What is the initial management for a minor thermal burn?

Initial Management of Minor Thermal Burns

For minor thermal burns, immediately cool the burn with clean running water for 5-20 minutes, then apply petrolatum or a petrolatum-based antibiotic ointment, cover with a non-adherent dressing, and provide oral analgesics for pain control. 1, 2

Immediate First Aid (First 20 Minutes)

Cooling is the critical first step:

• Apply clean running water (15-25°C) to the burn for 5-20 minutes to limit tissue damage and reduce pain 1, 3, 4
• This should be done as soon as possible after injury to arrest ongoing thermal damage 5
• Remove jewelry and constrictive items from the affected area before swelling occurs 1, 2

Important cooling caveats:

• For adults with burns <20% total body surface area (TBSA) and children with <10% TBSA, cooling is safe and recommended 6, 1
• Monitor children closely for hypothermia during cooling, especially with larger burns 1, 2
• Do not apply ice directly to burns as this causes further tissue damage 1, 3

Wound Cleaning and Assessment

After cooling, clean the wound:

• Use tap water, isotonic saline, or an antiseptic solution 6, 1, 3
• Assess burn depth, size, and location to guide treatment 3
• Perform wound care in a clean environment 6, 1

Topical Treatment Based on Burn Depth

For superficial (first-degree) burns:

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2
• Cover with a clean, non-adherent dressing 1, 2

For partial-thickness (second-degree) burns:

• Apply a thin layer of petrolatum-based antibiotic ointment 1, 3
• Cover with non-adherent dressing such as Xeroform, Mepitel, or Allevyn 1, 3
• Note: Silver sulfadiazine may prolong healing if used long-term on superficial burns and should be avoided 6, 1

Critical dressing principles:

• When applying dressings on limbs, prevent tourniquet effect from bandages 6, 1
• Monitor distal perfusion with circular dressings 6, 1
• Re-evaluate dressings daily 6, 1

Pain Management

Multimodal analgesia is recommended:

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs 1, 2, 3
• Consider combining acetaminophen and NSAIDs for significant pain 2
• For severe pain, short-acting opioids or ketamine may be necessary 6, 1
• Non-pharmacological approaches like cooling and appropriate dressings help reduce pain 6, 1

What NOT to Do

Common pitfalls to avoid:

• Do not apply butter, oil, or other home remedies 1, 3
• Do not break blisters as this increases infection risk 1, 3
• Do not use topical antibiotics as first-line treatment; reserve for infected wounds only 6, 1
• Do not provide routine antibiotic prophylaxis 6, 1
• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to hypothermia risk 6, 1

When to Refer for Specialist Care

Seek immediate medical attention for:

• Burns involving face, hands, feet, or genitals 1, 2, 3
• Partial-thickness burns covering >10% body surface area in adults (>5% in children) 1, 2, 3
• All full-thickness (third-degree) burns 1, 3
• Signs of infection or worsening condition 2
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 2
• Burns unlikely to heal within 14 days 4
• Severe pain unresponsive to first-line treatments 2