Specific burn treatment depends on the type and extent of the burn. Thermal burns are classified according to the depth of injury they produce in the tissues.
FIRST-DEGREE BURNS
First-degree burns are also known as superficial burns. These affect only the outermost layers of the skin. The most common type of first-degree burn is a common sunburn. Most sunburned skin is red, hot and painful. Chills may also accompany sunburns.
Treatment
The management of a superficial burn is mostly supportive in nature. If the tissue is still hot, apply cool, moist dressings. Do not use creams or ointments, especially those with an oil base, because they trap the heat. Some first aid sprays have anesthetics in them, which help relieve pain. Superficial burns usually resolve within a week, often ending up with the burnt layers of skin peeling off. Children or the elderly with large superficial burns should be evaluated at a hospital.
SECOND-DEGREE BURNS
Second-degree burns are referred to as partial thickness burns. These penetrate the skin deeper than superficial burns and cause more severe pain. You may also note evidence of blistering. These fluid-filled blisters help protect against infection. Do not pop the
blisters under any circumstances. If they break on their own, wash the area with soap and water, then apply clean dressings.
Treatment
For minor burns, including second-degree burns limited to an area no larger than 2 to 3 inches in diameter, take the following treatment steps:
• Cool the burn. Hold the burned area under cold running water for at least 5 minutes or until the pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Do not put ice on the burn as this can further damage the skin.
• Cover the burn with a sterile gauze bandage. Don’t use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin.
• An over-the-counter pain reliever may be indicated to help reduce pain. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve) or acetaminophen (Tylenol). Never give aspirin to children or teenagers.
• Minor burns usually heal without further treatment. They may heal with pigment changes in which the healed area is a different color from the surrounding skin. Watch for infection; increased pain, swelling, redness, fever or oozing. If infection develops, seek medical care.
• Do not use ice. Putting ice directly on a burn can cause frostbite, further damaging the fragile skin. Always wrap ice packs in a clean towel to provide insulation to the skin.
• Avoid popping blisters. Skin under a blister is vulnerable to infection.
THIRD-DEGREE BURNS
The most serious burns are painless and involve all layers of the skin. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning or other toxic effects may occur if smoke inhalation accompanies the burn.
Third-degree burns or full thickness burns are the most serious type of thermal burns. They leave the tissue looking charred and leathery. The hallmark of this type of burn is the patient only feeling pain around the edges of the burn due to the destruction of nerve endings.
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