Burn Treatment Phases: A Key Guide
Burn treatment starts immediately after an injury occurs and can last weeks, months, or even years, depending on its severity. The correct first aid and medical support can prevent infection, optimise healing time, and reduce the chance of scarring. Selecting the proper dressing for a burn is crucial; as the wound moves through different stages of healing, different dressings are needed.
Here’s what you need to know about managing a burn as it heals.
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The Stages of Burn Management
Burn care management is organised into three stages: emergent, acute, and rehabilitative. Healthcare professionals use this three-tiered framework to break down the steps of holistic patient care and healing: generally fluid replacement, wound healing, and psychosocial support.
Stage 1: Resuscitative/Emergent Phase
Focus: Immediate and potentially fatal problems caused by the burn injury.
Duration | Concerns | Actions |
| From the time of burn injury until capillary permeability is restored, usually 48-72 hours. | Fluid loss leading to hypovolemic shock and oedema formation. | Major fluid shifts from the vasculature into interstitial tissues (second-spacing) and areas with no fluid (third-spacing) can occur, causing vascular volume loss. Capillary permeability is restored with adequate fluid replacement. Patients with 15% Total Body Surface Area or more burns need at least two large bore IV access sites for infusing fluids. Crystalloid solutions (Lactated Ringer's) or colloidal solutions (albumin) are administered as scheduled. Fluid administration is adjusted based on patient response, such as urine output and vital signs. |
The Stages of Burn Management
Burn care management is organised into three stages: emergent, acute, and rehabilitative. Healthcare professionals use this three-tiered framework to break down the steps of holistic patient care and healing: generally fluid replacement, wound healing, and psychosocial support.
Stage 1: Resuscitative/Emergent Phase
Focus: Immediate and potentially fatal problems caused by the burn injury.
Duration |
| From the time of burn injury until capillary permeability is restored, usually 48-72 hours. |
Concerns |
| Fluid loss leading to hypovolemic shock and oedema formation. |
Actions |
Major fluid shifts from the vasculature into interstitial tissues (second-spacing) and areas with no fluid (third-spacing) can occur, causing vascular volume loss. Capillary permeability is restored with adequate fluid replacement. Patients with 15% Total Body Surface Area or more burns need at least two large bore IV access sites for infusing fluids. Crystalloid solutions (Lactated Ringer's) or colloidal solutions (albumin) are administered as scheduled. Fluid administration is adjusted based on patient response, such as urine output and vital signs. |
Stage 2: Acute Phase
Focus: Wound care and preventing complications.
Duration | Concerns | Actions |
| From the beginning of diuresis to wound healing or skin grafting, lasting weeks to months. | Wound care, preventing infection, and managing electrolyte imbalances. | Encourage movement to prevent contractures. Monitor lab values (sodium, potassium, glucose). Necrotic tissue sloughs off as granulation tissue forms. Partial-thickness burns heal in 10-21 days if kept moist and infection-free. Full-thickness burns require surgical excision and skin grafts for healing. |
Stage 2: Acute Phase
Focus: Wound care and preventing complications.
Duration |
| From the beginning of diuresis to wound healing or skin grafting, lasting weeks to months. |
Concerns |
| Wound care, preventing infection, and managing electrolyte imbalances. |
Actions |
Encourage movement to prevent contractures. Monitor lab values (sodium, potassium, glucose). Necrotic tissue sloughs off as granulation tissue forms. Partial-thickness burns heal in 10-21 days if kept moist and infection-free. Full-thickness burns require surgical excision and skin grafts for healing. |
Stage 3: Rehabilitative Phase
Focus: Maximising functional recovery and reintegration into society.
Duration | Concerns | Actions |
| From wound closure to the patient's return to optimal functioning, lasting months to years. | Physical rehabilitation, psychosocial support, and managing changes in body image. | Teach the patient how to manage newly healed skin, avoid direct sunlight, and perform dressing changes and wound care. Provide referrals to home care nursing services if necessary. Help the patient cope with changes in body image and facilitate reintegration into society. |
Stage 3: Rehabilitative Phase
Focus: Maximising functional recovery and reintegration into society.
