Uganda guidelines for the treatment of Burns

1st Degree Burns

Superficial epidermal injury. No blisters. Main sign: redness (erythema), tenderness. Do not count for TBSA calculation.

2nd Degree (Superficial Partial Thickness)

Blisters present. Pink moist wound, painful. Thin eschar. Heals in 10–14 days.

2nd Degree (Deep Partial Thickness)

No blisters. Wound is pale, moderately painful. Thick eschar. Heals in >1 month, may require surgical debridement.

3rd Degree (Full Thickness)

Full thickness skin destruction. Leather-like rigid eschar. Painless on palpation or pinprick. Requires skin graft.

4th Degree Burns

Full thickness destruction of skin, fascia, muscles, or bone. Lifeless body part.

Severity — Minor/Mild Burns

Adult: <15% TBSA. Child/Elderly: <10% TBSA. OR Full thickness burn <2% TBSA with no serious threat to function.

Severity — Moderate Burns

Adult: partial thickness 15–25% TBSA. Child/Elderly: partial thickness 10–20% TBSA. No serious threat to function, no cosmetic impairment of face, ears, hands, feet, or perineum.

Severity — Major/Severe Burns

Adult: partial thickness >25% TBSA OR full thickness >10% TBSA. Child/Elderly: partial thickness >20% TBSA OR full thickness >5% TBSA. Any age: burns of face, eyes, neck, ears, hands, feet, perineum, major joints; chemical, high voltage, or inhalation burns.

TBSA Estimation

Small areas: patient's open palm = 1% TBSA. Large areas: "Rule of Nines" or Lund-Browder chart. Exclude areas with erythema only.

Public awareness of burn risks and first aid: immediate cooling with cold water.

Construction of raised cooking fireplaces as safety measure.

Ensure safe handling of hot water and food; keep out of reach of children.

Particular care of high-risk persons near fires: children, epileptic patients, alcohol or drug abusers.

Encourage use of closed flames (hurricane lamps). Avoid candles.

Beware of possible cases of child abuse.

First Aid — All Burns (HC1)

Stop the burning process. Move patient to safety. Roll on ground if clothing is on fire. Switch off electricity. Cool the burn by pouring cold water over affected area for 30 minutes, especially in the first hour (reduces depth of injury). Remove soaked clothes, wash off chemicals, remove constrictive clothing or rings. Cover with clean dry cloth and keep patient warm.

Mild/Moderate Burns — At Health Facility (HC2)

Give oral or IV analgesics as required. If TBSA <10% and patient able to drink, give oral fluids, otherwise consider IV. Give Tetanus Toxoid if not fully immunised. Leave small blisters alone; drain large blisters.

Wound Dressing (HC2)

Dress with Silver Sulphadiazine cream 1%, add saline-moistened gauze or paraffin gauze and dry gauze on top. Small superficial 2nd degree burns: dress directly with paraffin gauze dressing. Change after 1–3 days then as needed. If wound infected: dress more frequently until infection controlled. Caution: Silver Sulphadiazine is contraindicated in pregnancy, breastfeeding, and premature babies.

Fluid Replacement Formula (Severe Burns)

Total IV volume in first 24 hours = (4 ml × weight in kg × % TBSA burned) + normal daily fluid requirement. Use crystalloids (Ringer's Lactate or Normal Saline). Give 50% of replacement in first 8 hours. Give remaining 50% over next 16 hours. Target: urine output 0.5 ml/kg/hour (adults); 1–2 ml/kg/hour (children <30 kg).

Severe Burns — Additional Management (HC3/HC4)

First aid and wound management as above PLUS: IV fluid replacement. If in shock, run IV fluids fast until BP improves. Monitor vital signs and urine output. Use antibiotics if systemic signs of infection: Benzylpenicillin 3 MU every 6 hours ± Gentamicin 5–7 mg/kg IV or IM once daily. Blood transfusion if necessary. If inhalation injury: give oxygen and refer for advanced life support.

Surgical Management

Escharotomy and fasciotomy for circumferential burns of fingers, hands, limbs, or torso. Escharectomy to excise dead skin. Skin grafting to cover clean deep burn wounds. Eye burns: irrigate with abundant sterile saline, apply eye ointment with pad, and refer.

Additional Care

Nutritional support. Physiotherapy of affected limb. Counselling and psychosocial support. Health education on prevention (epilepsy control, fire safety).