From the Guidelines
The recommended treatment for a second-degree burn in the Emergency Department (ED) involves cooling the burn with cool running water for about 10-15 minutes, followed by covering the burn with a nonadherent bandage or clean cloth to protect the wound and reduce pain. This approach is supported by the most recent guidelines, including the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The use of cool water for cooling is crucial, as it helps reduce pain, edema, and depth of injury, and speeds up the healing process, as noted in previous guidelines 1.
When managing a second-degree burn in the ED, it is essential to:
- Cool the burn with cool running water to stop the burning process and reduce pain
- Gently clean the wound with mild soap and water to remove debris or dead tissue
- Cover the burn with a sterile, non-adherent dressing, such as petroleum-impregnated gauze or silicone-based dressings, to protect the wound and reduce pain
- Consider pain management options, such as acetaminophen or ibuprofen
- Leave blisters intact unless they are large, tense, or likely to rupture
- Administer tetanus prophylaxis if needed
The goal of this treatment approach is to promote healing, prevent infection, and reduce the risk of complications, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life. According to the latest guidelines 1, covering the burn with a nonadherent bandage or clean cloth is a key step in protecting the wound and reducing pain until the burn can be assessed by a healthcare professional.
From the FDA Drug Label
Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch.
The recommended treatment for a second-degree burn in the Emergency Department (ED) includes:
- Cleansing and debridement of the burn wound
- Application of silver sulfadiazine cream, USP 1% under sterile conditions
- 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 2 2
From the Research
Treatment of Second-Degree Burns in the Emergency Department (ED)
The treatment of second-degree burns in the ED involves several considerations, including the burn site, patient age, and burn area. According to 3, a consensus on the treatment of second-degree burn wounds provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment, and infection treatment.
Nonsurgical Treatment
Nonsurgical treatment options for second-degree burns include the use of topical agents such as silver sulfadiazine, hyaluronic acid, and sucralfate. A study by 4 found that a fixed combination of hyaluronic acid and silver sulfadiazine was effective in treating second-degree burns and caused a significantly more rapid re-epithelialization of burns compared to silver sulfadiazine alone. Another study by 5 found that topical sucralfate dressing was efficacious in terms of development of early granulation in the healing of second-degree superficial burns compared to silver sulfadiazine dressing.
Comparison of Topical Agents
A comparison of topical agents for second-degree burns was conducted by 6, which found that a triple-antibiotic ointment enhanced reepithelialization and reduced scar depth and contraction compared to a silver-based foam dressing. The study suggests that a triple-antibiotic ointment should be considered as a control for studies evaluating novel topical burn therapies.
Prehospital Cooling
Prehospital cooling of severe burns is an essential aspect of burns management, as it can reduce the depth of the burn and improve clinical outcomes. A study by 7 found that appropriate cooling of severe burns presenting to the ED was inadequate, and education of the community and prehospital healthcare workers about the importance of early appropriate cooling of severe burns is required.
Key Considerations
- Burn site, patient age, and burn area should be considered when treating second-degree burns
- Topical agents such as silver sulfadiazine, hyaluronic acid, and sucralfate can be effective in treating second-degree burns
- Prehospital cooling of severe burns is essential to reduce the depth of the burn and improve clinical outcomes
- Education of the community and prehospital healthcare workers about the importance of early appropriate cooling of severe burns is required
Treatment Options
- Nonsurgical treatment: topical agents such as silver sulfadiazine, hyaluronic acid, and sucralfate
- Surgical treatment: may be necessary for deep second-degree burns or burns that do not respond to nonsurgical treatment
- Infection treatment: antibiotics may be necessary to prevent or treat infections in second-degree burns
- Prehospital cooling: cool running water for 10-20 minutes up to 3 hours after a burn can reduce the depth of the burn and improve clinical outcomes