How do you treat a hot water burn?

Treatment of Hot Water Burns

For hot water burns, immediately cool the burn with clean running water (15-25°C) for 10-20 minutes to halt the burning process and reduce pain. 1

Initial Assessment and Management

1. Safety First

   • Ensure scene safety by removing the source of heat
   • Remove any contaminated clothing, jewelry, or material from affected areas 1

2. Cooling the Burn

   • Use clean running water at 15-25°C (cool tap water)
   • Apply for 10-20 minutes
   • Avoid using ice as it can worsen tissue damage 2
   • Avoid extremely cold water (below 2°C) as it may not improve outcomes compared to cool water 2

3. Pain Management

   • Administer over-the-counter pain medication such as:
     • Acetaminophen 1g every 4-6 hours
     • NSAIDs if no contraindications exist 1

Burn Assessment

Assess burn severity using these criteria:

Burn Characteristic	Requires Medical Attention
Burns on face, hands, feet, or genitalia	Yes
Full-thickness burns	Yes
>10% TBSA in children	Yes
>20% TBSA in adults	Yes

• Use the "Rule of Nines" or Lund-Browder chart for accurate TBSA measurement 1
• Alternative method: patient's palm equals approximately 1% of their body surface area

Wound Care

1. For Minor Burns (First-Degree and Small Second-Degree)

   • Keep blisters intact to maintain a sterile environment 1
   • Gently cleanse with warm sterile water or saline
   • Apply a thin layer of antibiotic ointment
   • Cover with a sterile, non-adherent dressing applied loosely 1

2. For Moderate to Severe Burns

   • Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 3
   • Reapply once to twice daily or whenever the cream has been removed by patient activity 3
   • Cover with sterile, non-adherent dressing
   • Reapply silver sulfadiazine immediately after hydrotherapy 3

When to Seek Medical Attention

Seek immediate medical care for:

• Burns involving face, hands, feet, genitalia, or perineum
• Full-thickness (third-degree) burns
• Burns exceeding 10% TBSA in children or 20% TBSA in adults
• Signs of infection (increasing pain, redness, swelling, discharge, fever) 1

Important Considerations

• Timing matters: Early cooling can prevent superficial burns from progressing to deep burns, potentially reducing the need for skin grafting by approximately 32% 4
• Avoid common mistakes: Do not apply butter, oil, toothpaste, or other home remedies as these can trap heat and increase infection risk
• Monitor for hypothermia: Be cautious with prolonged cooling in children and those with large burn areas 5
• Do not use systemic antibiotic prophylaxis routinely as it may select for multidrug-resistant bacteria 1

The evidence strongly supports immediate cooling with running water as the most effective first-aid treatment for burns 4, 6. While there is some debate about the optimal duration of cooling, current guidelines recommend 10-20 minutes as an effective timeframe 1, 7.