Treatment of Burns Present for 20 Hours
For a burn that has been present for 20 hours, immediate cooling is no longer beneficial, but wound care should include cleaning, applying appropriate topical agents (petrolatum, antibiotic ointment, honey, or aloe vera), and covering with a clean nonadherent dressing. 1
Burn Assessment and Classification
- Determine burn depth and total body surface area (TBSA) to guide treatment decisions 1, 2
- Superficial (first-degree) burns involve only the epidermis and generally heal without scarring 1
- Partial-thickness (second-degree) burns involve the epidermis and part of the dermis 1
- Full-thickness (third-degree) burns involve destruction of the epidermis and injury to deeper layers 1
Treatment Algorithm Based on Burn Severity
For Minor Burns (Can Be Managed at Home):
- Clean the burn area gently 1
- Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to small partial-thickness burns 1
- Cover with a clean nonadherent dressing 1
- Administer over-the-counter pain medications such as acetaminophen or NSAIDs 1
- Remove any jewelry from the affected area to prevent constriction as swelling occurs 1
For Severe Burns (Require Medical Attention):
- Burns requiring specialized care include: 1, 2
- Burns involving the face, hands, feet, or genitalia
- Full-thickness burns of any size
- Partial-thickness burns >10% TBSA in adults or >5% in children
- Any burn with signs of infection
- Burns with signs of inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth)
Topical Treatment Options
- For burns being managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1
- For burns requiring medical attention, silver sulfadiazine cream may be applied to a thickness of approximately 1/16 inch once to twice daily 3
- Reapply silver sulfadiazine immediately after hydrotherapy if prescribed 3
Pain Management
- Administer over-the-counter analgesics such as acetaminophen or NSAIDs 1
- These medications are well-tolerated and effective for burn pain 1
Monitoring for Complications
- Watch for signs of infection (increased pain, redness extending beyond burn margins, purulent discharge, fever) 4, 5
- Monitor for adequate urine output (0.5-1 mL/kg/hr) in more severe burns 2
- Assess pain control regularly 2
Special Considerations
- At 20 hours post-burn, the initial inflammatory response has already occurred, so fluid resuscitation formulas are no longer applicable unless there are signs of dehydration 1, 6
- Prophylactic antibiotics are not indicated for outpatient management of burns and may increase bacterial resistance 5
- Patients with diabetes are at increased risk of complications and infection, and early referral to a burn center should be considered 5