What is the appropriate treatment for burns?

Appropriate Treatment for Burns

The appropriate treatment for burns includes immediate cooling with clean running water for 5-20 minutes, followed by appropriate dressing application based on burn severity, with specialized care required for burns involving face, hands, feet, genitals, or those covering >10% body surface area in adults or >5% in children. 1, 2, 3

Initial Assessment and Management

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2, 3
• Remove jewelry from the affected area before swelling occurs to prevent constriction and vascular ischemia 1, 2
• Monitor children closely for signs of hypothermia during cooling, especially with larger burns 1, 3
• If clean running water is not available, cooling superficial burns using ice wrapped in cloth may be reasonable for burns with intact skin 2, 3
• Cooling should be limited to burns covering <20% total body surface area (TBSA) in adults and <10% TBSA in children to avoid hypothermia 4

Treatment Based on Burn Severity

For Superficial (First-Degree) Burns:

• After cooling, administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain management 1, 3
• For small burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2
• Cover with a clean, non-adherent dressing 1, 3
• These burns generally heal without scarring and have low infection risk 1

For Partial-Thickness (Second-Degree) Burns:

• After cooling, clean the wound with tap water, isotonic saline, or an antiseptic solution 4, 3
• Cover with a clean non-adherent dressing 2, 3
• For larger burns requiring medical attention, the type of dressing depends on the TBSA, wound appearance, and patient's general condition 4, 3
• Silver sulfadiazine cream may be applied to a thickness of approximately 1/16 inch once to twice daily, though it may be associated with prolonged healing if used for a long time on superficial burns 4, 5

For Full-Thickness (Third-Degree) Burns:

• All full-thickness burns require immediate medical attention 2
• After cooling, cover with a clean, dry, non-adherent dressing while awaiting medical care 2

Pain Management

• Titrate analgesic medications based on validated comfort and analgesia assessment scales 4
• Consider intravenous ketamine combined with other analgesics for severe burn-induced pain 4
• For less severe burns, over-the-counter pain medications such as acetaminophen or NSAIDs are recommended 1, 3
• Non-pharmacological techniques can be combined with analgesic drugs for dressings when appropriate 4

Special Considerations

• Perform wound care in a clean environment with appropriate pain control 4, 3
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 3
• Monitor distal perfusion in case of circular dressings 3
• Silver sulfadiazine treatment should be continued until satisfactory healing has occurred or until the burn site is ready for grafting 5

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals require immediate medical attention 1, 2, 3
• Burns covering >10% body surface area in adults or >5% in children require medical evaluation 1, 2, 3
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) require immediate medical attention 1, 2, 3
• All full-thickness (third-degree) burns require medical attention 2

Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 2, 6
• Do not apply butter, oil, or other home remedies to burns 2
• Do not break blisters, as this increases infection risk 2
• Do not delay other resuscitation interventions for dressing application in severe burns 3
• Be aware that silver sulfadiazine may cause transient leukopenia, primarily characterized by decreased neutrophil count, with maximal depression occurring within 2-4 days of therapy initiation 5
• Avoid routine antibiotic prophylaxis for burn patients unless infection is present 3