Duration |
| From wound closure to the patient's return to optimal functioning, lasting months to years. |
Concerns |
| Physical rehabilitation, psychosocial support, and managing changes in body image. |
Actions |
Teach the patient how to manage newly healed skin, avoid direct sunlight, and perform dressing changes and wound care. Provide referrals to home care nursing services if necessary. Help the patient cope with changes in body image and facilitate reintegration into society. |
From ABC checks in the immediate aftermath of a burn to psychological adjustment in the months following, these stages support all aspects of burn management. When looking specifically at how wounds are treated, we need to consider the primary and secondary phases of burn treatment.
IN A NUTSHELL:
Burn management has three stages: emergent, acute, and rehabilitative. Focus areas include fluid replacement and shock prevention, wound care and infection control, and maximising functional recovery and psychosocial support, respectively.
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Primary and Secondary Phases of Burn Treatment
Primary and secondary burn treatment phases are not rigid, but generally they overlap the first two stages of burn treatment: the emergent/resuscitative, acute, and rehabilitative phases. Here’s a breakdown of each one with a focus on wound management.
Primary Phase Treatment
The primary phase of burn treatment corresponds to the emergent or resuscitative phase:
Duration | Focus | Actions |
| First 24-48 hours post-injury. |
|
|
Primary and Secondary Phases of Burn Treatment
Primary and secondary burn treatment phases are not rigid, but generally they overlap the first two stages of burn treatment: the emergent/resuscitative, acute, and rehabilitative phases. Here’s a breakdown of each one with a focus on wound management.
Primary Phase Treatment
The primary phase of burn treatment corresponds to the emergent or resuscitative phase:
Duration |
| From wound closure to the patient's return to optimal functioning, lasting months to years. |
Focus |
|
Actions |
|
Secondary Phase Treatment
The secondary phase of burn treatment encompasses the acute phase and the beginning of the rehabilitative or long-term recovery phase:
Acute Phase:
Duration | Focus | Actions |
| From the end of the emergent phase until the wound closes (weeks to months). |
|
|
Secondary Phase Treatment
The secondary phase of burn treatment encompasses the acute phase and the beginning of the rehabilitative or long-term recovery phase:
Acute Phase:
Duration |
| From the end of the emergent phase until the wound closes (weeks to months). |
Focus |
|
Actions |
|
Rehabilitative or Long-Term Recovery Phase:
Duration | Focus | Actions |
| Begins as the wound heals and can continue for months to years. |
|
|
Rehabilitative or Long-Term Recovery Phase:
Duration |
| Begins as the wound heals and can continue for months to years. |
Focus |
|
Actions |
|
Extended Phases
Beyond the primary and secondary phases, burn treatment includes the reconstruction phase, which focuses on improving function and appearance through surgical and non-surgical interventions.
IN A NUTSHELL:
Burn treatment has primary and secondary phases overlapping emergent/resuscitative, acute, and rehabilitative stages. Focus areas are stabilisation and shock prevention, wound healing and infection control, and long-term functional and aesthetic recovery, respectively.
Choosing Dressings for Burns
Thorough, regular assessments of the burn as it heals over time are instrumental in choosing the right dressings at the right times. Check the table below for considerations that affect dressing choices. Our guide, How to Choose the Best Dressing for Burns, explains this table and why healthcare professionals choose different burn dressings in more detail.
Factor | Consideration |
| Amount of Exudate |
|
| State of Tissue Around the Burn |
|
| Depth of the Burn |
|
| Contamination and Infection |
|
| Location and Size of the Burn Wound |
|
| Ease of Application and Removal |
|
| Patient Circumstances |
|
You can also refer to the British National Formulary for guidance on what type of dressing to use based on the nature of the burn wound.
Hydrogel and paraffin dressings are two popular dressing choices for primary and secondary phase treatment. Each has unique properties and has been specifically designed to optimise burn healing.
