What is the treatment for secondary burns?

Treatment for Secondary Burns

The treatment of secondary burns should include gentle cleansing with sterile water or saline, application of a thin layer of silver sulfadiazine cream for second and third-degree burns, and appropriate dressings to promote healing and prevent infection. 1, 2

Initial Assessment and Management

• Cool the burn with cold (15-25°C) running tap water for 10-20 minutes until pain is relieved 1
• Remove any contaminated clothing, jewelry, or material from affected areas 1
• Assess burn depth and total body surface area (TBSA) affected
• For extensive burns (>10% TBSA in children, >20% in adults), initiate IV fluid resuscitation with balanced crystalloid solutions 1

Wound Care Protocol

For Second and Third-Degree Burns:

1. Cleanse wounds by gently irrigating with warmed sterile water, saline, or dilute chlorhexidine (1/5000) 3, 1
2. Apply silver sulfadiazine cream 1% to a thickness of approximately 1/16 inch once to twice daily 2
   • Reapply whenever the cream has been removed by patient activity
   • Reapply immediately after hydrotherapy 1, 2
3. Dressing application:
   • Apply non-adherent dressings to denuded dermis (e.g., Mepitel™ or Telfa™) 3
   • Use a secondary foam or burn dressing to collect exudate (e.g., Exu-Dry™) 3
   • For superficial burns, topical application of antibiotic ointment may be sufficient 1, 4

Blister Management:

• Blisters should be decompressed by piercing and expression or aspiration of tissue fluid 3
• The detached epidermis may be left in situ to act as a biological dressing 3

Pain Management

• Implement a multimodal approach including:
  • Acetaminophen (1g every 4-6 hours)
  • NSAIDs for inflammatory pain
  • Opioids as needed for severe pain
  • Consider non-pharmacological techniques such as virtual reality or hypnosis 1

Nutritional Support

• Start nutritional support within 12 hours after significant burn injury
• Prefer oral or enteral routes over parenteral nutrition 1
• For extensive burns, provide 20-25 kcal/kg daily during the early catabolic phase
• During recovery (anabolic phase), increase to 25-30 kcal/kg daily 3

Monitoring and Complications

• Regularly assess wounds for signs of healing or complications
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge)
• Watch for respiratory compromise, especially with facial burns or burns occurring in enclosed spaces 1
• Consider transfer to a burn center for:
  • Burns involving face, hands, feet, genitalia, or perineum
  • Full-thickness burns
  • Burns exceeding 10% TBSA in children or 20% TBSA in adults
  • Evidence of clinical deterioration, extension of epidermal detachment, or local sepsis 3, 1

Rehabilitation

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

Important Considerations

• Silver sulfadiazine is the standard topical antimicrobial treatment for second and third-degree burns, with excellent spectrum of activity and low toxicity 2, 5
• Recent research suggests that triple-antibiotic ointment may enhance reepithelialization and reduce scarring compared to silver-based dressings for certain burns 6
• For superficial burns, simpler treatments like topical lotions, honey, aloe vera, or antibiotic ointment may be sufficient 4
• Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2

The evidence strongly supports that proper wound care with appropriate antimicrobial agents significantly reduces the risk of invasive infections and overall mortality in burn patients 5, 7.