Most burn injuries do not require hospitalization, although the sudden nature and urgency of burns drives many people to seek treatment in Emergency Rooms. Severe burns require major medical intervention and can be fatal.
Topical (applied to the skin) antibiotics
The skin is the body’s largest organ (averaging more than two square yards in adults) and performs many vital functions, including protecting the body from invasion by bacteria and viruses. Burned skin not only loses its ability to protect against invaders, it becomes a breeding ground for bacteria. Because infections slow healing and increase scarring, preventing and treating infections is one of the most important tasks of a hospital burn unit. More on secondary treatment.
Bandages 1) protect against infection; 2) reduce heat and water vapor loss from burned skin; 3) keep the patient more comfortable because the injured area is sensitive to air currents; 4) help keep limbs, fingers and toes in a proper position for healing; and 5) collect drainage from the wounds.
Elevating injured limbs or digits and escharotomies
A person with a serious burn injury goes into shock, which causes swelling. Badly burned skin becomes stiff and resists swelling, leading to increased pressure inside limbs, fingers or toes that can choke off blood flow. Keeping an injured limb raised reduces the pressure inside the limb by draining fluid. Surgical cuts (called escharotomies) in the burned skin can also allow the burned area to expand and decrease the pressure in the injured area.
As injured skin heals, the skin around the wound contracts (shrinks) toward the center of the wound as scar tissue forms in the wounded area. If joints in the area of injury are not regularly exercised, the scarred skin may become so tight that the joint cannot move normally. This is known as a contracture. Contractures often have to be treated (released) surgically. Consequently, even though exercising burned limbs can be painful, it increases flexibility and reduces long-term complications. Rehabilitation that is begun early and continues late in the healing process usually results in the greatest flexibility.
Some scars grow beyond or above the area of the wounded skin (known as hypertrophic scarring). While the reasons this occurs are not fully understood, keeping pressure on the scar as it forms helps reduce the amount of hypertrophic scarring. After scar tissue begins to form, garments that put pressure on the scar are often used.
Skin grafting is a technique doctors often use to treat burned areas of the skin. More information can be found in the skin grafts for burn treatment section of this website.
After the emergency burn treatment and patient stabilization, a detailed secondary survey of the injuries is made. Injuries often missed in the secondary survey include damage to the eyes and genitals.
Doctors typically order blood and urine tests: complete blood count, electrolytes, blood urea nitrogen, creatinine, glucose, venous blood gas (VBG), and carboxyhemoglobin. If the doctor is worried about damage to organs, he or she might order urine myoglobin, serum creatine kinase, or serum lactate tests. Arterial blood gas (ABG), chest radiograph, and an electrocardiogram (ECG) are obtained in any patient at risk for inhalation injury.
Patients with extensive burns have weakened immune systems. The immune system cells (neutrophils) can both overshoot and undershoot in response to the trauma, and the T lymphocyte dysfunction and cytokines they release are off balance. Patients often get bacterial infection in the burn area. The burn also destroys the physical barrier to tissue invasion, which permits spread of the bacteria deeper into the skin and through the lymph system. The dead (debris) tissue at the burn site is a breeding ground for parasites. Bacteria can get in the bloodstream. To protect against these nasty events, the doctor and nurses take action to prevent infections.
Tetanus immunization is given if the patient has not had one in the recent past, because of the increased risk of infection. The treatment team (doctors or nurses) almost always puts topical antibiotics on non-superficial burns. Some caregivers apply antibiotics to burn blisters; some do not. If the patient is moved to a burn center, burns are covered with clean, dry dressings and antibiotics are applied at the burn center. Cleaning and antibiotics are employed until skin grows over the burned area.
Long Term Treatment
Medical Research on Burn Treatment