What are the guidelines for outpatient treatment of severe burns?

From the Guidelines

Outpatient treatment of severe burns should be approached with caution, prioritizing partial-thickness burns covering less than 10% of total body surface area (TBSA) in adults or less than 5% in children, with no involvement of critical areas like face, hands, genitalia, or major joints. Initial management includes cooling the burn with room temperature water for 10-20 minutes, gentle cleansing with mild soap and water, and applying a topical antimicrobial agent. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, covering a partial- or full-thickness burn with a nonadherent bandage or clean cloth protects the wound and reduces pain while avoiding heat entrapment until the burn can be assessed by a health care professional. Key considerations for outpatient treatment include:

• Cooling the burn with room temperature water for 10-20 minutes
• Gentle cleansing with mild soap and water
• Applying a topical antimicrobial agent such as silver sulfadiazine 1% cream or bacitracin ointment
• Covering the burn with a non-adherent dressing like petroleum-impregnated gauze, followed by sterile gauze and secured with rolled gauze or tape
• Changing dressings daily or every other day, inspecting for signs of infection
• Pain management typically involves acetaminophen 650-1000mg every 6 hours and/or ibuprofen 400-600mg every 6 hours, with possible addition of short-term opioids like oxycodone 5-10mg every 4-6 hours for severe pain
• Tetanus prophylaxis should be administered if needed
• Patients should be instructed to elevate burned extremities, maintain adequate hydration, and consume a high-protein diet to support healing Immediate referral to a burn center is necessary if the patient develops signs of infection (increasing pain, redness, swelling, purulent drainage, fever), worsening pain despite medication, or if the burn appears to be deepening, as suggested by the management of severe thermal burns in the acute phase in adults and children 1.

From the FDA Drug Label

The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The burn areas should be covered with silver sulfadiazine cream, USP 1% at all times The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch. Reapply immediately after hydrotherapy. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting.

The guidelines for outpatient treatment of severe burns include:

• Cleansing and debriding the burn wounds
• Applying silver sulfadiazine cream, USP 1% under sterile conditions
• Covering the burn areas with the cream at all times
• Applying the cream once to twice daily
• Reapplying the cream after hydrotherapy
• Continuing treatment until satisfactory healing or until the burn site is ready for grafting 2. Silver sulfadiazine cream, USP 1% is indicated for the prevention and treatment of wound sepsis in patients with second and third degree burns 2.

From the Research

Guidelines for Outpatient Treatment of Severe Burns

The guidelines for outpatient treatment of severe burns involve a systematic approach to burn care, focusing on assessing the depth and extent of injury, and providing appropriate treatment and follow-up care.

• The American Burn Association has established criteria for determining which patients can be managed as outpatients and which require hospital admission or referral to a burn center 3.
• Burn depth and percentage of total body surface area involved are two key determinants of the need for referral to a burn center 4.
• Initial treatment is directed at stopping the burn process, and superficial (first-degree) burns can be treated with simple first-aid techniques and over-the-counter pain relievers 4.
• Partial-thickness (second-degree) burns require advanced dressings to protect the wound and promote a moist environment, while deep partial-thickness burns require immediate referral to a burn surgeon for possible early tangential excision 4.
• Full-thickness (third-degree) burns involve the entire dermal layer, and patients with these burns should automatically be referred to a burn center 4.

Treatment Options

Treatment options for outpatient burn care include:

• Topical application of lotions, honey, aloe vera, or antibiotic ointment for superficial burns 5.
• Topical antimicrobial agents or absorptive occlusive dressings for partial-thickness burns 5.
• Polyurethane dressings for exudative wounds, and hydrocolloid dressings as the wound dries up 6.
• Silver sulfadiazine or silver dressings for limited infections 6.

Follow-up Care

Follow-up care is important to assess patients for:

• Infection 5, 6, 3.
• Healing 5, 6, 3.
• Ability to provide proper wound care 3.
• Complications such as slow healing, scar formation, and contracture 3.
• Psychologic problems related to long-term disability or disfigurement from burn injuries 3.