What is the treatment for steam burns?

Steam Burn Treatment

The immediate treatment for steam burns should include cooling the burn with cold (15-25°C) tap water until pain is relieved, followed by cleaning, debridement, and application of a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream covered with a sterile, non-adherent dressing. 1, 2

Initial Management

1. Scene safety and immediate actions:

   • Ensure scene safety first, especially in industrial settings where steam pipes may have ruptured 3
   • Remove the victim from the steam source
   • Remove any contaminated clothing, jewelry, or material from affected areas 1

2. Cooling the burn:

   • Cool burns with cold (15-25°C) tap water until pain is relieved
   • Do NOT apply ice directly to burns as this can worsen tissue damage 1
   • Cooling should be done for at least 15 minutes 1

Assessment and Referral

• Assess burn severity using the Lund-Browder chart for accurate Total Body Surface Area (TBSA) measurement 1
• Consider referral to a burn specialist if burns involve:
  • Face, hands, feet, genitalia, or perineum
  • Full-thickness burns

  • 10% TBSA in children

  • 20% TBSA in adults 1

Steam burns can be particularly severe and often affect the hands in pediatric patients, with 50% potentially requiring operative intervention 4. They may also be accompanied by inhalation injuries, which significantly increase morbidity and mortality 3.

Wound Care

1. Cleaning and debridement:

   • Clean and debride the wound under sterile conditions 2
   • Leave intact blisters to improve healing and reduce pain 1

2. Topical treatment:

   • Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream to second and third-degree burns 1, 2
   • Reapply once to twice daily or whenever the cream has been removed by patient activity 2
   • Continue treatment until satisfactory healing or until the burn site is ready for grafting 2

3. Dressing:

   • Cover with a sterile, non-adherent dressing applied loosely 1
   • Dressings are not always required but may be used based on individual patient needs 2
   • Reapply silver sulfadiazine immediately after hydrotherapy 2

Special Considerations

Fluid Resuscitation

• For extensive burns (>10% TBSA in children, >20% in adults), initiate IV fluid resuscitation 1
• Use balanced crystalloid solutions (e.g., Ringer's Lactate) at 20 mL/kg in the first hour 1
• Target urine output of 0.5-1 mL/kg/h in adults 1

Inhalation Injury

• Assess for respiratory compromise, especially with facial burns or burns occurring in enclosed spaces 3
• Monitor closely for signs of respiratory distress, as steam can cause blistering and sloughing of bronchial mucosa 3

Nutritional Support

• Start nutritional support within 12 hours after burn injury 5, 1
• Prefer oral or enteral routes over parenteral nutrition 5

Pain Management

• Use a multimodal approach including acetaminophen, NSAIDs, and opioids as needed 1
• Consider non-pharmacological techniques such as virtual reality or hypnosis to reduce pain intensity 1

Rehabilitation

• Begin early range of motion exercises to prevent contractures 1
• Consider massage therapy to soften scar tissue and improve circulation 1
• Regular stretching exercises are recommended to improve flexibility 1

Common Pitfalls to Avoid

1. Do not apply ice directly to burns - this can worsen tissue damage 1
2. Do not use systemic antibiotic prophylaxis routinely - evidence suggests it should be avoided to prevent selecting for multidrug-resistant bacteria 5
3. Do not underestimate steam burns - they can be severe and may require surgical intervention, especially in children 6, 4
4. Do not neglect potential inhalation injuries - steam can cause significant respiratory damage that may not be immediately apparent 3
5. Do not delay referral to a burn specialist for burns meeting referral criteria 1