What is the recommended treatment for burn management?

Burn Management

Cool the burn immediately with clean running water for 5-20 minutes, then clean the wound, apply appropriate dressings based on burn severity and location, and provide multimodal analgesia while monitoring for complications that require specialist referral. 1, 2

Immediate First Aid (Within 3 Hours of Injury)

• Apply cool running water for 20 minutes to limit burn depth progression, reduce pain, and decrease the need for skin grafting 1, 3
• Cool burns in adults with total body surface area (TBSA) < 20% and children with TBSA < 10% in the absence of shock 4
• If clean running water is unavailable, superficial burns with intact skin may be cooled with ice wrapped in cloth 1
• Monitor children closely for hypothermia during cooling as they are at higher risk 1
• Remove jewelry and constrictive items before swelling occurs to prevent vascular compromise 1, 2
• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to hypothermia risk 1

Pain Management

• Use multimodal analgesia titrated to validated comfort and assessment scales 4
• Administer over-the-counter pain medications (acetaminophen or NSAIDs) for minor burns 1, 5
• For severe burn pain, use short-acting opioids and titrated intravenous ketamine combined with other analgesics 4
• Consider inhaled nitrous oxide when intravenous access is unavailable 4
• For highly painful injuries or procedures, general anaesthesia is an effective option 4
• Combine non-pharmacological techniques (virtual reality, hypnosis) with analgesic drugs for dressings when the patient is stable 4

Wound Cleaning and Assessment

• Clean the wound with tap water, isotonic saline, or an antiseptic solution in a clean environment with appropriate pain control 4, 1
• Assess burn size using the rule of nines, depth (first, second, or third degree), and location 6
• Do not break or pop blisters as this significantly increases infection risk 2
• Ideally consult a burns specialist to define the most appropriate dressing and whether blisters should be flattened or excised 4, 2

Dressing Application

For Minor Burns (First-Degree and Small Second-Degree)

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 5
• Cover with a clean non-adherent dry dressing 1, 2

For Larger or More Severe Burns

• The type of dressing depends on TBSA, wound appearance, and patient's general condition 1
• Antiseptic dressings may be appropriate for potentially contaminated partial-thickness burns 2
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect and monitor distal perfusion 1
• Ideally re-evaluate dressings daily 1
• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 1
• Avoid using silver sulfadiazine for prolonged periods on superficial burns as it may prolong healing 2

Antibiotic and Tetanus Prophylaxis

• Avoid routine antibiotic prophylaxis unless infection is present 1, 6
• Check tetanus immunization status as burns are tetanus-prone injuries 6

Criteria for Specialist Referral

Immediate Burn Center Consultation Required:

• Burns involving face, hands, feet, genitals, or other special areas with risk of functional impairment 1, 2, 5
• All full-thickness (third-degree) burns 1
• TBSA > 10% in adults or > 5% in children 1, 5, 6
• Chemical or electrical burns 6
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 1, 5
• Burns that become infected or are slow to heal 6

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 2
• Do not apply butter, oil, or other home remedies 2
• Do not delay other resuscitation interventions for dressing application in severe burns 1
• Wound care is not a priority and should be performed only after well-conducted resuscitation 4
• Do not use cooling for prolonged periods in patients with large TBSA burns due to hypothermia risk 4, 1

Follow-Up Monitoring

• Monitor for signs of infection: increased pain, redness, swelling, or discharge 2
• Keep the burn area clean and dry, changing dressings as recommended 2
• For burns on special areas like toes, monitor for functional impairment during healing 2
• Continue pain management as needed throughout the healing process 2