Burns: Drug Therapy

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.