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Treating Burns (First Aid)
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Treating Burns

John Kraft and Charles Lynde, MD, FRCPC

Burns are extremely dangerous injuries that result from exposure to sources of extreme heat. They are a major cause of preventable injury and death. In a 1998 statistic, 300 Canadians died from burn injuries, and 3493 more were hospitalized due to a severe burn injury. More than 75% of burn injuries occur inside or in the vicinity of people`s homes. Men burn themselves slightly more often than women at 60%, and children are often more likely to be injured by scalding. For adults, flame burns are the most common cause of burns.

Burns damage the surrounding skin and the capillaries, causing body fluid to leak into extravascular compartments. Dehydration can result from this as the fluids can leak through the wound and evaporate. For critical situations requiring emergency treatment, restoring fluids is a priority to prevent more serious problems such as shock, and to keep adequate tissue perfusion. Finally, the damaged skin becomes more prone to bacterial infections.

Burns are classified into three degrees according to their severity.

First degree burns:

  • Superficial layer of the skin is damaged.
  • Scarring is very rare for first degree burns, and often heals within three or four days.
  • The burned area will be painful, and red. The skin will not blister.
  • Most sunburns fall into this category of burns.

Second degree burns:

  • Second degree burns affect the dermis of the skin.


  • The wound is moist, pink, and painful, often with blisters.
  • The damaged skin will turn white when pressure is applied.
  • The wound should heal within three weeks with little scarring.


  • The wounded area will look pale, spongy, or hardened.
  • Pressure will not cause the skin to turn white.
  • Hair may be lost.
  • The burn is slow to heal, often taking over a month.

Third degree burns:

  • The skin is leathery.
  • The layers of the skin are destroyed.
  • There is numbing, and no pain or sensation in the damaged area.
  • Skin grafting is necessary.

Burns can often be quite deceptive, evolving over the first 48 hours. Caution must be taken when dealing with what could be a serious burn. If you are in doubt about the severity of your burn, don`t hesitate to go seek emergency care. Deep burns will require proper treatment including fluid and electrolyte replacement, as well as surgery for the skin (grafting, escharotomy). As a general rule, there are two measures for identifying the seriousness of a burn. The first is the aforementioned degree or severity of burns, and the second is by body surface area, the amount of skin that is damaged as a percentage of your total body area. As reference, the palm is considered to be 1% of your body surface area. Patients with first and second degree burns covering less than 15% of the body surface area, and third degree burns covering less than 2% of the body surface area can simply visit a doctor. Proper treatment should be provided there. More serious or more extensive burns must be treated at the hospital.

Treating Non-Emergency Burns:

  • First Aid—ice and water compresses
  • Use antihistamines and acetaminophen as required.
  • Clean, treat, and prevent wound infections with topical antibiotics.
  • Tetanus becomes a concern for second and third degree burns. Debridement, removal of dead skin may be done.
  • The body must be hydrated properly for all burns. For severe burns, fluid resuscitation and management in a proper hospital facility may be required.
  • The wound should be properly dressed using non-sticking gauzes to absorb leaking fluids. Jelonets and telfa pads can also be used for this purpose.

Properly identifying the severity of a burn is critical to managing and treating burns effectively. Serious burns should be managed in a specialized unit in a hospital. If you are unsure, but suspect that the burn is more serious, don`t hesitate to seek medical attention. For more information about skincare, visit


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