to stick.

Most times cooling has been done prior to me arriving, I then prefer clingfilm, analgesia and managing whatever other problems that arise.

For smaller superficial and partial burns the goo stuff seems fine.

That is purely my uneducated, unscientific bias.

In situations like this, I just wrap tape around the whole arm to make a base of dry plastic for the tape to stick to. And alcohol works better to dry and clean skin than plain wiping.

I haven't used the hydrogels except in home first aid use, and my kids complained that they hurt worse...I didn't get any more.

 

[mycrofft]

Hydrogels...worn by stuntmen on fire, right?

One more thing for the ER to cope with and clean off. Once the burn is cooled off, SNS gauze under a dry combine dressing, wrap it, and didimau.
What is the current feeling on pressure wrapping to restrict edema (with frequent distal check of circ/sense, of course)?

 

[the_negro_puppy]

We have burn aid but only really use it to soothe superficial burns.

We use gladwrap/clingwrap for partial and full thickness burns. No stick, easy to find and use.

We are taught to rinse burn for 5 mins for heat burns and up to 15 for chemical.

20 is probably a bit long but if its soothing the pain and not causing them to freeze then theres no harm in it.

 

[Smash]

Are Hydrogels in widespread use around your neck of the woods smash?

MM

Becoming increasingly more so. I seem to recall that they are very expensive, but I'm not sure how much they actually cost. I'm happy with cooling and clingfilm

In situations like this, I just wrap tape around the whole arm to make a base of dry plastic for the tape to stick to. And alcohol works better to dry and clean skin than plain wiping.

I haven't used the hydrogels except in home first aid use, and my kids complained that they hurt worse...I didn't get any more.

That sounds like a good idea. The only worry I would have would be with circumfrential burns (which the last pt I had as above, had) and the subsequent constriction as the limb swells up.

 

[abckidsmom]

Becoming increasingly more so. I seem to recall that they are very expensive, but I'm not sure how much they actually cost. I'm happy with cooling and clingfilm



That sounds like a good idea. The only worry I would have would be with circumfrential burns (which the last pt I had as above, had) and the subsequent constriction as the limb swells up.

Transpore tape is pretty stretchy, and would give you time to notice the swelling and redo it. You have to do something, and they frown on medics doing like they do in the hospital and just putting staples in to hold stuff in place.

 

[Melbourne MICA]

Hydrogoo

Some great thoughts guys. Like the practical points - the gooy mess when you don't want a gooey mess etc.

Cooling, clingwrap and dry dressing. PRN pain relief.

But these things are feral - they're everywhere. Also EMS services are all doing things different on burns but being sold the dummy on hydrogels big time in my opinion Just wrote a 50 page document on them for our service.

Scary stuff. Burn=Burnaid seems to be becoming like a subliminal mantra for staff. the hsopitals are worried and our biggest kids hospital has told us they don't want to see them on any burn child whatsoever.

DO you guys think all your staff from EMT's right through to crit care and Paras recognise the sequalae of burns and the right treatment approach on the cooling issue?

MM

 

[Melbourne MICA]

Pressure wrap

One more thing for the ER to cope with and clean off. Once the burn is cooled off, SNS gauze under a dry combine dressing, wrap it, and didimau.
What is the current feeling on pressure wrapping to restrict edema (with frequent distal check of circ/sense, of course)?

My understanding is oedema develops 8-12hrs post burn so not an issue for us. The burns units are more worried about perfusion shutdown from overzealous cooling especially on distal extremities. The same would go for any pressure dressing of wounds. You don't want pressurisation of the zone of stasis around the burn. It needs to be well perfused to promote re-epithelialisation. Even more so in hands and feets etc.

MM