How are burns staged and treated based on their degree?

Burn Staging and Treatment Based on Degree

Burns should be classified into superficial (first-degree), partial-thickness (second-degree), and full-thickness (third-degree) burns, with treatment escalating from topical lotions for superficial burns to silver sulfadiazine cream for partial and full-thickness burns, and immediate referral to burn specialists for severe cases. 1, 2

Burn Classification and Assessment

First-Degree (Superficial) Burns

• Affects only the epidermis
• Characterized by redness, pain, and minor swelling
• No blisters present
• Heals within 3-5 days without scarring

Second-Degree (Partial-Thickness) Burns

• Affects epidermis and part of the dermis
• Characterized by redness, pain, swelling, and blisters
• Moist appearance
• Blanches with pressure
• Healing time: 1-3 weeks depending on depth

Third-Degree (Full-Thickness) Burns

• Destroys entire epidermis and dermis
• May extend into subcutaneous tissue
• Appears dry, leathery, white, charred, or translucent
• No blanching with pressure
• No pain due to destruction of nerve endings
• Requires surgical intervention and skin grafting

Burn Severity Assessment Criteria

Immediate medical attention required for:

• Burns on face, hands, feet, or genitalia
• Any full-thickness burns

• 10% TBSA (Total Body Surface Area) in children

• 20% TBSA in adults 1

Treatment Protocol Based on Burn Degree

Initial Management for All Burns

1. Ensure scene safety (especially for electrical burns)
2. Remove contaminated clothing and jewelry
3. Cool burns with cold (15-25°C) tap water until pain subsides (avoid ice directly on burns)
4. Assess for airway compromise, breathing difficulties, or circulation problems 1

First-Degree (Superficial) Burns Treatment

• Cooling with water for pain relief
• Topical application of lotions, aloe vera, or moisturizers
• Pain management with acetaminophen or NSAIDs
• No dressings typically required 3

Second-Degree (Partial-Thickness) Burns Treatment

1. Clean and debride the wound
2. Apply a thin layer (1/16 inch) of 1% silver sulfadiazine cream
3. Cover with sterile, non-adherent dressing
4. Leave blisters intact to improve healing and reduce pain
5. Reapply silver sulfadiazine once to twice daily 1, 2

Third-Degree (Full-Thickness) Burns Treatment

1. Immediate referral to burn specialist or burn center
2. Clean and debride the wound
3. Apply silver sulfadiazine cream as temporary measure
4. Surgical debridement and skin grafting will be required
5. Fluid resuscitation for extensive burns 1, 2

Pain Management Protocol

Multimodal Approach

1. First-line: Acetaminophen 1g every 4-6 hours
2. Second-line: Add NSAIDs for inflammatory pain
3. Third-line: Short-acting opioids for severe pain
4. Consider ketamine for procedural pain
5. Non-pharmacological techniques (virtual reality, hypnosis) can supplement medication 1

Important Considerations and Pitfalls

Monitoring for Complications

• Watch for signs of compartment syndrome in extremity injuries (5 P's: pain, pallor, paresthesia, pulselessness, paralysis)
• Monitor for signs of infection (increased pain, redness, swelling, purulent drainage)
• Regular wound assessment is essential 1

Common Pitfalls to Avoid

1. Applying ice directly to burns - can worsen tissue damage
2. Breaking blisters - increases infection risk and delays healing
3. Using prophylactic antibiotics - not indicated for most burns 4
4. Inadequate pain control - can lead to increased anxiety and delayed healing
5. Failing to recognize burn depth accurately - can lead to inappropriate treatment

When to Refer to a Burn Specialist

• Full-thickness burns
• Burns >10% TBSA in children or >20% in adults
• Burns on face, hands, feet, genitalia, or perineum
• Circumferential burns
• Electrical or chemical burns
• Burns with inhalation injury
• Burns in patients with significant comorbidities 1, 4

Follow-up Care

• Continue silver sulfadiazine until satisfactory healing occurs or until the burn site is ready for grafting
• Begin early range of motion exercises to prevent contractures
• Regular stretching exercises to improve flexibility
• Massage therapy may help soften scar tissue
• Nutritional support should be started within 12 hours after extensive burn injury 1, 2