What is the prognosis and treatment for burns?

Burn Management: Prognosis and Treatment

The prognosis for burns depends primarily on the depth, extent (total body surface area affected), and location of burns, with immediate treatment focusing on cooling the injury with room temperature water for at least 10 minutes, followed by appropriate wound care and pain management. 1

Burn Assessment and Prognosis Factors

Accurate assessment is crucial for determining prognosis:

• Assessment Method: The Lund and Browder chart is the most accurate method for measuring total body surface area (TBSA) burned in both adults and children 1
• Poor Prognosis Indicators:
  • Full-thickness burns
  • Burns on face, hands, feet, or genitalia

  • 10% TBSA in children

  • 20% TBSA in adults

  • All require immediate medical attention 1

Initial Treatment Algorithm

1. Immediate Care:

   • Cool the burn with running water at room temperature (15-25°C) for at least 10 minutes 1
   • Provide adequate analgesia before any procedures 1
   • Assess for signs of shock or airway compromise

2. Blister Management:

   • Leave blisters intact to improve healing and reduce pain in partial-thickness burns 1
   • If drainage is necessary, pierce the blister at its base with a sterile needle, leaving the roof intact as a biological dressing 1
   • Apply gentle pressure with sterile gauze to facilitate drainage 1

3. Wound Care:

   • Clean and debride the wound gently 1
   • For second and third-degree burns, apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 1, 2
   • Apply a sterile, non-adherent dressing loosely 1
   • Reapply silver sulfadiazine once to twice daily, and immediately after hydrotherapy 2

Ongoing Treatment

Pain Management

• First-line: Acetaminophen 1g every 4-6 hours 1
• Second-line: Add NSAIDs for inflammatory pain 1
• Severe pain: Consider ketamine intravenous titration 1
• Breakthrough pain: Short-acting opioids at lowest effective dose 1

Infection Prevention

• Daily washing with antibacterial products to decrease colonization 1
• Change dressings using aseptic technique 1
• Monitor for signs of infection:
  • Document new blisters on a blister chart 1
  • Obtain bacterial and viral swabs if clinical signs of infection appear 1
  • Consider topical antimicrobials for short periods if infection is present 1
  • Use systemic antibiotics if there are local or systemic signs of infection 1

Nutrition and Hydration

• Start nutritional support within 12 hours after burn injury 1
• Monitor weight regularly (at least weekly) 1
• Maintain accurate intake/output records 1
• Insert nasogastric tube for feeding if oral intake is inadequate 1

Special Considerations

Treatment Duration

• Continue treatment with silver sulfadiazine until satisfactory healing occurs or the burn site is ready for grafting 2
• Do not withdraw treatment while there remains possibility of infection 2

Complications to Monitor

• Compartment syndrome in extremity injuries (pain, pallor, paresthesia, pulselessness, paralysis) 1
• Thrombosis risk in severe burns 1
• Contractures and scarring 1

Common Pitfalls to Avoid

1. Incorrect Assessment: Using Wallace rule of nines tends to overestimate TBSA, especially in children 1

2. Improper Blister Management: Debriding or removing the blister roof increases infection risk and pain 1

3. Inadequate Pain Control: Failure to provide analgesia before procedures increases patient distress 1

4. Delayed Nutritional Support: Nutritional deficits worsen outcomes; start support within 12 hours 1

5. Insufficient Monitoring: Regular wound assessment is essential to detect early signs of infection 1

Burns remain a significant cause of morbidity and mortality, with infection being the primary concern 3, 4. While early excision and skin grafting have improved outcomes 3, 5, proper outpatient management can effectively treat most burns 6. The ultimate goal extends beyond preservation of life and function to returning survivors as full participants to their families and communities 5.