What is the treatment for a patient with no significant past medical history or allergies who has 1st and 2nd degree burns?

Treatment for 1st and 2nd Degree Burns

Immediately cool the burn with clean running water for 5-20 minutes, remove jewelry before swelling occurs, then apply petrolatum-based ointment and cover with a non-adherent dressing, while administering over-the-counter pain medications like acetaminophen or NSAIDs. 1, 2, 3

Immediate First Aid (First 20 Minutes)

Cooling the Burn

• Cool with clean running water for 5-20 minutes to limit tissue damage, reduce pain, and improve healing outcomes 2, 3
• For adults with burns <20% total body surface area (TBSA) and children with <10% TBSA, cooling should be performed in the absence of shock 2
• If clean running water is unavailable, superficial burns with intact skin may be cooled with ice wrapped in cloth 3
• Monitor children closely for hypothermia during cooling, especially preadolescent children 2, 3

Remove Constricting Items

• Remove all jewelry from the affected area before swelling occurs to prevent constriction and vascular ischemia 1, 2, 3

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for burn pain 1, 2, 3
• These medications are well tolerated and generally recommended as first-line treatment 1
• For severe burns requiring medical attention, short-acting opioids and ketamine are effective options 2

Wound Care After Cooling

First-Degree Burns (Superficial)

• Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling 1, 2, 3
• Cover with a clean, non-adherent dressing 2, 3
• These burns generally heal without scarring and have low infection risk 3

Second-Degree Burns (Partial-Thickness)

• Clean the wound with tap water, isotonic saline, or antiseptic solution in a clean environment 2
• Apply a thin layer of petrolatum-based antibiotic ointment 2
• Cover with non-adherent dressing such as Xeroform, Mepitel, or Allevyn 2
• Silver sulfadiazine is FDA-approved for second-degree burns 4 and remains the most frequently used topical prophylactic agent 5, though it may prolong healing if used long-term on superficial burns 2
• Re-evaluate dressings daily for optimal monitoring 2

Critical Pitfalls to Avoid

• Do not apply ice directly to burns as this causes further tissue damage 2, 6
• Do not apply butter, oil, or other home remedies 2, 6
• Do not break blisters as this significantly increases infection risk 2, 6
• Do not use routine antibiotic prophylaxis - topical antibiotics should be dedicated to infected wounds only 2, 6
• Avoid prolonged use of external cooling devices to limit hypothermia risk 2
• When applying dressings on limbs, prevent bandages from inducing a tourniquet effect 2

When to Seek Immediate Medical Attention

Transfer to a specialized burn center or emergency department for: 1, 2, 3

• Burns involving the face, hands, feet, or genitals (may require surgical intervention to prevent permanent disability)
• Second-degree burns covering >10% body surface area in adults or >5% in children
• All full-thickness (third-degree) burns
• Signs of inhalation injury: soot around nose/mouth, difficulty breathing, singed nasal hairs, or facial burns
• Signs of infection: increasing redness, warmth, purulent drainage, or fever
• Increasing pain not controlled by over-the-counter medications

The American Burn Association specifically recommends that all partial-thickness burns involving the face be treated in a specialized burn center regardless of size due to high risk of functional and cosmetic disability 6.