What is the treatment for second-degree burns?

Treatment of Second-Degree Burns

The recommended treatment for second-degree burns includes immediate cooling with cold tap water (15-25°C) for at least 15 minutes, followed by application of 1% silver sulfadiazine cream to a thickness of approximately 1/16 inch once to twice daily, and covering with sterile, non-adherent dressings. 1, 2

Initial Management

1. Immediate cooling:

   • Cool the burn with cold (15-25°C) tap water until pain is relieved 1
   • Continue cooling for at least 15 minutes
   • NEVER apply ice directly to burns as this can worsen tissue damage

2. Wound assessment:

   • Evaluate burn depth, extent (% total body surface area), and location
   • Burns to face, hands, feet, genitalia, or >10% TBSA in children or >20% TBSA in adults require immediate medical attention 1

3. Decontamination:

   • Remove any contaminated clothing, jewelry, or material from affected areas 1
   • Leave burn blisters intact as this improves healing and reduces pain 1

Wound Care Protocol

Step 1: Wound Preparation

• Clean and debride the wound under sterile conditions 1, 2
• Protect intact blisters with loose sterile dressing to prevent accidental rupture 1

Step 2: Antimicrobial Application

• Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream to the burn wound 1, 2
• Silver sulfadiazine is specifically indicated as an adjunct for prevention and treatment of wound sepsis in second and third-degree burns 2
• Ensure the burn areas are covered with silver sulfadiazine cream at all times 2

Step 3: Dressing Application

• Cover the burn with a sterile, non-adherent dressing applied loosely 1
• While dressings are not always required with silver sulfadiazine, they may be used based on individual patient needs 2
• Reapply silver sulfadiazine immediately after hydrotherapy or when removed by patient activity 2

Pain Management

• Implement a multimodal approach to pain management:
  • First-line: Acetaminophen 1g every 4-6 hours 1
  • Second-line: Add NSAIDs for inflammatory pain 1
  • Third-line: Short-acting opioids and ketamine for severe pain 1
• Consider non-pharmacological techniques such as virtual reality or hypnosis to reduce pain intensity and anxiety 1

Ongoing Care

• Continue treatment with silver sulfadiazine until satisfactory healing has occurred or until the burn site is ready for grafting 2
• Begin early range of motion exercises to prevent contractures 1
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge, fever) 1
• Perform regular wound assessment to detect early signs of infection and monitor healing progress 1

Special Considerations

• For extensive burns, initiate fluid resuscitation with careful monitoring of fluid balance 1
• Start nutritional support within 12 hours after burn injury, preferably via oral or enteral route 1
• Monitor for signs of compartment syndrome in extremity injuries (5 P's: pain, pallor, paresthesia, pulselessness, paralysis) 1

Common Pitfalls to Avoid

• Applying ice directly to burns (causes vasoconstriction and can worsen tissue damage)
• Breaking intact blisters (increases infection risk and delays healing)
• Inadequate pain management (can lead to increased anxiety and delayed healing)
• Discontinuing antimicrobial treatment prematurely (may result in wound infection)
• Applying silver sulfadiazine too thickly (wastes medication and doesn't improve outcomes)

The 2024 consensus on second-degree burn treatment emphasizes the importance of standardized approaches to burn management, including proper prehospital first aid, appropriate non-surgical and surgical treatments, and infection prevention 3, 4, 5. This comprehensive approach aims to improve outcomes and reduce complications in patients with second-degree burns.