How should I initially manage a small (<2% total body surface area) superficial burn in an otherwise healthy adult, and what criteria indicate the need for emergency care?

Initial Management of Small Superficial Burns in Healthy Adults

For a small (<2% TBSA) superficial burn in an otherwise healthy adult, immediately cool the burn with clean running water for 5-20 minutes, then apply petrolatum-based ointment covered with a non-adherent dressing, and manage pain with oral acetaminophen or NSAIDs. 1, 2

Immediate First Aid (Within Minutes of Injury)

Cooling Protocol:

• Cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• The optimal duration remains uncertain based on available evidence, but 20 minutes is commonly recommended 3, 4
• Remove any jewelry or constrictive items before swelling develops to prevent vascular compromise 5
• Never apply ice directly, as this causes additional tissue damage 1, 2
• Never apply butter, oil, or home remedies, which worsen the injury 1, 5, 2

Wound Care Protocol

Cleaning and Preparation:

• Clean the wound with tap water, isotonic saline, or antiseptic solution (such as chlorhexidine 1:5000) 1, 5, 2
• Gently debride any loose tissue 1
• For tense blisters, perform sterile puncture to release fluid while leaving the blister roof intact as a biological dressing 1
• Do not break intact blisters, as this significantly increases infection risk 5, 2

Dressing Application:

• Apply a thin layer of petrolatum-based ointment (or petrolatum-based antibiotic ointment) as first-line treatment—this promotes faster reepithelialization compared to other agents 1, 2
• Cover with a non-adherent dressing (e.g., Mepitel, Telfa, or Xeroform) 1, 2
• Add a secondary absorbent or foam dressing to collect exudate 1
• Change dressings daily or as needed 2

Critical Pitfall: Avoid silver sulfadiazine as first-line therapy for superficial burns—it delays healing and worsens scarring 1, 2

Pain Management

• Administer oral acetaminophen or NSAIDs for mild-to-moderate pain 1, 2
• Pre-medicate 30-60 minutes before dressing changes 1
• Non-pharmacological methods like cooling and covering with petrolatum also reduce pain 1

Criteria Requiring Emergency Care or Specialist Referral

Immediate burn center referral is required for: 1, 5, 2

• Burns to function-sensitive areas: face, hands, feet, perineum, or major joints—regardless of size
• Burn size: >10% TBSA in adults
• Deep burns: >5% TBSA of partial or full-thickness burns
• Circumferential burns of any extremity or torso
• Electrical or chemical burns of any size
• Signs of inhalation injury: facial burns, singed nasal hairs, carbonaceous sputum, respiratory distress
• Vascular compromise: blue, purple, or pale extremities
• Age considerations: >75 years with comorbidities
• Signs of infection: increased pain, redness, swelling, purulent discharge, or systemic symptoms

Key Point: Even small partial-thickness burns on the toes, fingers, or other function-sensitive areas require specialist consultation due to high risk of functional impairment 5, 2

Follow-Up Monitoring

• Monitor for signs of infection: increased pain, redness, swelling, or discharge 5
• Reassess wound healing progress within 48-72 hours 6
• Any superficial burn failing to heal within 3 weeks requires specialist evaluation for possible skin grafting 7
• Continue daily dressing changes and pain management as needed 5, 2

Post-Healing Management

• For healed burns with hypopigmentation, dryness, or itching, apply petrolatum-based ointment with hydrocortisone 1% cream daily until symptoms resolve 1
• Avoid prolonged potent steroids, as they can cause further hypopigmentation 1