Burn Management Guidelines

Assessment and Triage

The Lund-Browder chart should be used as the standardized method to measure total burned body surface area (TBSA) in both adults and children, as it is the most accurate method for TBSA quantification 1, 2
TBSA is frequently overestimated (in 70-94% of cases), which can lead to excessive fluid administration 1, 2
For quick estimation in the field, the palm and fingers of the patient's hand (approximately 1% TBSA) can be used as a reference 2
Burn depth should be determined (superficial, partial thickness, or full thickness) to guide further management 2

Adults with TBSA burned > 20%, deep burns > 5%, presence of smoke inhalation, deep burns in areas that might lead to functional sequelae, or burns from high-voltage electricity should be referred to a burn center 3, 4
Adults with TBSA < 20% and one or more of the following conditions should also be referred: age > 75 years, severe comorbidities, known or suspected smoke inhalation, deep circular burns, superficial burns in function-sensitive areas, TBSA > 10%, deep burn 3-5%, burns from low-voltage electricity, or chemical burns 3, 5
Children with TBSA > 10%, deep burns > 5%, infants (< 1 year of age), severe comorbidities, smoke inhalation injuries, deep burns in function-sensitive areas, circular burns, electrical or chemical burns should be referred to a burn center 3, 5

Consult a burn specialist early, ideally through telemedicine if direct consultation is not available 6, 2
For adults with burns >15% TBSA and children with burns >10% TBSA, administer 20 mL/kg of balanced crystalloid solution (preferably Ringer's Lactate) within the first hour 7, 2
Establish intravenous access in unburned areas when possible; consider intraosseous access if IV access cannot be rapidly obtained 7, 2
Monitor for signs of hypovolemic shock due to inflammation, capillary leak syndrome, and microcirculation alterations 7

Clean the burn wound with tap water, isotonic saline solution, or an antiseptic solution 2
Consider whether blisters should be flattened or excised (ideally with burn specialist consultation) 2
Apply appropriate dressings based on burn depth, TBSA, wound appearance, and patient's general condition 2
When applying dressings, be careful to prevent bandages from causing a tourniquet effect 2
Monitor distal perfusion regularly when circular dressings are applied 2

Evaluate the need for escharotomy if a deep burn induces compartment syndrome that compromises circulation; this procedure should ideally be performed in a burn center 7, 2
Escharotomy carries risks of complications, particularly hemorrhage and infection, and should be performed only at a Burns Centre or after specialist advice if transfer is impossible 7
Consider thromboprophylaxis for severe burns 2
Avoid prolonged use of external cooling devices to prevent hypothermia 2
Provide adequate analgesia before wound cleaning and dressing application 2

Overestimation of TBSA, which can lead to excessive fluid administration 1, 2
Delaying specialist consultation, which may increase morbidity and mortality 2
Improper dressing application that restricts circulation 2
Routine use of systemic antibiotics for prophylaxis 2
Prolonged use of silver sulfadiazine on superficial burns, which may delay healing 2
Performing escharotomy without proper training or consultation 7, 2