Burns are injuries to the skin and underlying tissues caused by heat, chemicals, electricity, or radiation. Appropriate first aid reduces burn depth, pain, and complications.
Burn Classification by Depth
First-degree (superficial) burns. Affect only the epidermis. Red, dry, painful, no blistering. Example: mild sunburn. Heal in 3–5 days without scarring.
Second-degree (partial-thickness) burns. Affect the epidermis and part of the dermis. Red, moist, blistering, very painful. Superficial partial-thickness: heal in 2–3 weeks usually without scarring. Deep partial-thickness: may take longer and may scar.
Third-degree (full-thickness) burns. Destroy the epidermis and dermis, often extending into subcutaneous tissue. White, charred, or leathery; painless in the center (nerve endings destroyed); require skin grafting for healing.
Fourth-degree burns. Extend through skin into muscle, tendon, or bone. Rare but devastating. Require extensive surgical management.
Burn Assessment
Rule of Nines estimates total body surface area (TBSA) burned in adults: head and neck 9%, anterior trunk 18%, posterior trunk 18%, each arm 9%, each leg 18%, perineum 1%. In children, the head is proportionally larger (18%) and legs smaller (14% each). The palm of the persons hand (including fingers) equals approximately 1% TBSA — useful for small burns.
First Aid for Thermal Burns
Stop the burning process: remove the person from the source of heat. Cool the burn with cool (not cold) running water for 10–20 minutes. Do not use ice — it causes vasoconstriction and worsens tissue damage. Remove jewelry and clothing near the burn (unless stuck to the skin). Cover the burn with a clean, non-stick dressing or plastic wrap. Do not apply butter, toothpaste, ice, or home remedies. Do not break blisters — the intact blister provides a sterile barrier. For facial burns, sit the person upright to reduce swelling. Monitor for airway compromise in inhalation injuries (burns in enclosed spaces, facial burns, singed nasal hairs, hoarseness, carbonaceous sputum).
When to Seek Emergency Care
Third-degree burns. Burns >10% TBSA in adults or >5% in children. Burns involving the face, hands, feet, genitals, perineum, or major joints. Circumferential burns (around an extremity or the chest — can cause compartment syndrome or restrict breathing). Inhalation injury. Electrical or chemical burns. Burns in children, older adults, or those with medical conditions. Signs of infection in any burn.
Chemical Burns
Brush off dry chemicals before irrigation. Irrigate with copious water for 20 minutes or longer — do not use neutralizing agents (heat generated worsens burns). Remove contaminated clothing. For alkali burns (cement, drain cleaners), prolonged irrigation (30–60 minutes) is needed. For hydrofluoric acid burns, apply calcium gluconate gel and seek emergency care (risk of hypocalcemia and cardiac arrest).
Electrical Burns
Electrical injuries cause extensive internal damage with small external entry and exit wounds. Current passing through the body can cause cardiac arrhythmias, muscle damage, compartment syndrome, and renal failure. All electrical burns should be evaluated in an emergency department. ECG monitoring is needed. Do not approach a person still connected to an electrical source — turn off the power first.
Burn Infection
Burn wounds are susceptible to infection. Signs: increased pain, purulent drainage, foul odor, fever, and delayed healing. Prevention: strict hand hygiene, clean dressings, topical antimicrobials (silver sulfadiazine, mafenide acetate, silver-impregnated dressings). Tetanus prophylaxis should be updated.
Summary
Cool thermal burns immediately with running water to reduce depth and pain. Do not apply ice or home remedies. Burns are classified by depth and extent. Emergency care is needed for deep burns, burns >10% TBSA, burns involving critical areas, inhalation injury, electrical or chemical burns, and burns in vulnerable populations. Chemical and electrical burns have specific management considerations. Infection prevention is critical.