Indications for Referral | Initial Management in the Office | |
---|---|---|
Hand burn | Partial-thickness burns >10% of TBSA | Apply dressings including bacitracin, mafenide acetate (sulfamylon), mupirocin (Bactroban), aquacel, biobrane, hydrocolloids, mepilex, xeroform, or acticoat7 |
Third-degree burns | ||
Burns involving major joints | ||
Chemical or electrical burns | ||
Inhalation injury or concomitant trauma | ||
Special social, emotional, or rehabilitation needs | ||
Trigger finger | Conservative and steroid treatments show no improvements. Provider is not comfortable with steroid injection to the stenosing tenosynovitis. | Activity modification |
Splinting | ||
Short-term nonsteroidal anti-inflammatory drugs | ||
Hand laceration | Bite | Neurovascular exam |
Laceration caused by teeth | Sensory exam | |
Capillary refill greater than 2 seconds | Motor exam | |
Exposed bones | Achieve hemostasis with pressure | |
Contamination, early infection, and associated fractures | Irrigation with sterile or tap water | |
Provider unable to close the soft tissue | Soft-tissue closure | |
Pressure ulcers | Stage 3 and 4 wounds | Wound evaluation and staging |
Bleeding control | ||
Pressure reduction | ||
Correct any existing malnutrition | ||
Occlusive dressings | ||
Venous wounds | Necrotic tissue debridement | Compression and leg elevation |
Aspirin | ||
Pentoxifylline | ||
Arterial wounds | Wound with poor perfusion | Leg elevation |
No improvements with conservative treatment | Management of modifiable risk factors | |
Diabetic wounds | Refractory to conservative treatments | Wound culture |
Deep ulcers reaching muscle or bony tissue | Antibiotic therapy | |
Dressing changes | ||
Patient education | ||
Management of risk factors | ||
Lymphedema | Stage III | Decongestive therapy |
Patient education | ||
Skin tears | Open fractures, tendon, nerve, muscle lesions, or skin tears in the eyelids | Moist dressings: aquaphor, hydrogel, or bacitracin. |
Delayed healing (> 21 days) | Encourage fluid intake | |
Scar management | Scars present for more than 1 year | Structured scar assessment |
A concerning scar assessment | Subjective evaluation | |
Keloids, recurrent scars, contracture scars, atrophic scars, widespread scars, or patients with a positive family history of abnormal scarring | Compression therapy | |
Dynamic and static splints | ||
Antihistamines | ||
Hydrotherapy |
TBSA, Total body surface area.