What is the initial treatment for a 2nd (second) degree burn?

Initial Treatment for Second-Degree Burns

The initial treatment for second-degree burns should include immediate cooling with clean running water for 5-20 minutes, followed by appropriate wound dressing based on the burn size and characteristics. 1

Immediate First Aid Steps

• Cool the burn immediately with clean running water for 5-20 minutes to limit burn depth progression and reduce pain 1
• Monitor children for signs of hypothermia during cooling 1
• If clean running water is not available, superficial burns with intact skin may be cooled with ice wrapped in cloth 1
• Remove jewelry before swelling occurs to prevent constriction and vascular ischemia 1
• Consider over-the-counter pain medications (acetaminophen or NSAIDs) for pain management 1

Wound Cleaning and Assessment

• Clean the wound with tap water, isotonic saline, or an antiseptic solution 1
• Perform wound care in a clean environment with appropriate pain control 1
• Assess the burn for size, depth, and location to determine appropriate management 1
• Note that burns involving face, hands, feet, genitals, or >10% body surface area (>5% in children) require specialized burn center treatment 1

Dressing Application

• For small partial-thickness burns managed at home:

  • Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1
  • Cover with a clean non-adherent dressing 1

• For burns with intact skin or intact blisters:

  • Loosely cover with a clean cloth or non-adherent dry dressing 1

• For larger burns requiring medical attention:

  • The type of dressing depends on the total burn surface area (TBSA), wound appearance, and patient's general condition 1
  • Antiseptic dressings may be appropriate for large or contaminated burns 1

Special Considerations

• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 1
• Monitor distal perfusion in case of circular dressings 1
• Ideally, dressings should be re-evaluated daily 1
• Silver sulfadiazine is FDA-approved for prevention and treatment of wound sepsis in second and third-degree burns, but may be associated with prolonged healing if used long-term on superficial burns 2, 1
• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 1

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals 1
• All full-thickness burns 1
• Burns covering >10% body surface area in adults or >5% in children 1
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) 1
• Burns with signs of infection 1

Pitfalls to Avoid

• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 1
• Do not delay other resuscitation interventions for dressing application in severe burns 1
• Avoid routine antibiotic prophylaxis for burn patients unless infection is present 1
• Do not apply silver sulfadiazine for extended periods on superficial burns as it may delay healing 1