What is the treatment for a patient with burns caused by a brush fire?

Treatment for Burns Caused by Brush Fire

Immediately cool the burn with clean running water for 5-20 minutes, then apply petrolatum-based ointment or honey, cover with a non-adherent dressing, and provide oral pain medication—while urgently assessing for inhalation injury and determining if specialized burn center transfer is needed. 1, 2

Immediate First Aid (First 20 Minutes)

Stop the Burning Process

• Remove the patient from the fire source and extinguish any burning clothing 2
• Remove all jewelry and constrictive items from affected areas before swelling develops to prevent vascular compromise 2, 3

Cool the Burn Immediately

• Apply clean running water for 5-20 minutes to limit tissue damage progression and reduce pain 1, 2
• This single intervention reduces the need for skin grafting by approximately 32% and decreases the likelihood of superficial burns progressing to deep burns 4
• If clean running water is unavailable, ice wrapped in cloth may be used for superficial burns with intact skin only 1, 3
• Monitor children closely for hypothermia during cooling, especially preadolescent children and those with larger burns 1, 2
• For adults with burns <20% total body surface area (TBSA) and children <10% TBSA, cooling should be performed unless shock is present 2

Assess Burn Severity and Triage

Critical Red Flags Requiring Immediate Medical Attention

• Inhalation injury signs: soot around nose/mouth, singed nasal hairs, difficulty breathing, or hoarseness 1, 2, 3
• Burns involving face, hands, feet, or genitals (risk of permanent disability requiring surgical intervention) 1, 2, 3
• Partial-thickness burns >10% TBSA in adults or >5% TBSA in children 1, 2, 3
• All full-thickness (third-degree) burns 1, 2
• Circumferential burns of extremities or chest 2

Classify Burn Depth

• Superficial (first-degree): Intact skin, redness, pain—heals without scarring, low infection risk 1, 3
• Partial-thickness (second-degree): Epidermis destroyed with deeper layer injury, blistering—requires careful wound care 1, 2
• Full-thickness (third-degree): Complete destruction through all skin layers—always requires hospital treatment 1, 2

Wound Care After Cooling

For Superficial Burns (First-Degree)

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2, 3
• Cover with clean, non-adherent dressing 2, 3
• These can typically be managed at home if small and not involving critical areas 3

For Partial-Thickness Burns (Second-Degree)

• Clean the wound with tap water, isotonic saline, or antiseptic solution 2
• Apply thin layer of petrolatum-based antibiotic ointment 2
• Cover with non-adherent dressing such as Xeroform, Mepitel, or Allevyn 2
• Avoid breaking blisters as this increases infection risk 2
• Re-evaluate dressings daily if possible 2

For Full-Thickness Burns (Third-Degree)

• After cooling, cover with clean, dry, non-adherent dressing while awaiting emergency medical care 2
• Do not attempt home management—immediate hospital transfer required 1, 2

Critical Dressing Principles

• Perform wound care in clean environment with adequate analgesia 2
• When applying dressings on limbs, prevent tourniquet effect from bandages 2
• Monitor distal perfusion with circular dressings 2

Pain Management

Systemic Analgesia

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for mild to moderate pain 1, 2, 3
• For severe burns, multimodal analgesia should be used with medications titrated based on validated pain assessment scales 2
• Short-acting opioids and titrated intravenous ketamine are effective for severe burn-induced pain 2
• For highly painful injuries or procedures, general anesthesia may be necessary 2

Topical Antimicrobial Therapy (When Indicated)

Silver Sulfadiazine Use

• FDA-approved as adjunct for prevention and treatment of wound sepsis in second and third-degree burns 5
• Apply once to twice daily to thickness of approximately 1/16 inch under sterile conditions 5
• Important caveat: May be associated with prolonged healing if used long-term on superficial burns 2
• Should be dedicated to infected wounds only, not used as first-line prophylaxis 2
• Continue until satisfactory healing or burn site ready for grafting 5

Critical Pitfalls to Avoid

• Do not apply ice directly to burns—causes further tissue damage 2
• Do not apply butter, oil, or other home remedies 2, 3
• Do not use external cooling devices for prolonged periods—risk of hypothermia 2
• Do not routinely prescribe prophylactic antibiotics—not recommended for burn patients 2
• Do not use topical antibiotics as first-line treatment—reserve for infected wounds 2
• Do not delay transfer to specialized burn center when indicated 1, 6

Ongoing Management Considerations

For Burns Managed in Hospital Setting

• Prompt control of shock and pain is of prime importance 5
• Cleanse and debride burn wounds before applying antimicrobial therapy 5
• Fluid resuscitation critical for large burns to prevent multisystem organ failure 1, 6
• Burns involving large surface area can lead to significant fluid loss requiring specialized intensive care 1, 6