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In Kashmir, it is estimated that 20,000 people are treated every year for burn injuries. Of these approximately 15,000 require hospitalisation.

By: Tawfeeq Irshad Mir

Injuries that result from direct contact with, or exposure to, any thermal, chemical, electrical, or radiation source are termed as burns. Burn injuries occur when energy from a heat source is transferred to the tissues of the body and the depth of injury is related to the temperature and the duration of exposure or contact.

Burn care has improved in recent decades, resulting in a lower mortality for victims of burn injuries. Dedicated burn canters have been established in which multi disciplinary team members work together to care for the affected person (s). Advances in pre-hospital and inpatient care have contributed to reducing the mortality rate and ensuring recovery. However, despite these advances, many people still die each year from burns.

In Kashmir, it is estimated that 20,000 people are treated every year for burn injuries. Of these approximately 15,000 require hospitalisation.

After traversing a lot of literature on burns, seeking guidelines from world health organisation, after surfing thousands of research papers on burn management, I propose an improvised model of health care for burn patients and here it goes: .

Wound car

First aid:

  • If the patient arrives at the health facility without first aid having been administered, drench the burn thoroughly with cool water to prevent further damage and remove all burned clothing.
  • If the burn area is limited, immerse the site in cold water for 30 minutes to reduce pain and oedema and to minimize tissue damage. If the area of the burn is large, apply clean wraps over the burned area, after it has been doused with cool water, to prevent systemic heat loss and hypothermia.
  • Hypothermia is a particular risk in young children and the first 6 hours following injury are critical; transport the patient with severe burns to a hospital as soon as possible.

Initial treatment

  • Initially, burns are sterile. Focus the treatment on speedy healing and prevention of infection.
  • In all cases, administer tetanus prophylaxis. Except in very small burns, debride all bullae. Excise adherent necrotic (dead) tissue initially and debride all necrotic tissue over the first several days.
  • After debridement, gently cleanse the burn with 0.25% (2.5 g/litre) chlorhexidine solution, 0.1% (1 g/litre) cetrimide solution, or another mild water- based antiseptic.
  • Do not use alcohol-based solutions.
  • Gentle scrubbing will remove the loose necrotic tissue. Apply a thin layer of antibiotic cream (silver sulfadiazine).
  • Dress the burn with petroleum gauze and dry gauze thick enough to prevent seepage to the outer layers.

Daily treatment

  • Change the dressing daily (twice daily if possible) or as often as necessary to prevent seepage through the dressing. On each dressing change, remove any loose tissue.
  • Inspect the wounds for discoloration or haemorrhage, which indicate developing infection.
  • Fever is not a useful sign as it may persist until the burn wound is closed.
  • Cellulitis in the surrounding tissue is a better indicator of infection.
  • Give systemic antibiotics in cases of haemolytic streptococcal wound infection or septicaemia.
  • Pseudomonas aeruginosa infection often results in septicaemia and death.

Treat with systemic aminoglycosides.

  • Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5% aqueous) is the cheapest, is applied with occlusive dressings but does not penetrate eschar. It depletes electrolytes and stains the local environment.
  • Use silver sulfadiazine (1% miscible ointment) with a single layer dressing. It has limited eschar penetration and may cause neutropenia.
  • Mafenide acetate (11% in a miscible ointment) is used without dressings. It penetrates eschar but causes acidosis. Alternating these agents is an appropriate strategy.
  • Treat burned hands with special care to preserve function.

− Cover the hands with silver sulfadiazine and place them in loose polythene gloves or bags secured at the wrist with a crepe bandage;

− Elevate the hands for the first 48 hours, and then start hand exercises;

− At least once a day, remove the gloves, bathe the hands, inspect the burn and then reapply silver sulfadiazine and the gloves;

− If skin grafting is necessary, consider treatment by a specialist after healthy  granulation tissue appears.

Healing phase

  • The depth of the burn and the surface involved influence the duration of the healing phase. Without infection, superficial burns heal rapidly.
  • Apply split thickness skin grafts to full-thickness burns after wound excision or the appearance of healthy granulation tissue.
  • Plan to provide long term care to the patient.
  • Burn scars undergo maturation, at first being red, raised and uncomfortable. They frequently become hypertrophic and form keloids. They flatten, soften and fade with time, but the process is unpredictable and can take up to two years.

In children

- The scars cannot expand to keep pace with the growth of the child and may lead to contractures.

- Arrange for early surgical release of contractures before they interfere with growth.

  • Burn scars on the face lead to cosmetic deformity, ectropion and contractures about the lips. Ectropion can lead to exposure keratitis and blindness and lip deformity restricts eating and mouth care.
  • Consider specialized care for these patients as skin grafting is often not sufficient to correct facial deformity.


  • Patient’s energy and protein requirements will be extremely high due to the catabolism of trauma, heat loss, infection and demands of tissue regeneration.

If necessary, feed the patient through a nasogastric tube to ensure an adequate energy intake (up to 6000 kcal a day).

  • Anaemia and malnutrition prevent burn wound healing and result in failure of skin grafts. Eggs and peanut oil and locally available supplements are good.

The writer is Bsc Hons in Nursing at GMC Srinagar and can be reached at

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