Burns

Symptoms

DEFINITION

• A burn is a heat (thermal), chemical or electrical injury to the skin.

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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.

Degrees of Burn Severity

• 1st Degree (superficial burns): Reddened skin without blisters (usually does not need to be seen).
• 2nd Degree (partial thickness burns): Reddened skin with blisters (heals from bottom up, takes 2 to 3 weeks).
  • Small intact blisters (narrower then 2 inch or 5 cm) can usually be left alone; initial debridement is not needed. An intact blister serves as a physiologic dressing,  decreases the risk of infection, and reduces pain. However, most blisters over 1 inch (2.5 cm) will go on to rupture.
  • Large intact blisters (wider than 2 inch or 5 cm) almost always rupture within a couple days of the burn. They should be debrided (remove dead blister skin). Generally, this is best done by a physician or other health care provider.
  • All ruptured blisters need debridement (removal) of the dead skin. . This can be done by you, a physician, or other health care provider. Most ruptured 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 (full thickness burns): Deep burns with white or charred skin. The area also loses sensation to pain and touch (i.e. 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.

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See More Appropriate Topic (instead of this one) If

• You have a SUNBURN
• Chemical gets in your eye from, use EYE - CHEMICAL IN

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FIRST AID Advice 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.
• For burns on the face, apply a cold wet washcloth. (Reason: lessens the depth of the burn and relieves pain)

FIRST AID Advice for Smoke Inhalation, Chemical Fume Inhalation, or Carbon Monoxide Exposure:

Immediately move to fresh air...

• Go outdoors (best)
• Or move to an open door / window (in extreme weather conditions)  

FIRST AID Advice 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.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Difficulty breathing after exposure to fire, smoke, or fumes
• Difficulty breathing with burn to the face 
• Burn area larger than 10 palms of hand, with blisters (i.e., large second or third degree burn)
• NOTE: For all above thermal and chemical burns, see First Aid

Call Your Doctor Now (night or day) If

• You think you have a serious burn
• Burn area larger than 4 palms of hand
• Blister (intact or ruptured) and larger than 2 inches (5 cm)
• Blister (intact or ruptured) on the hand and larger than 1 inch (2.5 cm)
• Blisters (intact or ruptured) on the face, neck, or genitals
• Burn completely circles an arm or leg 
• Caused by very hot substance and center of burn is white (or charred)
• Caused by an electrical current
• Caused by explosion or gun powder
• Caused by acid or alkali (lye)
• Caused by a chemical on skin and there is a blister
• NOTE: For all above thermal and chemical burns, see First Aid
• Hoarseness or cough after exposure to fire and smoke
• Headache or nausea after exposure to fire and smoke
• 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
• Minor burn of foot or lower leg and you have diabetes  
• Minor burn and last tetanus shot over 10 years ago

Self Care at Home If

• Minor thermal or chemical burn and you don't think you need to be seen  
• Questions about burning sensation from hot peppers

Care at Home

HOME CARE ADVICE 

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. Ruptured (Broken or Open) Blisters:
   • You should remove the dead blister skin for any ruptured blisters. 
   • Method 1:   The easiest way to do this is gently wipe away the dead skin with some wet gauze or a wet washcloth. 
   • Method 2: If that fails, trim off the dead skin with a fine scissors.
4. Antibiotic Ointment for Ruptured Blisters:
   • Apply an antibiotic ointment (e.g., OTC bacitracin) directly to a Band-Aid or dressing (Reason: prevent unnecessary pain of applying it directly to burn). 
   • Then apply the Band-Aid or dressing over the burn.
   • Change the dressing every other day. Use warm water and 1 or 2 wipes with a wet washcloth to remove any surface debris.
   • Be gentle with burns.

