What is the proper treatment for burns?

Proper Treatment for Burns

Immediately cool the burn with clean running water for 5-20 minutes, then apply a petrolatum-based antibiotic ointment and cover with a non-adherent dressing. 1, 2, 3

Immediate First Aid Management

Initial Cooling

• Remove the patient from the thermal source and begin active cooling with running water immediately 1
• Cool burns in adults with total body surface area (TBSA) <20% and children with TBSA <10% in the absence of shock 1
• Apply cool running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2, 3
• Cooling can be effective for up to 60 minutes after injury, though immediate cooling is preferred 4
• Monitor young children (<4 years) for signs of hypothermia during cooling (shivering, visible coldness), particularly if whole-body cooling is used 1
• Remove jewelry from affected areas before swelling occurs to prevent vascular compromise 2, 3

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain control 2, 3, 5
• For highly painful injuries or procedures, deep analgesia or general anesthesia may be required 1

Wound Preparation and Blister Management

Cleaning the Wound

• Cleanse wounds with tap water, isotonic saline solution, or an antiseptic solution before dressing application 1, 3
• Wound care should be performed in a clean environment 1

Blister Management

• For intact blisters, leave the detached epidermis in place to act as a biological dressing 3, 5
• Decompress blisters by piercing at the base with a sterile needle (bevel up) and expressing fluid while preserving the blister roof 3, 5
• Do not completely break or pop blisters as this significantly increases infection risk 2, 3, 5

Topical Treatment and Dressing Application

Topical Agents

• Apply a petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) after cooling 2, 3
• Alternatively, apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin 3
• Avoid silver sulfadiazine for prolonged use on superficial burns as it is associated with delayed healing 1, 2, 3, 5
• Apply topical antimicrobial agents only to sloughy or infected areas, not to the entire burn surface 3

Dressing Selection

• Cover with a non-adherent dressing such as Mepitel, Telfa, sterile gauze, or interface dressings 1, 2, 3
• No specific dressing type has been proven superior to others 1
• When applying dressings to limbs, prevent tourniquet effect and monitor distal perfusion with circular dressings 1
• Re-evaluate dressings daily 1, 3

Antibiotic and Prophylaxis Considerations

Antibiotic Use

• Do not administer routine systemic antibiotic prophylaxis to burn patients 1, 3
• Reserve topical antibiotics for infected wounds only, not as first-line treatment 1
• Use antimicrobial dressings for large or contaminated burns 1

Thromboprophylaxis

• Routinely prescribe thromboprophylaxis for severe burns patients in the initial phase 1

Tetanus Prophylaxis

• Check and update tetanus immunization status as burns are tetanus-prone injuries 6

When to Refer to Specialized Burn Care

Mandatory Referral Criteria

• Burns involving face, hands, feet, or genitalia require specialized care regardless of size 2, 3, 5
• Burns covering >10% TBSA in adults or >5% TBSA in children should be treated in a specialized burn center 2, 3, 5
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 2
• Chemical or electrical burns 6
• Deep burns requiring skin grafting 6, 7
• Signs of infection, wound conversion, or delayed healing 3

Critical Pitfalls to Avoid

• Do not apply ice directly to burns as this causes further tissue damage 2, 3, 5
• Do not apply butter, oil, or other home remedies to burns 2, 3
• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods to limit hypothermia risk 1, 3
• Do not transport severe burn patients with external cooling devices in place 1
• Do not delay other resuscitation interventions for dressing application 1
• Do not delay seeking medical attention for burns in sensitive areas or covering large surface areas 2, 3