What is the proper treatment for burns?

Proper Treatment for Burns

The immediate and proper treatment for burns is to cool the burn with clean running water for 5-20 minutes, followed by appropriate wound care based on burn severity. 1

Initial Management

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular ischemia 1, 3
• 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 1
• Monitor children closely for signs of hypothermia during cooling, especially with larger burns or when cooling is performed on young children 1, 4

Treatment Based on Burn Severity

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
• Administer over-the-counter pain medications like acetaminophen or NSAIDs for pain control 1, 4

Partial-Thickness (Second-Degree) Burns:

• After cooling, clean the wound with tap water, isotonic saline, or an antiseptic solution 1
• Apply a thin layer of petrolatum-based antibiotic ointment 1
• Cover with a non-adherent dressing such as Xeroform, Mepitel, or Allevyn 1
• For partial-thickness burns requiring medical attention, silver sulfadiazine cream may be 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

Pain Management

• Use multimodal analgesia with medications titrated based on validated comfort and analgesia assessment scales 1
• For minor burns, over-the-counter pain medications such as acetaminophen or NSAIDs are recommended 4
• For severe burn-induced pain, titrated intravenous ketamine can be combined with other analgesics 1
• For highly painful injuries or procedures, general anesthesia may be necessary 1

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 1, 3
• Do not apply butter, oil, or other home remedies to burns 1, 3
• Do not break blisters, as this increases infection risk 1, 3
• Avoid external cooling devices (e.g., Water-Jel dressings) for prolonged periods to limit the risk of hypothermia 1
• Do not use topical antibiotics as first-line treatment; reserve them for infected wounds only 1
• Avoid routine antibiotic prophylaxis for burns patients 1

When to Seek Medical Attention

• Seek immediate medical care for burns that involve the face, hands, feet, or genitals 1, 4
• Seek immediate medical care for partial-thickness burns covering >10% body surface area in adults (>5% in children) 1, 4
• 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
• Seek immediate medical care for burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 1, 3

Special Considerations for Facial Burns

• All partial-thickness burns involving the face require evaluation at a specialized burn center due to high risk of functional and cosmetic disability 3
• Facial burns require special attention due to the risk of airway compromise from swelling 3
• Even small partial-thickness burns on the face require specialized care to optimize cosmetic outcomes 3

Evidence on Cooling Duration

Recent evidence shows no significant difference in outcomes between cooling burns with running water for ≥20 minutes compared to <20 minutes in terms of burn size as percentage of total body surface area 2. However, immediate cooling has been shown to reduce the prevalence of deep burns by approximately 32%, potentially reducing the need for skin grafting 6.