Burns: First Aid, Types and Treatment

Burn first aid: what to do right now

1. Stop the burning. Move away from the heat source. Remove clothing and jewelry near the burn unless stuck to the skin. With a chemical burn, brush off dry chemical and remove contaminated clothing.
2. Cool the burn under cool (not ice-cold) running water for 20 minutes. This is useful up to 3 hours after the burn. For chemical burns, rinse for at least 20 minutes.
3. Keep the person warm. Cool only the burn, not the whole body, especially in children, to avoid hypothermia.
4. Cover the burn loosely with plastic cling film laid in strips (not wrapped tightly) or a clean, non-fluffy dressing.
5. Relieve pain with acetaminophen (paracetamol) or ibuprofen, following the label dose.
6. Raise a burned arm or leg to reduce swelling.
7. Call 911 for serious burns. For electrical injuries, switch off the power before touching the person.

Do not:

• use ice, iced water, butter, oils, toothpaste or egg whites
• pop blisters
• apply fluffy cotton or adhesive dressings directly to the burn

Burn degrees

Burns can look shallower in the first 24 to 48 hours than they really are, so doctors often reassess them.

Types of burns

Thermal burns

The most common type, from flames, hot liquids (scalds), steam and hot surfaces. Scalds from hot drinks, bath water and cooking are the leading cause of burns in young children. Water at 140 °F (60 °C) can cause a deep burn in seconds. See thermal burns.

Chemical burns

Acids and alkalis such as drain cleaner, oven cleaner, cement and battery acid. Alkali burns can penetrate deeply and continue to damage tissue. Chemicals in the eye need immediate rinsing for at least 20 minutes and emergency care. See chemical burns.

Electrical burns

Electrical injuries can look small on the skin but cause deep damage to muscles, nerves and the heart. Anyone with an electrical injury from mains power should have an ECG.

Radiation burns

Sunburn is the most common. Radiotherapy can also cause skin burns.

Friction burns

From road rash or treadmill accidents, combining a burn with a scrape.

Inhalation injury

Smoke inhalation damages the airway and lungs and can cause carbon monoxide poisoning. It is a common cause of death in house fires.

How burns are assessed

Doctors estimate the burn size as a percentage of total body surface area. The person's palm, including fingers, is about 1% of their body. The "rule of nines" is used for larger burns in adults. Burns of more than 10% of body area in children or 15% to 20% in adults need IV fluids and specialist burn center care.

The American Burn Association recommends burn center referral for partial-thickness burns over 10% of body area, full-thickness burns of any size, burns to critical areas, chemical, electrical and inhalation injuries, and burns in people with other serious medical conditions.

Treatment

Minor burns at home

• clean gently with mild soap and water
• apply petroleum jelly or a non-adherent dressing, changed daily or as advised
• leave intact blisters alone. If a blister breaks, keep it clean and covered
• keep the area out of the sun while healing, and use SPF 30 or higher for at least a year afterward
• make sure your tetanus vaccine is up to date. A booster is needed if your last one was more than 5 years ago for a burn wound

Medical and specialist treatment

• specialized dressings, including silver-containing or biosynthetic dressings
• IV fluids for large burns
• pain control and nutrition support
• surgery to remove dead tissue and skin grafts for deep burns
• escharotomy, cutting through tight burned skin that restricts blood flow or breathing
• physical and occupational therapy, splinting and pressure garments to prevent contractures

Complications

• wound infection and sepsis
• dehydration and shock with large burns
• scarring and contractures, where tight scar tissue limits movement
• hypothermia
• breathing problems after smoke inhalation
• psychological effects, including post-traumatic stress disorder

Burning sensation without a burn

If your skin feels like it is burning but there is no burn, the cause is different. A red, hot, swollen, burning arm or leg may be cellulitis, a skin infection that needs prompt antibiotics. A burning feeling with tingling or pain from light touch suggests nerve irritation, as in shingles or neuropathy. Waves of heat across the face, chest or whole body are often hot flashes, an overactive thyroid, fever or anxiety. See skin burning and burning sensation.

Preventing burns

• set water heaters to 120 °F (49 °C) or lower
• keep hot drinks and pan handles out of children's reach, and test bath water
• install smoke alarms on every level and test them monthly
• store chemicals and lighters out of reach
• use sunscreen and protective clothing

Frequently asked questions

What is the first thing to do for a burn?

Cool the burn under cool running water for 20 minutes as soon as possible. Remove jewelry and loose clothing near the burn, then cover it loosely with cling film or a clean dressing. Do not use ice, butter or creams. Seek emergency care for serious burns.

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

Second-degree burns blister and are very painful, with moist, red or pink skin. Third-degree burns damage the full skin thickness and look white, waxy, leathery, brown or charred, and may feel numb because nerves are destroyed. Third-degree burns always need medical care.

When should I go to the hospital for a burn?

Go to the ER for burns larger than your palm with blisters, deep burns of any size, burns to the face, hands, feet, genitals or joints, chemical or electrical burns, burns with smoke inhalation, and burns in babies or older adults. Seek care for signs of infection.

Should I pop a burn blister?

No. The blister protects the healing skin from infection. Leave it intact and cover it with a non-stick dressing. If it breaks on its own, gently clean the area, apply petroleum jelly and keep it covered. Large or painful blisters can be managed by a clinician.

How long does a burn take to heal?

Superficial burns heal in about 3 to 7 days. Superficial second-degree burns heal in 1 to 3 weeks, usually with little scarring. Deep second-degree and third-degree burns take longer and often need skin grafts. Protect healing skin from the sun for at least a year.