IN A NUTSHELL:
Choosing burn dressings depends on exudate levels, tissue state, burn depth, contamination, wound location, and ease of application. To promote optimal healing, healthcare professionals select dressings to manage moisture, infection, protection, and patient-specific factors.
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Hydrogel Dressings
Hydrogel dressings are synthetic, hydrophilic dressings with very high water content. They have been developed to support wound healing by creating a moist, protective layer that seals over a wound area.
Hydrogel dressings provide cushioning and defend against contaminants and harmful bacteria that threaten to infect the wound. They also act as a ‘second skin’, mimicking the natural skin membrane that’s been burned away to retain moisture and support natural re-epithelialization (regrowing the skin’s surface) while absorbing some exudate.
Hydrogel dressings are considered some of the best for burns, especially when applied soon after the burn occurs. Their cooling hydrogel helps dissipate heat around the wound from the moment of application, with a continued cooling effect. The cooling effect helps to stop the spread of heat to lower tissues, reducing potential damage and pain. Many hydrogel dressings for burns contain antibacterial or antimicrobial ingredients that help to prevent infection.
What kind of burns can be treated with a hydrogel dressing?
Burns should be treated with a hydrogel-impregnated dressing as soon as possible. Hydrogel's ability to retain a moist, protective environment makes it optimal for primary phase burn treatment. Burnshield offers some of the best hydrogel dressings available for burns. Burnshield dressings are suitable for first-, second-, or third-degree burns, including facial burns and scalds.
Burnshield products are made from a specially formulated hydrogel for high-performance burncare. Burnshield hydrogel contains tea-tree oil, which consistently cools a burn wound area and keeps the wound moist to accelerate the healing process. Burnshield hydrogel turns clear on application, meaning it’s easy to monitor a burn visually, which is essential in the immediate moments after a burn.
IN A NUTSHELL:
Hydrogel dressings, with tea-tee oil and high water content, provide a moist, protective layer for burns. They protect against contaminants and support natural skin regrowth while cooling the wound to reduce damage and pain. They are suitable for all burn degrees.
Paraffin Dressings
Paraffin dressings consist of a fine layer of gauze impregnated with paraffin ointment, which maintains moisture around the wound and prevents the gauze from adhering to the exposed tissue. The paraffin ointment is usually sterile and allergy-safe, reducing the chance of infection and ensuring the wound doesn’t dry out, promoting the skin’s natural re-epithelialization process.
For effective care, a paraffin burn dressing is usually covered with a secondary absorbent wound dressing that will absorb excess moisture, preventing the wound from drying out or overmacerating.
What kind of burns can be treated with a paraffin burn dressing?
Paraffin tulle gras dressings like Jelonet are ideal secondary phase burn treatment dressings. Professionals have also supported using Jelonet in primary phase treatment in some cases, including a review on first aid and treatment of minor burns, favouring “covering the clean burn with a simple gauze dressing impregnated with paraffin (Jelonet). Avoid using topical creams as these will interfere with subsequent assessment of the burn.”
Jelonet dressings do not contain a cooling agent, but if a burn is cooled or if a cooling agent is used, then a Jelonet dressing can be applied as a primary phase burn treatment dressing in cases of minor burns and superficial burns.
Jelonet dressings are made from open-weave, sterile gauze impregnated with allergy-safe paraffin. The gauze is woven with interlocking threads that prevent fraying or linting when cut to shape, reducing the risk of loose material contaminating the wound site.
Jelonet gauze easily conforms to the contours of a wound and has excellent wicking properties, which means it draws exudate away from the wound area. This allows excess liquid to pass into an absorbent secondary dressing, helping to manage moisture levels around the wound site.
IN A NUTSHELL:
Paraffin dressings, made of gauze with paraffin ointment, keep wounds moist, prevent adherence, and support healing. Ideal for secondary phase treatment, they may also be used in primary care for minor burns or superficial. Jelonet dressings, allergy-safe and sterile, conform well to wounds and effectively manage exudate with a secondary absorbent dressing.
