Initial Treatment for Second-Degree Burns

Immediate First Aid Steps

The American Heart Association recommends cooling the burn immediately with clean running water for 5-20 minutes to limit burn depth progression and reduce pain 1, 3, 4
Monitor children for signs of hypothermia during cooling, as recommended by the American College of Cardiology 1, 2
If clean running water is not available, superficial burns with intact skin may be cooled with ice wrapped in cloth, according to the American Heart Association 1, 2
Remove jewelry before swelling occurs to prevent constriction and vascular ischemia, as advised by the American College of Cardiology 1, 2
Consider over-the-counter pain medications (acetaminophen or NSAIDs) for pain management, as recommended by the American Heart Association 1, 5

Clean the wound with tap water, isotonic saline, or an antiseptic solution, as recommended by the American Society of Anesthesiologists 3, 6
Perform wound care in a clean environment with appropriate pain control, according to the American Society of Anesthesiologists 3, 6
Assess the burn for size, depth, and location to determine appropriate management, as advised by the American College of Cardiology 1, 2
Note that burns involving face, hands, feet, genitals, or >10% body surface area (>5% in children) require specialized burn center treatment, according to the American Heart Association 1, 5

For small partial-thickness burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera, as recommended by the American Heart Association 1, 5
Cover with a clean non-adherent dressing, according to the American Heart Association 1, 5
For larger burns requiring medical attention, the type of dressing depends on the total burn surface area (TBSA), wound appearance, and patient's general condition, as advised by the American Society of Anesthesiologists 3, 6

When applying dressings on limbs, prevent bandages from creating a tourniquet effect, as recommended by the American Society of Anesthesiologists 3, 6
Monitor distal perfusion in case of circular dressings, according to the American Society of Anesthesiologists 3, 6
Ideally, dressings should be re-evaluated daily, as advised by the American Society of Anesthesiologists 3, 6
Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only, according to the American Society of Anesthesiologists 3, 6

Burns involving the face, hands, feet, or genitals require immediate medical attention, as recommended by the American Heart Association 1, 5
All full-thickness burns require medical attention, according to the American College of Cardiology 1, 2
Burns covering >10% body surface area in adults or >5% in children require medical attention, as advised by the American Heart Association 1, 5
Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs) require immediate medical attention, according to the American Heart Association 1, 5

Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia, as warned by the American Society of Anesthesiologists 3, 6
Do not delay other resuscitation interventions for dressing application in severe burns, according to the American Society of Anesthesiologists 3, 6
Avoid routine antibiotic prophylaxis for burn patients unless infection is present, as recommended by the American Society of Anesthesiologists 3, 6