1. Significant resources are required for wound care of major burns. At the Role 1 or Role 2, consider rapidly transferring a patient to a higher echelon of care if possible, providing dry dressings and hypothermia protection enroute. Bear in mind that any dressings will likely be immediately removed upon arrival at the next echelon of care to facilitate patient evaluation.
  2. Debride burns by removing sloughed skin, blisters, and debris, and apply an effective topical antimicrobial, within the first 24 hours postburn.
  3. Whenever possible, do debridement in the OR, thereby providing a clean, warm environment to both examine the wounds and place sterile dressings. Use chlorhexidine gluconate or similar antiseptic cleanser. Debridement may be facilitated by scrub brushes and/or gauze sponges. Definitive removal of burn eschar (sharp/surgical excision) will be performed after stabilization and transport to the Burn Center.
  4. Topical antimicrobials. One of the following regimens should be used for burn-wound care.
  5. Face burns. Shave and debride the face, covering wounds with a topical antibiotic ointment QID such as bacitracin. Ear burns are prone to chondritis; apply Sulfamylon cream twice a day. (An alternative is Silvadene cream.) Avoid pressure from endotracheal tube ties or pillows.
  6. Avoid over-wetting dressings to avoid maceration of tissues. Frequent assessment of the patient’s temperature is necessary to prevent hypothermia secondary to wet dressings, especially during air evacuation.