Therapeutic target
Best possible care and improvement of prognosis
Therapy recommendations
- Wound care (dressing changes always under adequate analgesia/anesthesia):
- Expose wound and cool (do not use ice water because of the risk of cooling; see “Further therapy”)
- From grade 2b burns (see below burns/classification): remove necrotic tissue (debridement; surgical, hydrosurgical, enzymatic).
- Wound covering with non-adherent dressing material.
- Antiseptic gel and ointments for the prevention of wound infections.
- Fluid intake in the early phase primarily with crystalloid solutions (full electrolyte solution; see below infusions).
- Analgesia according to WHO staging scheme:
- Non-opioid analgesic (paracetamol, first-line agent; also or ibuprofen, if appropriate).
- Low-potency opioid analgesic (eg, tramadol) + non-opioid analgesic.
- High-potency opioid analgesic (e.g., morphine) + non-opioid analgesic plus esketamine (intravenous anesthetics) in a perfusor
- Early and full necrectomy/complete removal of necrotic (dead) tissue (see “Surgical Therapy” below).
- Infection prophylaxis
- Tetanus prophylaxis or tetanus vaccine protection is to be evaluated
- Plastic care / defect coverage after averting the danger to life.
- See also under “Further therapy“.
Infusions
Drug group | Dosage | Special features |
Full electrolyte solution | 1 ml x kg bw x % vKOF* in the first 4 h. | Baxter-Zellner scheme |
4 ml/kg bw x % vKOF/ 24 h (of which 50% in the first 8 h; 50% in the following 16 h). | Parkland-Baxter scheme |
* vKOF = body surface area burned.
- Many other schemes exist; the ideal solution is still controversial; however, too aggressive fluid administration should not be performed
- 0.5-1 l/h of a crystalloid solution should be given in adults
- It should be given 10-20 ml/kg bw/h in children.
- Colloids should not be used
- Albumin, Fresh Frozen Plasma (FFP), if applicable.