Burns — Uganda (General Adult population)
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).
Related Clinical Tools
