What is the recommended treatment for burn management?

Burn Management

Immediate First Aid (Within 3 Hours of Injury)

Cool the burn immediately with clean running water for 20 minutes to limit tissue damage, reduce pain, and improve outcomes including decreased need for skin grafting and surgical intervention. 1, 2

• Apply cooling within 3 hours of injury for maximum effectiveness 3, 2
• For burns with total body surface area (TBSA) <20% in adults or <10% in children, cooling should be performed in the absence of shock 4
• Monitor children closely for hypothermia during the cooling process 1
• If clean running water is unavailable, superficial burns with intact skin may be cooled with ice wrapped in cloth 1
• Remove all jewelry and constrictive items before swelling occurs to prevent vascular compromise 1, 5

Common Pitfall: Do not use external cooling devices like Water-Jel dressings for prolonged periods due to hypothermia risk 1. Do not apply ice directly to burns or use butter, oil, or other home remedies 5.

Pain Management

Implement multimodal analgesia titrated to validated comfort scales, combining pharmacological and non-pharmacological approaches. 4

• For minor burns: Over-the-counter acetaminophen or NSAIDs 1, 6
• For severe burns: Titrated intravenous ketamine combined with other analgesics, particularly short-acting opioids 4
• For dressing changes: Consider inhaled nitrous oxide when IV access is unavailable, or general anesthesia for highly painful procedures 4
• Non-pharmacological techniques (virtual reality, hypnosis) should be combined with medications when the patient is stable 4

Wound Cleaning and Assessment

Clean the wound with tap water, isotonic saline, or antiseptic solution in a clean environment with appropriate analgesia or general anesthesia. 4, 1

• Assess burn depth, size (using rule of nines), and location 1, 3
• Do not break or pop blisters as this significantly increases infection risk 5
• Ideally consult a burn specialist to determine whether blisters should be flattened or excised 4, 5

Assessment for Transfer to Burn Center:

• Burns >10% TBSA in adults or >5% TBSA in children 1, 3
• Burns involving face, hands, feet, genitals, or perineum 1, 5
• All full-thickness burns 1
• Chemical or electrical burns 3
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 1

Dressing Application

For first-degree burns: Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera, then cover with a clean non-adherent dressing 1, 6

For second-degree burns managed at home: Apply petrolatum-based products and cover with clean non-adherent dressing 1

For larger or deeper burns: The dressing type depends on TBSA, wound appearance, and patient's general condition 1, 5

For severe burns requiring medical attention:

• Apply silver sulfadiazine cream 1% once to twice daily to a thickness of approximately 1/16 inch under sterile conditions 7
• Cover burn areas at all times with the cream, reapplying after hydrotherapy or patient activity 7
• Continue treatment until satisfactory healing or the burn site is ready for grafting 7
• Dressings are not required but may be used if patient needs dictate 7

Critical Considerations:

• When applying dressings on limbs, prevent tourniquet effect and monitor distal perfusion 1
• Re-evaluate dressings daily ideally 1
• Do not delay resuscitation interventions for dressing application in severe burns 1

Antimicrobial Management

Reserve topical antibiotics for infected wounds only; do not use as first-line prophylaxis. 1

• Antimicrobial dressings are recommended for minor burns 3
• Avoid oral antibiotics unless signs of infection are present 1, 3
• Do not use silver sulfadiazine for prolonged periods on superficial burns as it may prolong healing 5

Common Pitfall: Routine antibiotic prophylaxis should be avoided in burn patients without infection 1.

Tetanus Prophylaxis

Check and update tetanus immunization status, as burns are tetanus-prone wounds. 3

Follow-Up and Monitoring

• Monitor for signs of infection: increased pain, redness, swelling, or discharge 5
• Burns that become infected or are slow to heal should be discussed with a burn unit 3
• For burns on special areas (hands, feet, toes), monitor for functional impairment during healing 5
• Keep burn area clean and dry, changing dressings as recommended 5