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for a detailed examination of the size and depth of the wound. A burn
dressing should be placed immediately after wound assessment.
Management
Blisters. For minor burns, blisters provide a biologic dressing and intact
blisters should not be ruptured, unless they are large, crossing joints or
limiting activity, or those obscuring the assessment of the degree of overall
injury. Once the blister has ruptured spontaneously, it will likely need
debridement to improve healing and prevent infection. For these less
extensive debridements, a single dose of intranasal or intramuscular opioids
can be effective and avoid the need for placement of an intravenous
catheter. Ruptured blisters should be unroofed using gauze and sterile saline
to remove devitalized tissue, and antimicrobial ointment should be placed
on the exposed wound surface.
Dressings. A superficial burn does not require dressing, and pain control
with ibuprofen or acetaminophen can be given as needed. Following
cleaning, a topical dressing is applied directly to the wound surface. We
recommend bacitracin for the face, head, and perineum as well as the
fingers and toes if there is a risk of ingestion, Polysporin Ophthalmic for
periorbital burns, and silver sulfadiazine (Silvadine) or triple antibiotic
ointment for all other burns. Of note, Silvadine cannot be used in patients
with a sulfa allergy. Silver-impregnated dressings have also shown
promising results. Work to identify the best dressing to encourage healing
and reduce infection risk is ongoing, and practice may vary based on
provider or institutional preference. Following the selected topical
treatment, a nonadherent dressing is placed on the burn, which can then be
wrapped with gauze.
Dressings should be changed twice each day. The parent should rinse off
residual antibacterial ointment with warm water and inspect the wound.
Signs of infection, such as redness and tenderness around the margin of the
burn, warrant immediate evaluation by a physician. A gray-greenish
material formed by serous drainage from the burn mixing with the silver

sulfadiazine cream is often mistaken for purulence. If the burn is healing
well, the parent should reapply the antibiotic ointment and dress the wound