What Is the Immediate Management for Burns? First Aid

Irrespective of the type or severity of the burn, immediate first aid should be performed before the ambulance arrives:

• Protect the person from further harm: If possible, make sure the person you are helping is no longer in contact with the source of the burn.
• Cool the burn: Keep flushing the area with cold water for a minimum of 10 minutes. Do not apply ice or ointments.
• Remove excess clothing: Clothes and jewelry can be removed, especially things that are hot or can increase temperature.
• Move to a cooler place: Move the person to an open place that is properly ventilated or to a place that is cooler.
• Cover the burn with a thin cloth: Use a dry cloth or gauze to cover the burned area.
• Call for help: Call an ambulance if the burn is severe, especially if the victim is a child or an elderly person.

Paramedics or medical staff can assess the extent of the burn and determine the degree of the burn. Medical management includes the following steps:

Airway

• Check for stridor, hoarseness, black sputum, respiratory difficulty, singed nasal hair, or face puffiness which are symptoms of airway burn/inhalation injury.
• Check for oropharyngeal burns such as the presence of soot in the mouth, edema, and erythema.
• Check for signs of severe neck burns.
• Allow the person to lie down on the ground and secure the airway.
• Intubate the person if breathing difficulty is noted.
• In the case of carbon monoxide poisoning, keep the person on oxygen support.
• Immobilize the spine and prevent further injury, if present.

Breathing

• Escharotomy is an emergency surgical treatment that involves surgical division of burned skin and allowing adequate ventilation.
• This procedure is done for full thickness burns or circumferential chest burns.

Circulation

• Intravenous fluid infusion is done in the case of early shock.
• Liquids can be given through oral and intravenous routes.

Assessment of total body surface area (TBSA)

TBSA is the assessment of the percentage of skin involved in the burn. If TBSA is above 10, the person must undergo fluid resuscitation.

Burn injuries are categorized into three types based on the extent of the injury:

• First-degree burn
• Second-degree burn
• Third-degree burn 

First-degree burn

Burns that damage the outermost layer of the skin (epidermis) are often caused by sunburn or overexposure to the sun. The skin is normally intact, but it may appear red, be warm to the touch, and feel uncomfortable. Small blisters and swelling in and around the area of damage may be present.

Second-degree burn

Second-degree burns occur when the second layer of the skin (dermis) is burned. These types of burns usually have the following characteristics:

• Redness
• Blisters
• Pain and swelling

In general, a second-degree burn that is less than 2-3 inches (7 cm) in length is considered minor. If the burned area is larger than this or if it covers body parts such as the feet, face, eye, ears, or crotch, urgent medical attention is required. Failure to treat the burn immediately could lead to severe deformity or loss of function.

Third-degree burn

Third-degree burns are a medical emergency and should be evaluated and treated by a physician. Regardless of size or area of the body involved, a third-degree burn is extremely dangerous because it affects all layers of skin and could result in irreversible tissue damage. Skin may appear burned, blackened, or white but is not painful because the nerves are destroyed. Skin texture can be extremely dry or leathery. 

Minor first- or second-degree burns may take days to heal. During this period, it is crucial to monitor the affected region for the following signs:

• Infection
• Redness that extends beyond the burned area
• Changes in the appearance of the wound 
• Slight fever that is not relieved by over-the-counter drugs 

As the skin heals, it may become itchy and irritated. This is typical and will resolve on its own over time. Use of lotion on a regular basis may help keep the skin hydrated and reduce irritation. If the itching is unbearable, an over-the-counter antihistamine may be useful in relieving discomfort.

During the healing process, both the wound and any dressings should be kept clean. Once the burn has healed, limit exposure to direct sunlight and wear sunscreen at all times. Consult your physician if you have any questions.