What is the proper treatment for burns?

Treatment of Burns

The immediate treatment for burns should be cooling with clean running water for 5-20 minutes to limit tissue damage and reduce pain. 1, 2

Initial Management

• Immediately remove the victim from the source of the burn 2
• Cool the burn with room temperature tap water (15°C to 25°C) as soon as possible but no later than 30 minutes after injury 1
• Continue cooling for 5-20 minutes to limit tissue damage and reduce pain 2, 3
• Do NOT use ice or ice water for cooling as this can increase tissue damage 1, 2
• Remove any jewelry or tight items from the affected area before swelling occurs 2, 3
• Monitor for hypothermia, especially in children or with large burns 1, 2

Burn Assessment and Limitations for Cooling

• For adults, cooling is recommended for burns with total body surface area (TBSA) < 20% 1
• For children, cooling is recommended for burns with TBSA < 10% 1
• Do not cool large burns if there is risk of hypothermia or if the patient is in shock 1

Wound Care After Cooling

• Leave burn blisters intact as this improves healing and reduces pain 1
• Cover the burn with a clean, non-adherent dressing 2, 3
• For small burns, it's reasonable to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera before covering 2
• Clean the wound with tap water, isotonic saline solution, or an antiseptic solution before applying dressings if medical care is delayed 1
• Avoid applying butter, oil, or other home remedies to burns 2

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs 2, 3
• For severe pain, ketamine is an effective drug for burn-induced pain and can limit morphine consumption 1
• Short-acting opioids may be necessary for more severe burns 1
• Non-pharmacological treatments such as cooling and covering burns can help improve pain control 1

When to Seek Medical Attention

• Seek immediate medical care for:
  • Burns involving the face, hands, feet, or genitalia 2, 3
  • Partial-thickness (second-degree) burns covering >10% TBSA in adults or >5% in children 2, 3
  • All full-thickness (third-degree) burns 2, 3
  • Burns with signs of inhalation injury (soot around nose/mouth, difficulty breathing) 2
  • Burns that appear infected or are very painful 2

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 1, 2
• Do not apply butter, oil, or other home remedies to burns 2
• Do not break blisters as this increases infection risk 1, 2
• Do not delay seeking medical attention for serious burns 2, 3
• Do not cool large burns without monitoring core temperature 1

Early cooling of burns with tap water has been shown to reduce the need for skin grafting by approximately 32% 4, highlighting the importance of this simple first aid measure in preventing progression of burn depth.