From the Guidelines
For burns treatment, immediately cool the burn with cool running water for 10-20 minutes to stop the burning process and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This initial step is crucial in reducing the severity of the burn and promoting healing.
- Remove jewelry or tight items from the burned area before swelling occurs to prevent further injury.
- For minor burns (first-degree or small second-degree), apply petroleum jelly or aloe vera gel after cooling, then cover with a sterile non-stick bandage changed daily.
- Take over-the-counter pain relievers like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6 hours as needed for pain, as suggested by the guidelines 1.
- Avoid breaking blisters as they protect against infection. For third-degree burns or large second-degree burns (larger than 3 inches or on face, hands, feet, genitals, or major joints), seek immediate medical attention, as these severe burns require professional wound care, possibly including prescription antibiotics, specialized dressings, and in some cases, skin grafting 1. Burns heal better in moist environments, which is why petroleum jelly is recommended over traditional remedies like butter or toothpaste, which can trap heat and increase infection risk. It is essential to note that while hyperbaric oxygen therapy (HBOT) may be considered for certain cases of carbon monoxide poisoning, there is no strong evidence to support its use for burn wound healing 1. In terms of fluid resuscitation, hourly urine output should be targeted, with a goal of 0.5–1 mL/kg/h in adults, and adjustments made based on clinical response and haemodynamic parameters to avoid under- or over-resuscitation 1.
From the FDA Drug Label
Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The burn areas should be covered with silver sulfadiazine cream, USP 1% at all times The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting.
Burns Treatment with Silver Sulfadiazine Cream, USP 1%
- Apply the cream to the burned area under sterile conditions after cleansing and debridement.
- Cover the burn area with the cream at all times.
- Apply the cream once to twice daily to a thickness of approximately one sixteenth of an inch.
- Reapply immediately after hydrotherapy.
- Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2.
From the Research
Burns Treatment Overview
- Burns treatment typically involves immediate first aid interventions to minimize damage and promote healing
- One common first aid intervention for thermal burns is cooling with running water
Cooling Duration for Thermal Burns
- The ideal duration of cooling remains controversial and inconsistent across organizations 3
- A systematic review of the evidence found no benefit for cooling for 20 minutes or more compared to less than 20 minutes for outcomes such as burn size, depth, and complications 3
- The review included four observational studies, with 48% of burns cooled for 20 minutes or more, but the evidence is of very low certainty due to limitations in study design, risk of bias, and indirectness 3