What is the treatment for a burn patient?

Treatment for Burn Patients

The treatment for burn patients should begin with immediate cooling of the burn with clean running water for 5-20 minutes for adults with <20% total body surface area (TBSA) burns and children with <10% TBSA burns, followed by appropriate wound care based on burn depth, pain management, and infection prevention. 1, 2

Initial Management

• Immediately cool the burn with clean running water (15-25°C) for up to 40 minutes to limit tissue damage, reduce pain, and prevent burn progression 1, 2, 3
• Remove jewelry from the affected area before swelling occurs to prevent constriction 1, 4
• Avoid cooling large burns (>20% TBSA in adults, >10% in children) or using ice directly on burns as this can cause tissue ischemia and hypothermia 2, 5
• Monitor children closely for signs of hypothermia during cooling 1, 4

Treatment Based on Burn Depth

Superficial (First-Degree) Burns:

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 4
• Cover with a clean, non-adherent dressing 1, 4
• Administer over-the-counter pain medications like acetaminophen or NSAIDs for pain control 4

Partial-Thickness (Second-Degree) Burns:

• After cooling, clean the wound with tap water, isotonic saline, or an antiseptic solution 1, 2
• Apply a thin layer of petrolatum-based antibiotic ointment 1
• Cover with a non-adherent dressing 1
• For second and third-degree burns, silver sulfadiazine cream may be applied to a thickness of approximately 1/16 inch once to twice daily to prevent and treat wound sepsis 6

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

Pain Management

• Use multimodal analgesia with medications titrated based on validated comfort and analgesia assessment scales 7
• Titrated intravenous ketamine can be combined with other analgesics for severe burn-induced pain 7
• Short-acting opioids and ketamine are effective for managing burn-induced pain 7, 1
• For highly painful injuries or procedures, general anesthesia may be necessary 7, 1
• Non-pharmacological techniques should be combined with analgesic drugs for dressings when appropriate 7

Wound Care

• Burn wound care should be performed in a clean environment and may require deep analgesia or general anesthesia 7, 2
• The type of dressing depends on the TBSA, local appearance of the wound, and patient's general condition 7, 2
• For burn wounds requiring silver sulfadiazine, apply to a thickness of approximately 1/16 inch once to twice daily 6
• Reapply silver sulfadiazine immediately after hydrotherapy and whenever it has been removed by patient activity 6
• Continue treatment with silver sulfadiazine until satisfactory healing has occurred or until the burn site is ready for grafting 6

Special Considerations

• For chemical burns, immediate water lavage for up to 60 minutes is recommended 8
• Early excision of burn wounds and rapid wound coverage can minimize physiologic alterations from thermal injury 9
• Initiate nutritional support within 12 hours after burn injury, preferably via oral or enteral routes 2
• Routinely prescribe thromboprophylaxis for severe burns patients in the initial phase 2

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals require specialized burn center treatment 1, 4
• Burns covering >10% TBSA in adults or >5% in children should be referred to a burn center 1, 2
• All full-thickness (third-degree) burns require immediate medical attention 1
• Burns showing signs of infection or that are very painful require immediate medical care 1
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) require immediate medical attention 1, 4

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 1, 5
• Do not apply butter, oil, or other home remedies to burns 1
• Do not break blisters, as this increases infection risk 1
• Avoid prolonged use of silver sulfadiazine on superficial burns as it may delay healing 1, 2
• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 1, 2
• Avoid routine use of topical antibiotics for uninfected wounds to prevent antimicrobial resistance 2