Proper Procedure for Burn Injury Dressing
Burn wound dressings should be performed in a clean environment with appropriate pain control, after ensuring proper resuscitation is complete, to reduce pain, protect the wound from contamination, and limit heat loss. 1
Initial Assessment and Cooling
- For burns in adults with total burned body surface area (TBSA) <20% and children with TBSA <10%, immediately cool the burn with clean running water for 5-20 minutes to limit burn progression and reduce pain 1
- Avoid cooling large burns (>20% TBSA in adults, >10% in children) due to risk of hypothermia 1
- Remove all jewelry near the burn site before swelling occurs to prevent constriction and vascular compromise 2, 3
- Monitor children closely for signs of hypothermia during cooling 1, 3
Pain Management Before Dressing
- Titrate intravenous analgesics based on validated comfort and analgesia assessment scales 1
- Consider intravenous ketamine combined with other analgesics for severe burn-induced pain 1
- For highly painful procedures, deep analgesia or general anesthesia may be required 1
- Non-pharmacological techniques (virtual reality, hypnosis) can be combined with analgesics when appropriate 1
Wound Cleaning
- Clean the burn wound with tap water, isotonic saline solution, or an antiseptic solution 1, 3
- Perform wound care in a clean environment with appropriate pain control 1
- Consult a burns specialist if possible to determine whether blisters should be flattened or excised 1
Dressing Selection and Application
- Select dressing based on TBSA, local appearance of the wound, and patient's general condition 1, 3
- For small partial-thickness burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 3
- For larger or deeper burns, antiseptic dressings may be appropriate, especially for contaminated wounds 1
- Avoid using silver sulfadiazine for prolonged periods on superficial burns as it may delay healing 1, 4
- Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 1, 3
Dressing Application Technique
- When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1, 3
- In case of circular dressings, monitor distal perfusion regularly 1
- Cover the wound with a clean, non-adherent dressing 1, 3
- For specialized dressings like mafenide acetate solution, follow specific application instructions (cover with fine mesh gauze, then wet eight-ply dressing) 5
Follow-up Care
- Re-evaluate dressings daily when possible 1
- External cooling devices (e.g., Water-Jel dressings) should not be used for prolonged periods due to risk of hypothermia 1
- In the prehospital phase, burn wounds can be covered with sterile gauze, interface dressings, or non-adhesive dressings 1
When to Refer to a Burn Center
- Burns involving the face, hands, feet, or genitals require specialized burn center treatment 2, 3
- Burns covering >10% TBSA in adults or >5% in children should be referred to a burn center 2, 3
- Any full-thickness burns require evaluation by burn specialists 2, 3
Common Pitfalls to Avoid
- Do not delay other resuscitation interventions for dressing application in severe burns 1
- Avoid routine antibiotic prophylaxis for burn patients unless infection is present 1, 3
- Do not use silver sulfadiazine for prolonged periods on superficial burns as it is associated with poorer healing outcomes compared to biosynthetic, silicon-coated, and silver dressings 1, 4
- Avoid applying dressings too tightly, especially on extremities, as this can cause a tourniquet effect and compromise circulation 1