Emergency treatment process that assesses burn degree and surface area in thermal, chemical or electrical burns and includes cooling, dressings, fluid therapy and infection control.
Indication
- First-degree burn (only the upper skin layer, redness and pain)
- Second-degree superficial/deep burn (blisters, weeping wound, severe pain)
- Third-degree burn (full skin thickness, white/charred, painless appearance)
- Burns covering more than 10% of the total body surface area
- Burns to the face, hands, feet, genital area and over joints
- Electrical or chemical burns
- Suspected inhalation injury (smoke exposure)
Preparation
- The burn area is cooled with running lukewarm water for 20 minutes (no ice)
- Clothing and jewelry over the burn are removed if not adhered to the skin
- In chemical burns, the agent is rinsed away with copious water (acid/base neutralization is not performed)
- The patient is covered with a clean cloth before being brought to the emergency department
How it's performed
- Burn degree and surface area are calculated using the 'rule of nines' (in adults: head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%)
- In second- and third-degree burns, fluid resuscitation is administered per the Parkland formula (4 mL × weight × burn percentage in the first 24 hours; half within the first 8 hours)
- The wound is cleaned, devitalized tissue is removed (debridement), and a silver-containing antibacterial dressing is applied
- Tetanus immunization status is checked and given if needed
- Intravenous analgesics are administered for pain control
- In suspected airway burn injury, intubation and oxygen therapy are initiated
Post-procedure
- First-degree burns generally heal in 5-7 days; second-degree may take 2-3 weeks
- Deep second-degree and third-degree burns are referred to a burn center or plastic surgery
- Dressings are changed every 1-3 days and signs of infection (fever, redness, foul odor) are monitored
- In a healing burn, sun protection and moisturizers are applied
- Physiotherapy is planned for areas at risk of contracture and hypertrophic scarring
Risks
- Hypovolemic shock (due to fluid loss in extensive burns)
- Wound infection, sepsis
- Scar tissue, contracture and joint range-of-motion limitation
- Respiratory failure (inhalation injury)
- Compartment syndrome (in circumferential deep burns)
FAQ
Is it correct to apply toothpaste, yogurt or butter on a burn?
No. These applications contaminate the wound, prevent heat dissipation and increase infection risk. Only cooling with running lukewarm water is recommended.
Should I pop the blisters in a burn with bullae?
No, blisters should not be opened on their own. The fluid beneath the blister provides natural protection. If they need to be opened, this is done by healthcare personnel under sterile conditions.
Which burns require an immediate emergency department visit?
Burns larger than 10%, on the face/hands/feet/genitals, over joints, deep burns, electrical or chemical burns, and smoke inhalation require an emergency department visit.
Will color differences remain after a burn heals?
In second- and third-degree burns, color differences may be visible for weeks to months. Sun protection helps reduce this discoloration.
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