Thermal Burns

First aid for thermal burns

1. Stop the burning. Move away from the heat. For clothing on fire: stop, drop and roll, or smother flames with a blanket.
2. Cool the burn under cool or lukewarm running tap water for 20 minutes. This helps even if started up to 3 hours after the injury. Do not use ice, iced water or very cold water.
3. Remove jewelry, watches and clothing near the burn, unless they are stuck to the skin.
4. Keep the person warm. Cool only the burned area, as large burns and cold water can cause hypothermia, especially in children.
5. Cover the burn loosely with plastic cling film laid in strips (not wrapped tightly), or a clean non-fluffy dressing.
6. Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose. Do not give aspirin to children or teenagers.
7. Raise a burned arm or leg to reduce swelling.

Do not apply butter, oil, toothpaste, egg whites, flour or creams to a fresh burn. Do not pop blisters. Do not put fluffy cotton wool on a burn.

Types of thermal burns

Other burn types are covered separately: chemical burns, electrical injury and sunburn. For a general overview of all burns, see burns.

How burn depth is judged

Burns often look less severe in the first 24 to 48 hours and may "declare" their true depth later. A doctor may recheck the wound after a day or two.

How burn size is estimated

• Palm method: the person's palm including fingers is about 1 percent of their body surface area. Useful for small or scattered burns.
• Rule of nines (adults): head and neck 9 percent, each arm 9 percent, front of trunk 18 percent, back of trunk 18 percent, each leg 18 percent, genitals 1 percent. Children have relatively larger heads and smaller legs, so special charts are used.
• Simple redness without blisters is not counted.

When a burn needs a burn center

The American Burn Association recommends burn center referral for:

• Partial-thickness burns over 10 percent of body surface area.
• Any full-thickness burn.
• Burns to the face, hands, feet, genitals, perineum or major joints.
• Electrical, chemical or inhalation injuries.
• Burns in people with serious medical conditions.
• Burns with major trauma.
• Burned children in hospitals without pediatric expertise.

Medical treatment

• Cleaning and dressings: modern dressings keep the wound moist, reduce pain and limit dressing changes. Silver-containing dressings help prevent infection.
• Blister care: large or tense blisters may be drained or removed by a clinician.
• Tetanus booster if not up to date.
• Pain control, especially during dressing changes.
• IV fluids for large burns, which cause major fluid loss.
• Surgery: removing dead tissue and skin grafting for deep burns.
• Escharotomy: cuts through tight, burned skin that encircles a limb or chest to restore blood flow and breathing.

Antibiotics are not routinely given unless the wound becomes infected.

Caring for a minor thermal burn at home

• After cooling, keep the burn clean and covered with a non-stick dressing or plastic wrap.
• Change the dressing as advised, typically every 1 to 3 days.
• Leave small blisters intact.
• Moisturize healed skin with a fragrance-free cream; it will be itchy.
• Protect healing and healed skin from sun for at least a year to reduce darkening.
• Watch for infection: increasing pain, redness spreading beyond the burn, pus, smell or fever.

Complications

• Infection and, in large burns, sepsis.
• Scarring, including raised (hypertrophic) scars and keloids.
• Contractures: tight scars that limit movement over joints.
• Hypothermia and fluid loss in large burns.
• Psychological effects: anxiety, post-traumatic stress and body image concerns.

Preventing thermal burns

• Set your water heater to 120 °F (49 °C) or lower, and test bath water before putting a child in.
• Keep hot drinks away from children, and do not hold a child while drinking something hot.
• Turn pan handles inward and use back burners.
• Keep children away from ovens, irons, hair straighteners, fireplaces and grills.
• Install smoke alarms on every level and test them monthly.
• Never use gasoline to start or revive a fire.

Frequently asked questions

What is a thermal burn?

A thermal burn is an injury caused by external heat, such as hot liquids, steam, flames or hot surfaces. It is the most common type of burn. Other burns are caused by chemicals, electricity, radiation or friction, which are managed slightly differently.

What is the first aid for a thermal burn?

Cool the burn under cool or lukewarm running water for 20 minutes, remove jewelry and loose clothing near it, then cover it loosely with plastic wrap or a clean non-fluffy dressing. Keep the rest of the person warm. Do not use ice, butter or creams.

Should I put ice on a burn?

No. Ice and iced water can damage burned skin further by restricting blood flow, and can cause hypothermia if the burn is large. Use cool or lukewarm running tap water for 20 minutes instead. It still helps if started within 3 hours of the burn.

Should I pop a burn blister?

No. An intact blister protects the healing skin from infection. If a blister bursts, gently clean it and cover with a non-stick dressing. Large, tense blisters or blisters over joints may be drained by a clinician.

How do I know if a burn is serious?

A burn is serious if it is larger than the person's palm with blisters, looks white, brown, black or leathery, goes around a limb, or affects the face, hands, feet, genitals or a joint. Burns in babies, older adults and people inhaling smoke also need prompt medical care.