What is the proper care for a burn?

Proper Care for Burns

The proper care for a burn involves immediate cooling with clean running water for 5-20 minutes, followed by application of a petrolatum-based ointment and covering with a non-adherent dressing. 1, 2

Initial Management

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 3
• Remove any jewelry from the affected area before swelling occurs to prevent constriction 1
• For adults with burns covering <20% of total body surface area (TBSA) and children with <10% TBSA, cooling should be performed in the absence of shock 4
• Monitor children closely for signs of hypothermia during cooling, especially with larger burns 1

Treatment Based on Burn Severity

Superficial (First-Degree) Burns:

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2
• Cover with a clean, non-adherent dressing 2
• Administer over-the-counter pain medications like acetaminophen or NSAIDs for pain control 1

Partial-Thickness (Second-Degree) Burns:

• After cooling, clean the wound with tap water, isotonic saline, or an antiseptic solution 4
• Apply a thin layer of petrolatum-based antibiotic ointment 2
• Cover with a non-adherent dressing such as Xeroform, Mepitel, or Allevyn 2
• For larger burns, silver sulfadiazine cream may be appropriate, applied to a thickness of approximately 1/16 inch once to twice daily 5

Full-Thickness (Third-Degree) Burns:

• After cooling, cover with a clean, dry, non-adherent dressing while awaiting medical care 1
• All full-thickness burns require immediate medical attention 1

Wound Care Considerations

• Burn wound care should be performed in a clean environment and may require deep analgesia 4
• The type of dressing depends on the TBSA, local appearance of the wound, and patient's general condition 4
• Silver sulfadiazine may be associated with prolonged healing if used for a long time on superficial burns 4
• When applying dressings on limbs, prevent bandages from inducing a tourniquet effect 4
• In the case of circular dressings, monitor distal perfusion 4
• Ideally, dressings should be re-evaluated daily 4

Pain Management

• Multimodal analgesia should be used with medications titrated based on validated comfort and analgesia assessment scales 4
• Titrated intravenous ketamine can be combined with other analgesics for severe burn-induced pain 4
• Short-acting opioids and ketamine are effective for managing burn-induced pain 4
• For highly painful injuries or procedures, general anesthesia may be necessary 4

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 1
• Do not apply butter, oil, or other home remedies to burns 1, 2
• Do not break blisters, as this increases infection risk 1
• External cooling devices (e.g., Water-Jel dressings) should not be used for prolonged periods to limit the risk of hypothermia 4
• Topical antibiotics should not be used as first-line treatment but dedicated to infected wounds only 4
• Routine antibiotic prophylaxis is not recommended for burns patients 4

When to Seek Medical Attention

• Seek immediate medical care for burns that involve the face, hands, feet, or genitals 1, 2
• Seek immediate medical care for partial-thickness burns covering >10% body surface area (>5% in children) 1, 2
• Seek immediate medical care for all full-thickness (third-degree) burns 1
• Seek immediate medical care for burns showing signs of infection or that are very painful 1, 2
• Seek immediate medical care for burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1