Burn Treatment Guidelines

Initial Assessment and First Aid

For adults, cool burns with clean running water for 5-20 minutes if the total body surface area (TBSA) is less than 20% and the patient is not in shock, as recommended by the American Society of Anesthesiologists 1
For children, cool burns with clean running water for 5-20 minutes if the TBSA is less than 10% and the patient is not in shock, according to the American Academy of Pediatrics 1
Cooling for 20-39 minutes significantly reduces the need for skin grafting (P<0.001), as reported by the American Burn Association 1

Administer titrated intravenous ketamine combined with opioids for severe burn pain, as recommended by the American Society of Anesthesiologists 1
Use short-acting opioids for dressing changes, as suggested by the American Pain Society 1
All analgesics must be titrated using validated pain assessment scales, according to the American Society of Anesthesiologists 1

Adults require burn center referral if they have a TBSA greater than 20%, deep burns greater than 5%, smoke inhalation, deep burns in function-sensitive areas, high-voltage electrical burns, chemical burns, or are over 75 years old with a TBSA greater than 10%, as recommended by the American Burn Association 2
Children require burn center referral if they have a TBSA greater than 10%, deep burns greater than 5%, are under 1 year old, have electrical burns, burns in function-sensitive areas, or circular burns, according to the American Academy of Pediatrics 2

Wound care is not a priority until after adequate resuscitation, as reported by the American College of Surgeons 3, 1
Avoid prolonged use of silver sulfadiazine on superficial burns, as it delays healing, according to the American Burn Association 3, 1
Ideally, consult a burn specialist before applying dressings to determine the optimal approach, as recommended by the American College of Surgeons 3, 1

The American Burn Association recommends using the Lund-Browder chart for accurate total body surface area (TBSA) calculation in both adults and children 4

The American College of Surgeons advises that any electrical burn in children is automatically classified as severe 5
The American College of Emergency Physicians suggests that high-voltage electrical burns in adults require burn center referral 6, 4
The American Burn Association recommends that chemical burns (such as hydrofluoric acid) require burn center referral regardless of size 6, 4

The American College of Surgeons recommends assessing for compartment syndrome by checking for tightness, swelling, burning pain, and distal neurovascular compromise 7
The American Burn Association advises that blue, purple, or pale extremities indicate poor perfusion requiring emergency escharotomy 4, 7
The American College of Emergency Physicians suggests that burns in function-sensitive areas (face, hands, feet, perineum) require burn center evaluation regardless of TBSA 6, 4
The American College of Surgeons recommends avoiding delaying specialist consultation and not waiting for pulse loss in suspected compartment syndrome, as irreversible damage occurs within 6-8 hours 7
The American Burn Association advises that hand burns with blanched skin falling off fingers indicate deep partial- or full-thickness injury requiring immediate specialist referral 4