What is the treatment for burns?

Burn Treatment Management

The treatment of burns requires immediate cooling with cold running water (15-25°C) for 20 minutes, followed by appropriate wound care including silver sulfadiazine cream application for second and third-degree burns, and referral to a burn specialist for severe cases. 1

Initial Assessment and Management

Burn Severity Assessment

• Use the Lund-Browder chart (pediatric version) for accurate Total Body Surface Area (TBSA) measurement in children 2
• For quick estimation in prehospital settings, use the palm method (patient's palm = approximately 1% TBSA) 2
• Burns requiring immediate medical attention 1:
  • Burns involving face, hands, feet, or genitalia
  • Full-thickness burns

  • 10% TBSA in children

  • 20% TBSA in adults

Immediate Care

1. Cooling the burn:

   • Apply cold running water (15-25°C) for 20 minutes 1
   • Do NOT apply ice directly to the burn as this can cause further tissue damage
   • Cooling should be done as soon as possible after injury

2. Blister management:

   • Keep blisters intact when possible to maintain a sterile environment 1
   • For large blisters, consider decompressing by piercing while leaving the roof intact as a biological dressing 1

Wound Care

Topical Treatment

1. For second and third-degree burns:

   • Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 3
   • Reapply once to twice daily or whenever the cream has been removed by patient activity 3
   • Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 3

2. Dressing application:

   • Silver sulfadiazine cream can be used without dressings, though dressings may be applied if necessary 3
   • Use non-adherent dressings for denuded areas (e.g., Mepitel™ or Telfa™) 1
   • Consider silver-containing products for sloughy areas 1

Infection Prevention

• Monitor for signs of infection: increasing pain, redness, swelling, discharge, fever 1
• Take swabs for bacterial and candidal culture from lesional skin on alternate days 1
• Do not administer systemic antibiotics prophylactically; only use when clinical signs of infection are present 1

Fluid Resuscitation for Severe Burns

For adults with ≥20% TBSA burns or children with ≥10% TBSA burns:

• Administer 20 ml/kg of balanced crystalloid solution in the first hour 1
• Balanced electrolyte solutions are preferred over 0.9% saline for large volume resuscitation to avoid hyperchloremic acidosis 1

Pain Management

• Use multimodal analgesia based on validated comfort and analgesia assessment scales 1
• Offer analgesia prior to any blister procedure or dressing change 1
• Consider ketamine as an adjunct for severe burn-induced pain 1
• Non-pharmacological techniques (virtual reality, hypnosis) may be helpful during dressings in stable patients 1

Specialized Care Considerations

When to Refer to a Burn Specialist

• Seek referral to a burn specialist to determine whether the patient should be admitted to a burns center 2
• Consider telemedicine to improve initial assessment when burn specialists are not readily available 2
• If admission to a burns center is indicated, direct admission is preferred 2

Emergency Interventions

• Perform escharotomy if deep burns cause compartment syndrome affecting limbs, trunk, or compromise airways/circulation 2, 1
• This procedure should ideally be performed in a burns center by an experienced provider 2

Rehabilitation and Nutritional Support

• Begin early range of motion exercises to prevent contractures 1
• Provide continuous enteral nutrition throughout the acute phase 1
• Deliver 20-25 kcal/kg daily during the early catabolic phase, increasing to 25-30 kcal/kg during recovery 1

Common Pitfalls to Avoid

• Applying ice directly to burns (causes additional tissue damage)
• Delaying cooling (reduces effectiveness)
• Undertriaging burns (increases morbidity and mortality) 2
• Overtriaging burns (consumes inappropriate resources) 2
• Using prophylactic antibiotics without signs of infection
• Inadequate pain management during procedures