BURNS

Injury Definition

  • 1st  Degree Burn (superficial burns) - Reddened skin without blisters (usually doesn't need to be seen)
  • 2nd  Degree Burn (partial thickness burns) - Reddened skin with blisters (heals from bottom up, takes 2 to 3 weeks)
    • Small closed blisters (narrower than 1 inch) serve as a dressing and reduce pain. Also the blister fluid contains protective chemicals.
    • Large closed blisters (wider than 1 inch) may need debridement. They commonly break open and the dead skin then needs to be removed
    • All open blisters need trimming of the dead skin (can be done by caller or in the office). Most open blisters are empty of fluid. A blister with a small opening and slow fluid leak can be recognized by the appearance of wrinkled skin.
  • 3rd  Degree Burn (full thickness burns) - Deep burn with white or charred skin. The burned area loses sensation to pain and touch (feels numb). Usually needs a skin graft to prevent bad scarring if it is larger than a quarter (1 inch or 2.5 cm) in size.

General Information

  • Thermal burns are skin injuries caused by heat. Common examples are burns from hot water or hot drinks. Other common causes of thermal burns include hot ovens, stoves, electric or kerosene space heaters, exhaust pipes, hot grease, hair-curling irons, and clothes irons.
  • Chemical burns result from lye, acids, or other tissue-damaging chemicals splashed on the skin. If the chemical is washed off immediately, most of these accidents will cause only first-degree burns.

First Aid for Thermal Burns

  • Immediately (don't take time to remove clothing) put the burned part in cold tap water or pour cold water over it for 10 minutes.  (Reason: lessens the depth of the burn and relieves pain)

First Aid for Chemical Burns

  • Immediately remove any contaminated clothing.
  • Then flush the chemical off the skin with warm water for 10 minutes. For large areas, use a shower.

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WHEN TO CALL YOUR DOCTOR FOR BURNS

Call 911 Now (you may need an ambulance) If:

  • Large 2nd or 3rd degree burn
  • Difficulty breathing with burn to the face
  • Difficulty breathing after exposure to flames, smoke, or fumes

Call Your Doctor Now (night or day) If:

  • You think you have a serious burn
  • Blister is present  (EXCEPTION: small closed blister less than ½ inch wide)
  • Center of the burn is white or charred
  • Burn completely circles an arm or leg
  • Eye or eyelid burn
  • Electrical current burn
  • Explosion or gun powder caused the burn
  • Acid or alkali (lye) burn
  • Chemical on skin that causes a blister
  • Hoarseness or cough after exposure to flames, smoke, or fumes
  • Headache or nausea after exposure to flames, smoke, or fumes
  • Burn looks infected

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

  • You think you need to be seen

Call Your Doctor During Weekday Office Hours If:

  • You have other questions or concerns
  • Diabetes and mild burn of foot or lower leg

Self Care at Home If:

  • Mild thermal or chemical burn and you don't think you need to be seen

HOME CARE ADVICE FOR 1ST DEGREE BURNS OR SMALL BLISTERS

  1. Reassurance: A mild thermal or chemical burn can be treated at home.
  2. Cleansing: Wash the area gently with an antibacterial liquid soap and water once a day.
  3. Blisters: Don't open any small closed blisters; the outer skin protects the burn from infection. For small broken blisters, trim off the dead skin with a fine scissors. (Reason: the area under these flaps of skin can become an ideal breeding ground for infection.)
  4. Antibiotic Ointment: For burns with broken blisters, apply an over the counter antibiotic ointment (e.g. Bacitracin) and cover it with some gauze or a Band-Aid. (Reason: to decrease pain and risk of infection) Change the dressing daily.
  5. Tetanus Shot: If your last tetanus shot was more than 10 years ago, you need a booster. Call your doctor during regular office hours (within the next 3 days).
  6. Expected Course: It will probably hurt for 2 days and peel like a sunburn in about a week. Fortunately, first and second-degree burns don't leave scars.
  7. Pain Medication: For pain relief, apply cold compresses and take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  8. Call Your Doctor If:
    • Severe pain persists more than 2 hours after giving pain medicine.
    • Burn starts to look infected (pus, red streaks, increased tenderness)
    • You become worse or develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Adult HouseCalls Online. Copyright © 2000-2004 David Thompson, M.D. FACEP

Reviewed 8/2004

Revised 8/2004

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