What is the treatment for primary second-degree burns in a primary care setting in Malaysia?

Treatment of Primary Second-Degree Burns in Primary Care KKM Malaysia

Immediate cooling with clean running water for 5-20 minutes is the first-line treatment for second-degree burns, followed by application of appropriate dressings and pain management. 1, 2

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 2
• Monitor children closely for signs of hypothermia during cooling, especially with larger burns 1, 2
• Do not apply ice directly to burns as this can cause further tissue damage 2
• Do not apply butter, oil, or other home remedies to burns 2

Wound Care for Second-Degree Burns

• After cooling, clean the wound with tap water, isotonic saline, or an antiseptic solution 2
• Apply a thin layer of petrolatum-based antibiotic ointment 1, 2
• Cover with a non-adherent dressing such as Xeroform, Mepitel, or Allevyn 2
• Do not break blisters, as this increases infection risk 2, 3
• Preserving the blister roof acts as a biological dressing to help with pain management and promote healing 3

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control 1, 2
• For severe burn-induced pain, multimodal analgesia should be used with medications titrated based on validated comfort and analgesia assessment scales 1
• Titrated intravenous ketamine can be combined with other analgesics for severe burn-induced pain 1
• If the patient is stable, non-pharmacological techniques should be combined with analgesic drugs for dressings 1

Topical Antimicrobial Treatment

• Silver sulfadiazine cream 1% can be used as an adjunct for the prevention and treatment of wound sepsis in second-degree burns 4
• Apply silver sulfadiazine cream to a thickness of approximately 1/16 inch once to twice daily 4
• Reapply after hydrotherapy or whenever the cream has been removed by patient activity 4
• Note that silver sulfadiazine may be associated with prolonged healing if used for a long time on superficial burns 2

When to Refer to Specialized Care

• Refer patients with burns involving the face, hands, feet, or genitals regardless of size 2, 5
• Refer patients with partial-thickness burns covering >10% body surface area in adults (>5% in children) 2, 5
• Refer patients with burns showing signs of infection or that are very painful 2
• Refer patients with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 2

Follow-up Care

• Monitor the burn for signs of infection such as increased pain, redness, swelling, or discharge 2
• Keep the burn area clean and dry, changing dressings as recommended 2
• Continue pain management as needed with over-the-counter medications 2
• Treatment with silver sulfadiazine cream should be continued until satisfactory healing has occurred 4

Special Considerations

• For burns on functional areas like joints or digits, monitor for any signs of functional impairment during the healing process 6
• Deep partial-thickness burns may require specialized care to prevent functional disability and optimize cosmetic outcomes 6, 5
• Prophylactic systemic antibiotics are not indicated for outpatient management and may increase bacterial resistance 5
• Patients with diabetes mellitus are at increased risk of complications and infection, and early referral to a burn center should be considered 5