Burn Injury: First Aid, Types and Treatment

First aid for burns: what to do now

1. Stop the burning. Move away from the heat source. Turn off electricity before touching someone with an electrical burn. For chemical burns, brush off dry powder and remove contaminated clothing.
2. Cool the burn under cool (not ice-cold) running water for 20 minutes. Cooling is helpful up to 3 hours after the injury. For chemical burns, flush for at least 20 minutes and longer for alkalis.
3. Remove jewelry, watches and tight clothing near the burn before swelling starts. Do not pull off anything stuck to the skin.
4. Keep the person warm. Cool the burn, not the person. Watch for shivering, especially in children.
5. Cover the burn loosely with plastic cling wrap laid on in strips, or a clean, non-fluffy dressing.
6. Relieve pain with acetaminophen (paracetamol) or ibuprofen at the label dose.
7. Raise burned limbs to reduce swelling.

Types of burns by cause

• Thermal burns: flames, hot objects, steam and scalds from hot liquids. Scalds are the most common burns in young children.
• Chemical burns: acids, alkalis (such as drain cleaner and cement), and other caustic substances. They may keep burning until fully washed off.
• Electrical injuries: current passing through the body can damage muscles, nerves and the heart, even with small skin wounds.
• Radiation burns: sunburn and radiotherapy.
• Friction burns: road rash and rope or treadmill burns.
• Cold burns: from frostbite or freeze sprays.

Burn degrees: how deep is it?

Burn depth often becomes clearer over 2 to 3 days, so a doctor may reassess it.

How burn size is estimated

Burn size is measured as a percentage of total body surface area (TBSA). The palm of the person's hand, including the fingers, is about 1% of their body surface. The "rule of nines" estimates larger areas in adults: each arm about 9%, each leg 18%, the front and back of the trunk 18% each, and the head 9%. Children's heads are proportionally larger. Superficial (first-degree) burns are not counted.

Medical treatment

Minor burns

• Gentle cleaning with mild soap and water
• Non-stick dressings, changed as directed, often every 2 to 3 days
• Blisters are usually left intact. Large or tense ones may be drained by a clinician
• Topical products such as petroleum jelly or prescribed antimicrobial dressings
• A tetanus booster if not up to date

Major burns

These are treated in hospital, often at a specialist burn center:

• Airway support for inhalation injury, which may need a breathing tube
• IV fluids calculated from burn size and body weight, because large burns leak fluid and can cause shock
• Pain control and nutrition support, as burns greatly increase calorie needs
• Surgery: removing dead tissue (debridement) and covering wounds with skin grafts or skin substitutes
• Escharotomy: cutting through tight, burned skin around a limb or chest to restore blood flow or breathing
• Infection prevention: wound care and monitoring for sepsis

Rehabilitation

Physical and occupational therapy, pressure garments and scar treatments reduce contractures and improve appearance. Psychological support helps with trauma and body image.

Complications

• Infection, the most common complication, which can lead to sepsis
• Dehydration and shock in large burns
• Breathing problems from inhalation injury and smoke inhalation
• Low body temperature
• Raised, thick scars and keloids
• Contractures, where scar tissue tightens and limits movement
• Changes in skin color
• Emotional effects such as anxiety, depression and PTSD

Prevention

• Set water heaters to 120 °F (49 °C) or lower, and test bath water before bathing a child.
• Keep hot drinks, kettle cords and pot handles out of children's reach.
• Install smoke alarms on every level and test them monthly.
• Store chemicals in original containers, locked away.
• Use sunscreen and protective clothing outdoors.

Frequently asked questions

What is the best first aid for a burn?

Cool the burn under cool running water for 20 minutes as soon as possible, remove nearby jewelry and clothing that is not stuck, then cover loosely with cling wrap or a clean dressing. Do not use ice, butter or creams. Seek help for large, deep or high-risk burns.

How do I know if a burn is second or third degree?

Second-degree burns are red, blistered, moist and very painful. Third-degree burns look white, leathery, brown or charred, and may be painless because nerves are destroyed. Any suspected third-degree burn needs medical care.

Should I pop a burn blister?

No. Blisters protect the healing skin underneath from infection. Leave them intact and cover them with a non-stick dressing. If a blister is very large, tense or in an awkward place, a clinician may drain it safely.

When should I go to the ER for a burn?

Go to the ER for burns that are large, deep, white or charred, on the face, hands, feet, genitals or major joints, electrical or chemical burns, burns with breathing problems or smoke exposure, and burns in very young or older people.

How long does a burn take to heal?

Superficial burns heal in about 3 to 7 days. Superficial partial-thickness burns take 1 to 3 weeks. Deeper burns can take longer than 3 weeks and often need skin grafts. A burn not healing within 2 weeks should be checked.