What is the management of a Fraser burn?

Management of Fraser Burns

Fraser burns should be managed with immediate cooling with room temperature water (15-25°C) for at least 10 minutes, followed by wound cleansing, debridement, application of silver sulfadiazine cream, and appropriate pain management according to a stepped approach starting with acetaminophen and NSAIDs before opioids. 1

Initial Assessment and Classification

1. Assess burn severity using the Lund and Browder method to measure total body surface area (TBSA) affected 1
2. Determine depth of burn (partial vs. full-thickness)
3. Evaluate critical locations (face, hands, feet, genitalia)
4. Consider immediate medical attention if:
   • Burns affect face, hands, feet, or genitalia
   • Full-thickness burns

   • 10% TBSA in children

   • 20% TBSA in adults 1

Immediate Management

1. Control pain and shock 1

   • Start with acetaminophen 1g every 4-6 hours (maximum 4g/day)
   • Add NSAIDs for inflammatory pain
   • Reserve opioids for severe pain only, at lowest effective dose
   • Use ketamine for severe burn pain during procedures

2. Wound care 1, 2

   • Cool the burn with room temperature water (15-25°C) for at least 10 minutes
   • Clean and debride the wound under sterile conditions
   • Leave blisters intact unless specifically indicated
   • Apply silver sulfadiazine cream 1% to a thickness of approximately 1/16 inch
   • Cover with sterile, non-adherent dressing applied loosely
   • Reapply cream once to twice daily and whenever removed by patient activity

Ongoing Management

1. Infection prevention 1, 2, 3

   • Apply silver sulfadiazine cream until satisfactory healing occurs or until the burn site is ready for grafting
   • Regularly evaluate for signs of infection (increased redness, warmth, swelling, discharge, fever)
   • For extensive burns, consider isolation in a private room with strict infection control practices

2. Alternative topical antimicrobials 4

   • Mafenide acetate 5% topical solution may be used, particularly for grafted areas
   • For grafted areas, cover with fine mesh gauze and keep wet with mafenide solution
   • Monitor for potential side effects including acidosis

3. Surgical intervention 1, 5

   • Consider early excision of eschar for non-viable tissue
   • Evaluate need for skin grafting, particularly for full-thickness burns
   • Refer to specialized burn center if:
     • Burn is extensive (>20% TBSA)
     • Affects critical areas
     • Is full-thickness
     • Shows signs of infection or complications

4. Nutritional support 1, 6

   • Start nutritional support within 12 hours after burn injury
   • Prefer oral or enteral routes
   • Monitor weight regularly (at least weekly)
   • Maintain accurate fluid intake/output records

Special Considerations

1. Monitor for complications 1

   • Assess distal circulation, sensation, and motor function every 15-30 minutes for circumferential burns to detect compartment syndrome
   • Consider thromboprophylaxis for severe burns

2. Avoid common pitfalls 1

   • Do not use ice or ice-cold water (increases tissue damage)
   • Do not apply butter, homemade remedies, or prophylactic antibiotics
   • Do not break blisters intentionally
   • Do not withdraw silver sulfadiazine treatment while infection risk remains unless significant adverse reaction occurs 2

3. Non-pharmacological interventions 1

   • Consider virtual reality or hypnosis to reduce pain intensity and anxiety
   • Implement regular stretching exercises to improve flexibility and reduce contractures
   • Consider massage therapy to soften scar tissue and improve circulation

The management approach should continue until healing is complete or the burn site is ready for grafting 2. For moderate to severe burns, a multidisciplinary approach involving burn specialists is recommended to optimize outcomes 5, 7.