• May 2, 2007, Antidepressant drugs: Update to the existing black box warning on the prescribing information on all antidepressant medications to include warnings about the increased risks of suicidal thinking and behavior in young adults ages 18 to 24 years old during the first one to two months of treatment.

Minor Burns (other burns justify immediate referral to a burn specialist. Consider referral of major burn victims to one of the major burn centers in the United States: http://www.ameriburn.org/verification_verifiedcenters.php )

1. Definitive Diagnosis Completed
2. Initial Therapy
   • Manage the burn area with sterile technique as the major complication of a burn is infection. Prevention of infection is a major goal of therapy.
   • Cleanse gently to remove any foreign matter.
   • Apply a sterile cold or ice saline compress to the burn area for up to 20 minutes. Avoid direct contact of ice to the skin.
   • Under sterile conditions, apply a webbed medicated gauze to the burn area and cover with a bulky loose webbed bandage dressing.
   • Give tetanus toxoid when appropriate.
   • Prescribe analgesics. Initially give by injection, if necessary, to assist in the cleansing and dressing of the burn. Then give orally for three to five days.
   • Redress under sterile conditions with a webbed medicated gauze dressing every three to five days until healed.
   • The routine use of oral antibiotics is not necessary or proven to reduce the incidence of serious infection or hasten healing. However, if there is evidence of infection, prescribe oral broad-spectrum antibiotics.
   • Many minor burns are completely healed in less than 10 days.
   • Consultation or referral to a burn specialist is appropriate for patients with third degree burns because most require grafting.
   • Estimate a return-to-work date for temporary transitional and regular work at each visit.
   • Prescribe level of activity at work and job modifications at each visit.

3. Secondary Evaluation for Patients with Minimal Improvement after 7-10 Days of Therapy
   • If the burn is not healing well by this time, perform a careful evaluation for infection, vascular compromise, diabetes, and other systemic factors, which may delay healing.
   • Review history to make sure that the patient is complying with the prescribed care of the burn.
   • Review for superimposed infection.
   • Redress the burn if any signs of infection exist, prescribe antibiotics, and immobilize the injured part.
   • Re-evaluate every three to four days. If healing does not progress by 7–10 days, refer to a specialist.

Definition: There are three levels of burns:

First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.

Second-degree burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering.

Third-degree burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.

Editor-in-Chief, Philip L. Denniston, Jr. and Senior Medical Editor, Charles W. Kennedy, MD, together pilot the group of approximately 80 members. See the ODG Treatment in Workers Comp Editorial Advisory Board.

Electronic copies of the updated guideline: Available to subscribers from the Work Loss Data Institute Web site.

Print copies: Available from the Work Loss Data Institute, 169 Saxony Road, Suite 210, Encinitas, CA 92024; Phone: 800-488-5548, 760-753-9992, Fax: 760-753-9995; www.worklossdata.com.

• Background information on the development of the Official Disability Guidelines of the Work Loss Data Institute is available from the Work Loss Data Institute Web site.
• Appendix. ODG Treatment in Workers' Comp. Methodology description using the AGREE instrument. Available to subscribers from the Work Loss Data Institute Web site.

Electronic copies: Available to subscribers from the Work Loss Data Institute Web site.

Print copies: Available from the Work Loss Data Institute, 169 Saxony Road, Suite 210, Encinitas, CA 92024; Phone: 800-488-5548, 760-753-9992, Fax: 760-753-9995; www.worklossdata.com.

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