Treatment of Minor Burns

Classification of Burns

  1. First Degree-Superficial burns that only involve the epidermis with swelling, redness, and pain. Doesn't blister and heals quickly without scarring.
  2. Second Degree -the entire epidermis is involved and usually blisters. Very painful and healing will take 7-14 days.
  3. Third Degree- these are full thickness burns with the entire epidermis and dermis involved. The nerves endings are destroyed and usually there is no pain. Because of the inability to epithelialize, grafting is necessary.
First Aid for Burns
  1. Cooling as soon as possible. This can limit the inflammation and thermal damage. Best to use cool water or ice pack wrap. Ice application has been associated with frostbite and should be avoided. 
  2. Pain Control- Acetaminophen usually helpful but may need to use opiates such as codeine. 
  3. Check immunization status and update tetanus if necessary.
  4. Debridement of Bulla- there are some differences of opinion regarding breaking of blisters.
    1. Some suggest leaving intact because the blister acts as a barrier to infection and others debride all blisters. 
    2. Most agree that after blister ruptures necrotic skin skin should be removed.
  5. Application of Antibiotics- suggest use of ointments
    1. Mucopiricin- good Streptococcal and Staphylococcal coverage.
    2. Neosporin 
    3. Silvadene- has good gram negative coverage and gram negative infections predominate in the second week after the burn. Disadvantage is because it is difficult to see the burn under the Silvadene. 
  6. Cleaning the Wound- use of plain water or soap and water. May use water on cotton swab to remove crusted material. 
  7. Dressing- should use a non-adherent dressing
    1. Vaseline gauze
    2. Telfa pads
    3. May want to inspect the wound frequently but not necessarily take off the entire dressing. Can inspect for warmth, redness, and drainage without removing all the layers.
Most minor burns that occur can usually be treated as outpatients. Guidelines are that if it covers less than 10% of the body surface area, inpatient treatment not necessary. 

Reference

  1. Hansbrough JF and Hansbrough W. Pediatric Burns. Pediatrics in Review. 1999; 20:117-124.
  2. Schiller, William. Burn Management in Children. Pediatric Annals August, 1996.
  3. Rodgers Gail Reducing the toll of childhood Burns Contemporary Pediatrics April 2000