What is the initial treatment for a patient with a burn to the hand?

Initial Treatment for Hand Burns

Immediately cool the burn with clean running water for at least 10-20 minutes, then loosely cover with a clean, non-adherent dressing, and arrange urgent referral to a burn specialist because all hand burns involving partial-thickness or full-thickness depth require specialized care to prevent permanent functional disability. 1, 2, 3

Immediate First Aid (First 20 Minutes)

Cooling Protocol

• Apply cool or cold running water (15-25°C) to the burn as soon as possible and continue for at least 10-20 minutes 1, 2
• This cooling reduces pain, edema, depth of injury, speeds healing, and may reduce the need for excision and grafting 1, 4
• Remove all jewelry from the hand immediately before swelling occurs to prevent vascular compromise and constriction 2
• Monitor for hypothermia, especially in children or if the burn covers a large surface area 1, 2

Critical Pitfalls During Cooling

• Never apply ice directly to the burn as this causes tissue ischemia and further damage 1, 2
• Do not use prolonged external cooling devices (like Water-Jel dressings) as they increase hypothermia risk 2
• If running water is unavailable, use a clean cool (not freezing) compress as a substitute 1

Pain Management

• Administer over-the-counter analgesics immediately: acetaminophen or NSAIDs for pain control 2, 5
• For severe pain, titrated intravenous opioids or ketamine may be necessary and should be considered early 2, 3
• Multimodal analgesia should be used with medications titrated based on validated pain assessment scales 2

Wound Coverage After Cooling

• After the 10-20 minute cooling period, loosely cover the burn with a clean, non-adherent dressing 1, 2, 3
• The dressing should be loose to avoid creating a tourniquet effect on the hand 2
• For superficial burns only: after cooling, you may apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera before covering 2, 5
• Do not break any blisters as this increases infection risk 2, 3

Mandatory Specialist Referral

All hand burns require immediate evaluation by a burn specialist or burn center because: 3

• Hand burns are considered function-sensitive injuries regardless of total body surface area 3
• Deep burns in function-sensitive areas like hands require specialized surgical techniques and therapy to prevent permanent functional disability 3
• The American Burn Association specifically requires expert opinion for all hand burns 3
• Direct admission to a burn center (rather than sequential transfers) improves survival and functional outcomes 3

Specific Referral Criteria for Hand Burns

• Any partial-thickness (second-degree) or full-thickness (third-degree) hand burn requires immediate specialist referral 2, 3
• Even superficial burns on the hands warrant specialist evaluation 3
• Use telemedicine consultation if immediate specialist access is unavailable to guide initial management and determine transfer urgency 3

Monitoring for Complications While Awaiting Transfer

Watch for Compartment Syndrome

• Monitor for blue, purple, or pale fingers indicating poor perfusion 3
• These signs require emergency escharotomy and immediate transfer 3
• Check distal perfusion regularly if any circular dressings are applied 2

Signs Requiring Immediate Medical Attention

• Difficulty breathing or signs of inhalation injury (soot around nose/mouth, singed nasal hairs) 2, 5
• Signs of infection: increased pain, redness extending beyond burn margins, swelling, or purulent discharge 3
• Any burn showing blistering or broken skin 1

What NOT to Do

• Do not apply butter, oil, or other home remedies 2, 3
• Do not delay specialist referral for any partial-thickness or full-thickness hand burn, as undertriage increases morbidity and mortality 3
• Do not use systemic antibiotics prophylactically; reserve for clinically evident infections only 2, 3
• Do not use silver sulfadiazine on superficial burns as prolonged use may delay healing 2, 3
• Do not attempt definitive wound care beyond initial cooling and covering—this is the specialist's role 3