What is the recommended treatment for a patient with a 2nd degree burn?

Treatment of Second-Degree Burns

Immediately cool the burn with clean running water for 5-20 minutes, then apply petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin, and polymyxin B) and cover with a non-adherent dressing. 1, 2

Immediate First Aid

• Cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Monitor preadolescent children for hypothermia during the cooling process 1
• Remove all jewelry from the affected area before swelling occurs to prevent vascular compromise 1, 2
• Never apply ice directly to burns as this causes further tissue damage 1, 2
• Do not apply butter, oil, or other home remedies 1

Pain Management

• Administer over-the-counter acetaminophen or NSAIDs for pain control 1, 3
• For severe burn pain in hospitalized patients, consider multimodal analgesia with titrated intravenous ketamine combined with other analgesics 4

Wound Cleaning and Preparation

• Clean the wound with tap water, isotonic saline, or antiseptic solution before applying any dressing 2
• Do not break or pop blisters as this significantly increases infection risk 1
• If blisters are intact, preserve the blister roof as a biological dressing to help with pain management and promote healing 3
• If drainage is necessary, pierce the blister at the base with a sterile needle (bevel facing up) while preserving the roof 3

Topical Treatment Options

Primary recommendation: Apply petrolatum-based antibiotic ointment (triple antibiotic containing bacitracin, neomycin sulfate, and polymyxin B) 1, 3

Alternative options include:

• Paraffin gauze as a primary dressing, which creates a non-adherent barrier 2
• Honey or aloe vera 3
• Bland emollient to support barrier function 3

Important caveat regarding silver sulfadiazine: While FDA-approved for second-degree burns 5, the American Burn Association recommends avoiding prolonged use of silver sulfadiazine (Silvadene) on superficial burns as it may delay healing 1, 2, 3

Dressing Application

• Cover with a clean, non-adherent dressing after applying topical treatment 1, 2
• Change dressings every 1-2 days based on wound condition 2
• Reassess the wound during each dressing change to monitor healing and check for infection 2

Special Safety Consideration for Oxygen Therapy

• Avoid oil-based emollients near the nostrils when oxygen is in use due to combustion risk 1
• Petrolatum-based antibiotic ointments are safe on facial burns in patients receiving oxygen 1
• Ensure hands are dried after using alcohol-based sanitizers before applying topical agents 1

When to Refer to Specialized Burn Care

Immediate referral is required for:

• Burns involving the face, hands, feet, or genitalia (regardless of size) 1, 2, 3
• Burns covering >10% body surface area in adults (>5% in children) 1, 2, 3
• Deep partial-thickness burns requiring possible early tangential excision 6
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1

Infection Monitoring

• Monitor for increased pain, redness extending beyond burn margins, swelling, or purulent discharge 2
• Do not use prophylactic systemic antibiotics—reserve them only for clinically evident infections 2, 6
• Topical antimicrobials can be used in conjunction with dressings when necessary for contaminated wounds 2

Key Pitfalls to Avoid

The most common errors in second-degree burn management include:

• Applying ice directly (causes additional tissue damage) 1, 2
• Breaking blisters unnecessarily (increases infection risk) 1
• Using home remedies like butter or oil 1
• Prolonged use of silver sulfadiazine on superficial burns (delays healing) 1, 2, 3
• Delaying medical attention for burns in sensitive areas or large surface areas 1