5. Intact (Closed) Blisters:

   • First 7 Days After a Burn: Leave intact blisters alone.
   • After 7 Days: You can gently remove the blisters. The easiest way to do this is gently wipe away the dead skin with some wet gauze or a wet washcloth.
6. 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).
7. Expected Course:
   • Burns usually hurt for 2-3 days.
   • First Degree Burns: Usually peel like a sunburn in about a week. The skin should look nearly normal after 2 weeks.
   • Second Degree Burns: Blisters usually rupture within 7 days. Second degree burns take 14-21 days to heal (longer than first degree burns). Sometimes the skin looks a little darker or lighter than before after it has healed.
   • Scarring: Fortunately, first- and second-degree burns don't leave scars.
8. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: 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.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
9. Call Your Doctor If:
   • Severe pain persists more than 2 hours after taking pain medicine.
   • Burn starts to look infected (pus, red streaks, increased tenderness)
   • You become worse

Mouth or Lip Pain from Hot Food or Drink

1. Reassurance:
   • Minor burns of the mouth from hot food usually are painful for 2 days.
   • They heal quickly because the lining of the mouth heals twice as fast as the skin.
2. General Information:
   • Handling Hot Peppers: Handling certain types of chili peppers can cause skin irritation and burning pain. This usually resolves without any skin damage. The burning pain should resolve over 1 hour.
   • Biting a Hot Pepper: Biting a hot pepper causes a painful burning sensation of the involved skin or mucous membranes. The discomfort usually last 10-20 minutes. The skin will not blister or be damaged in any way.
3. Local Ice:
   • Put a piece of ice in the mouth immediately for 10 minutes (Reason: reduce swelling and pain).
   • Rinse the mouth with ice water every hour for 4 hours.
4. Expected Course:
   • The pain usually resolves after 2 days.
   • Second degree burns can cause some blisters that quickly turn into shallow ulcers. These take 3 or 4 days to heal. They normally have a white surface.
5. Call Back If:
   • Difficulty with swallowing occurs
   • Difficulty with breathing occurs
   • Pain becomes severe
   • You become worse.

Preventing Tetanus

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).

Burning Sensation from Hot Peppers

1. Treatment for Skin Pain from Handling Hot Peppers:
   • WASH the skin with soap and warm water, to remove the pepper oils.
   • COVER the painful skin area with vegetable oil (for hands/fingers soak in vegetable oil) for 1 hour. The vegetable oil absorbs the pepper oils and will slowly reduce the pain. If vegetable oil is not available, you can try using milk or cream (dairy products contain a substance that absorbs the pepper oil). Dairy products that are "fat-free" will not work.
2. Treatment for Mouth Pain from Handling Hot Peppers:
   • RINSE your mouth several times with milk or cream.
   • Dairy products contain a substance that absorbs the pepper oil.
3. Call Your Doctor If:
   • Pain persists more than 1 hour
   • Blisters appear
   • You become worse.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

Burn - First Degree

The photo shows a 6 inch (15 cm) wide area of mild redness without blistering on the forearm. This thermal burn was caused by spilled hot water

First Aid Care Advice:

• Immediately put the burned part in cold tap water or pour cold water over it for 10 minutes or cover with a cold wet washcloth.
• Reason: This lessens the depth of the burn and relieves pain.  

 Burn - Second Degree

The photo shows a significant second degree burn of the hand. Note the large areas of skin blistering.

First Aid Care Advice:

• Immediately 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).
• Cover with a cold wet washcloth and seek emergency care.

Burns - The Rule of Nines

Each part of the body contributes a predictable portion of the total body surface area.

• Head and neck - 9%
• Each arm - 9 %
• Anterior chest and abdomen 18%
• Entire back - 18%
• Each leg - 18%
• Genital region - 1%

First Aid - Burn - Chemical

• Remove any contaminated clothing.
• Brush any dry chemical off the skin.
• Flush the chemical off the skin with warm water for 10 minutes.
• For large areas, use the shower.

First Aid - Burn - Thermal

• Immediately put the burned part in cold tap water or pour cool water over it for 10 minutes (Reason: lessen the depth of the burn and relieve the pain) .
• For burns on the face, apply a cold wet washcloth.
• Do this immediately (don't take time to remove clothing).

Note: A thermal burn is any burn caused by heat.