Burn injuries in MWDs are typically caused by fires, motor vehicle mufflers, stoves, caustic chemicals, or explosions. While uncommon, these injuries can cause not only severe pain and complicated local wounds, but also result in serious metabolic abnormalities and systemic infection that can lead to life-threatening compromise.
Burn Classification
Burns affecting dogs are physically similar to those in humans. Hair may need to be carefully clipped over burned areas for adequate assessment. Superficial burns are red and painful, similar to sunburn, involving the outer layer of the epidermis. Superficial partial-thickness burns are red or mottled, with epidermal sloughing, fluid leakage, swelling, and extreme hypersensitivity (pain), involving the epidermis and variable amounts of dermis. Hair should not easily pull out. Deep partial-thickness burns are black or yellow-white and hair follicles are destroyed, and the skin surface is dry. These burns are generally less painful, as nerve endings are destroyed. If any hair remains, it will pull out easily. Full-thickness burns are black, dry, and leathery. These burns have destroyed the epidermis and dermis and expose underlying connective tissue, muscle, and bone. Any eschar that forms is painless.
Inhalation Injury
Burn patients may have significant inhalation injury. Clinical signs of inhalation and pulmonary injuries may not manifest for several hours. Clinical signs of inhalation injury include stertor or stridor, harsh cough or upper airway sounds, coughing, production of dark sputum, tachypnea, and respiratory distress. MWDs with inhalation injury should be observed closely for need for orotracheal intubation or (uncommonly) tracheostomy to manage the airway. Intubate or perform tracheostomy for any MWD with observed respiratory distress or if in doubt about the patency of the airway (See CPG 3).
Estimation of Total Body Surface Area (TBSA) Burn Extent in Dogs
- Determine the severity of the burn once the MWD has been resuscitated and stabilized. General characteristics of the wound that are important to examine include color, texture, presence or absence of pain, moistness, and extent of swelling, if present.
- Estimate the percent of the total body surface area (TBSA) that is burned by using a modification of the “Rule of 9s” used for humans:4
- ADD the estimated percent of burn from EACH of the following body areas:
- Head and neck (H/N) – 9%
- Chest (C) – 18%
- Abdomen (A) – 18%
- Each forelimb (L FL, R FL) – 9%
- Each hindlimb (L HL, R HL) – 18%
- TBSA = H/N + C + A + L FL + R FL + L HL + R HL. For example, the estimated TBSA burn for a dog with burns to the chest and abdomen and left forelimb would be 18% (chest) + 18% (abdomen) + 9% (L FL) = 45%.
- The percent TBSA is important in assessing severity, anticipating problems, and determining prognosis. Patients with TBSA >20% often have severe metabolic problems (e.g., hypovolemic shock, albumin and electrolyte losses, acidoses, renal failure); patients with TBSA >50% have a poor prognosis.4 Any discussion of prognosis must take into consideration not only the TBSA but also the severity of burn. Note that initial evaluation of severity of burn wound may be inaccurate, as wounds often progress over a period of 3-7 days before completely manifesting ultimate severity.4-5
General Patient Management Recommendations
- Monitor and treat for complications related to burn injury, to include shock, fluid losses, respiratory problems, and electrolyte abnormalities, see appropriate CPGs. Stabilize the patient first. Manage pain using appropriate analgesics (See CPG 16 and Table 17).
- Cool the burned skin using cool water (45-65° F) by immersion, application of compresses, or gentle spray for at least 30 minutes. Do not apply ice to any burned skin, as the vasoconstriction it causes may impede wound healing and may worsen the extent of tissue damage. Measure the patient’s rectal or esophageal temperature frequently to monitor for and prevent hypothermia.
- Minimize potential contamination of burned skin. Wash hands thoroughly before handling patients; wear clean exam gloves (superficial burns, superficial partial-thickness burns) or sterile surgical gloves (deep partial-thickness burns, full-thickness burns); do not contact wounds with things such as personal clothing, stethoscopes, or other instruments or monitors; wear barrier protection when handling deep partial-thickness burns and full-thickness burns; change gloves and wash hands before handling other burn wounds and invasive devices on the same patient.
- Follow strict aseptic technique when placing invasive devices and use clean examination gloves whenever handling catheters, adapters, fluid lines, etc. Unless absolutely necessary, do not place invasive devices through burned skin. Provide antibiotic coverage using the guidelines in CPG 14 only for MWDs presumed to be immunocompromised, with pneumonia or acute lung injury, or with sepsis or suspected sepsis.
- Provide excellent nursing care. Turn or rotate the MWD every 4 hours if recumbent, and perform Passive Range of Motion (PROM) exercises of all limbs except burned limbs every 4 hours. Provide soft, padded bedding. Prevent urine scalding and fecal soiling. Allow MWDs to eat and drink if able.
Specific Burn Wound Management Recommendations
- Depending on severity and extent of burn, the patient may require daily heavy sedation or general anesthesia to allow debridement and management. Extreme care must be taken to monitor burn patients adequately during sedation or anesthesia (See Table 17).
- Superficial or superficial partial-thickness burns are generally managed with daily cool water lavage, followed by topical silver sulfadiazine cream application until healed or the wound worsens.
- Deep partial-thickness and full-thickness burns need varying degrees of daily wound debridement. This may be accomplished by use of conservative debridement, chemical debridement, or surgical debridement.
- Conservative debridement of deep partial-thickness and full-thickness burns involves hydrotherapy using sterile saline lavage under light pressure or application of a wet-to-dry saline dressing under a light bandage for several hours, followed by removal of obvious necrotic or dead tissue using aseptic technique. Surgical debridement may be necessary in very deep or widespread wounds to more aggressively remove necrotic tissue; however, HCPs should not routinely perform surgical debridement
- MWDs should be evacuated to veterinary facilities for this level of care.
- Following debridement, apply silver sulfadiazine (SSD) cream, petrolatum, or hydrogel dressings in a thin layer directly on the wound and cover the burn with a non-adherent dressing (if the wound area is bandaged) or leave the burn uncovered (if bandaging is not permissible due to wound size or location).
- Bandage burn wounds if the burn area is amendable to application (i.e., the bandage can be placed without increasing patient discomfort, the burn area is relatively small, and the bandage will not increase the potential for wound injury). If there is any doubt about whether to bandage a burn wound or not, it is better to leave the wound unbandaged. In most cases, a wet-to-wet bandage is recommended to keep wounds moist and improve comfort. Change bandages at least daily or more often if wound exudate is excessive or the bandage becomes soiled.
Table 17. Management of Burn Wounds in MWDs