UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Burns, Part II

Posted: 8/13/2010 by Adam Friedlander, MD (Updated: 8/17/2022)
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A common debate on the topic of pediatric burns is whether or not blisters should be debrided.  ALL PEDIATRIC BURN BLISTERS SHOULD BE DEBRIDED.  There are two reasons for this:

1. Without debridement of burn blisters, the depth of a burn cannot be assessed, and such an assessment will certainly affect treatment and disposition.
2. There is conflicting (poor) evidence that blister fluid provides both protective and damaging properties, however, there is excellent evidence that ruptured blisters, or large blisters which are likely to rupture, carry a higher risk of infection if not debrided. Therefore, all blisters should be debrided. 

The best method for debriding blisters uses sterile gauze soaked in saline, and it is important to note that pain is almost universally decreased after debridement. 

The "1, 2, 3 Ouch!" technique is exactly what it sounds like (count to three with the child, and then wipe quickly, like tearing off a bandage), and works well in older children with smaller burn areas.  Sedation may be necessary for extensive debridements, and these children may need to be taken to the OR for debridement under anesthesia.  Some burn centers utilize non-operating room anesthesia (NORA) areas for such debridements that may be prolonged or painful, but do not require the full resources of an operating room.

References

Sargent, RL. Management of blisters in the partial-thickness burn: an integrative research review. J Burn Care Res 2006; 27:66.

Alsbjorn, B, Gilbert, P, Hartmann, B, et al. Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party. Burns 2007; 33:155.