What is the proper treatment for burns?

Burn Treatment

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

Immediate First Aid (Within First 30 Minutes)

Cooling Protocol

• Apply clean running water at room temperature (15°C to 25°C) for 5-20 minutes as soon as possible after injury to reduce pain, depth of injury, and need for skin grafting 3, 1, 2
• Start cooling within 30 minutes of injury for maximum benefit 3
• Monitor children closely during cooling for signs of hypothermia, especially with burns >10% total body surface area (TBSA) 3, 1
• Adults with TBSA <20% and children with TBSA <10% should be cooled in the absence of shock 3

Critical Actions During Cooling

• Remove jewelry and constrictive items immediately before swelling occurs to prevent vascular compromise 1, 4
• Remove contaminated clothing if not stuck to the skin 5

Wound Care After Cooling

Cleaning

• Cleanse the wound with tap water, isotonic saline, or antiseptic solution 3, 4

Blister Management

• Leave burn blisters intact - this improves healing and reduces pain 3
• If epidermis is already detached, leave it in place to act as a biological dressing 4

Topical Treatment

• Apply petrolatum-based antibiotic ointment (such as triple antibiotic containing bacitracin, neomycin sulfate, and polymyxin B) as first-line treatment 1, 2
• Apply a thin layer and cover with clean, non-adherent dressing 1, 2
• Change dressing daily or as needed 2
• Avoid silver sulfadiazine for superficial burns as it delays healing and worsens scarring 3, 1, 2

Alternative Topical Agents

• Honey may be used and shows reduced healing time (7.8 days faster than silver sulfadiazine) with less hypertrophic scarring 2
• Aloe vera is reasonable for small burns managed at home 2

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs after cooling 1, 2, 4
• For severe pain during dressing changes, consider titrated intravenous ketamine combined with other analgesics 3
• Non-pharmacological techniques (virtual reality, hypnosis) may be combined with medications when appropriate 3

Fluid Resuscitation for Extensive Burns

• Administer 20 mL/kg of intravenous crystalloid solution within the first hour for adults with burns ≥20% TBSA and children with ≥10% TBSA 4
• Use balanced crystalloid solutions, preferably Ringer's Lactate 4

When to Seek Specialized Burn Center Care

Immediate Transfer Required For:

• Burns involving face, hands, feet, or genitalia regardless of size - high risk of functional disability and cosmetic deformity 1, 2, 4
• Burns >10% TBSA in adults or >5% TBSA in children 1, 4
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 2, 4
• Circumferential burns 2
• Blue, purple, or pale extremities indicating vascular compromise 2

Critical Pitfalls to Avoid

Never Do These:

• Do not apply ice or ice water - this increases tissue damage and can cause cold injury 3, 1, 2, 4, 6
• Do not apply butter, oil, or home remedies - these exacerbate injury 1, 2, 4
• Do not break or pop intact blisters - significantly increases infection risk 1, 2, 4
• Do not use silver sulfadiazine as first-line therapy on superficial burns - delays healing 3, 1, 2
• Do not apply oil-based emollients near nostrils in patients on oxygen therapy due to combustion risk 1

Antibiotic Prophylaxis

• Routine systemic antibiotic prophylaxis is not recommended for burn patients 3
• Apply topical antimicrobials only to areas with necrotic tissue, not the entire burn surface 4

Ongoing Monitoring

• Reevaluate dressings daily 3, 4
• Monitor for signs of infection (increased pain, redness, swelling, discharge) 4
• Continue treatment until satisfactory healing occurs or the burn site is ready for grafting 7