Burns

The first step in treating a burn properly is to assess the severity and extent of the injury. Burns are divided into four categories: first, second, third, and fourth degree. If you have to treat a burn, you need to know how to determine whether it is mild, moderate, or severe. If it is severe, you also need to know what to do while waiting for emergency medical assistance.

Mild or moderate burns: What to look for

First-degree burns affect only the epidermis, or thin outer layer of skin. In this case, the skin is usually red, swollen, and painful, but not blistered. Second-degree burns occur when the epidermis has been burned through, and the underlying layer of skin (the dermis) is also seared. Blisters usually form, and the skin has an intensely red, splotchy look. Second-degree burns are typically more painful than first-degree burns.

If a first-degree burn affects only a small area of skin you can treat it as a minor burn, according to the American Red Cross. However, if large areas of skin on the hands, feet, face, groin, buttocks, or over a major joint are burned, call your doctor or go to a local medical facility.

If a second-degree burn covers an area only a few inches in diameter and doesn't affect your hands, feet, face, groin, genitals, buttocks, or a major joint, you may also treat it as a minor burn. Otherwise, get medical help immediately. Someone burned in these areas may need a specialist for treatment. Treating mild to moderate burns promptly will ease pain, limit the injury, and speed healing.

What to do

The best way to treat mild to moderate burns is to cool them immediately. This prevents further tissue damage. First, remove any jewelry or loose clothes from the affected area. Don't remove clothing that has stuck to the burned area, however, or you may cause additional injury to the skin.

Then hold the burned area under cold running water for at least five minutes or until the pain subsides, or immerse the burn in cold water. You can also apply a cold compress to the burn if water is unavailable or unclean. Don't use ice water or put ice directly on a burn, as this may further damage the skin.

Next, cover the burn with a sterile non-adhesive gauze bandage, wrapped loosely to avoid pressure. (Bandaging protects blistered skin from potential contamination by airborne bacteria.) Change the bandages daily if the burn is blistered and oozing, and take an over-the-counter pain reliever if the burn continues to hurt. An anti-inflammatory pain reliever, such as ibuprofen, can help reduce inflammation as well as the pain.

Blisters sometimes form over second-degree burns. Try not to break these: Blisters are part of the body's normal healing process and protect against infection. If a blister does break, wash the area gently with mild soap and cool water, then -- if the burn is not serious -- apply an antibiotic ointment to prevent infection. If it's severe, don't apply an ointment or lotion of any kind. Have your doctor look at the burn and help you decide whether to apply ointment and, if so, which antibiotic preparation is likely to be most effective.

Small first-degree or second-degree burns can take up to three weeks to heal completely. During that time, watch for signs of infection, including redness, swelling, oozing, increased pain, or fever. If you develop any of these symptoms, get medical help. Even after the burn heals, it's a good idea to protect the area with sunscreen for at least a year whenever you go out.

More serious burns: What to look for

Third-degree burns turn the skin waxy-looking, pale, or charred. They are also deep enough to destroy nerve endings, which is why they may actually hurt less, initially, than first- or second-degree burns.

Fourth-degree burns are those that damage fat, muscle, tissues, bones, and organs beneath the skin. These burns are the most serious and are often life-threatening, but remember that the extent of the burn is important. Even second-degree and third-degree burns can be life-threatening if they are extensive or become infected.

What to do

For these serious burns, call 911 immediately. Check to see if the burn victim is breathing. If not, clear the airway and perform cardiopulmonary resuscitation (CPR). Do not try to remove clothing that is stuck to the burn, but remove jewelry before swelling begins and don't apply antibiotic ointment or any other type of lotion. Don't put water on a severe burn, either. Instead, cover the area of the burn with a cool, moist, sterile bandage or clean cloth.

To prevent infection, be especially careful not to breathe or cough on the burn. While waiting for emergency help, take steps to prevent shock by laying the victim down, elevating his or her feet about 12 inches, and covering the person with a blanket. However, don't place the victim in this position if you suspect a head, neck, back, or leg injury, or if the position causes the victim pain.

References

Handbook of First Aid and Emergency Care. American Medical Association.

American College of Emergency Physicians. First Aid Manual.

The American Red Cross First Aid & Safety Handbook.

MayoClinic.com. First aid: Burns. http://www.mayoclinic.com/health/first-aid-burns/FA00022

American College of Family Physicians: http://familydoctor.org/638.xml

Lancaster General Hospital. Burns. http://www.lancastergeneral.org/content/greystone_21227.asp MedlinePlus. U.S. National Library of Medicine and the National Institutes of Health. Burns. http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm

Rush University Medical Center. Second-Degree Burns. http://www.rush.edu/rumc/page-P01757.html

Lucchesi M. Burns. Thermal. eMedicine. http://www.emedicine.com/ped/topic301.htm

The Merck Manual of Diagnosis and Therapy. Chapter 276, Burns. http://www.merck.com/mrkshared/mmanual/section20/chapter276/276a.jsp