Lesson
Stabilize the Person and Stop the Burning Process
Burn assessment begins with scene safety, airway, breathing, circulation, trauma, ongoing exposure, inhalation, circumferential restriction, and hypothermia rather than the appearance of the skin.
- Scene safety
- Inhalation
- Shock
- Circumferential injury
- Hypothermia
Do not create a second patient
Deterioration can be delayed
Burns can hide other injury
Avoid systemic hypothermia
Protect the rescuer
Do not touch an energized patient or enter an unsafe fire, smoke, chemical, or structural scene. Disconnect hazards only when trained and able to do so safely.
Recognize inhalation risk
Enclosed-space exposure, facial burns, soot, carbonaceous sputum, hoarseness, stridor, respiratory distress, or altered mentation requires urgent airway and toxic-gas evaluation.
Find trauma and shock
Assess hemorrhage, blast injury, falls, fracture, head and spine injury, hypotension, altered mentation, and other causes of shock rather than attributing everything to the burn.
Watch circumferential restriction
Deep burns around a chest or limb can restrict ventilation or perfusion as edema develops. Monitor respiratory mechanics and distal neurovascular status closely.
Quick check
Lesson
Describe Tissue Injury by Depth
Modern burn language uses superficial, superficial partial-thickness, deep partial-thickness, and full-thickness injury. Appearance, moisture, blanching, sensation, and evolution matter across skin tones.
- Superficial
- Blister
- Blanching
- Pinprick
- Full thickness
Not counted in TBSA
Dermis remains viable
Healing risk rises
Specialized care is required
Identify superficial injury
Superficial burns are dry, blanching, painful, and limited to epidermis. They are not counted in TBSA calculations used for burn resuscitation.
Identify superficial partial thickness
Moist, red or variably colored, blistered, blanching, and very painful tissue suggests viable superficial dermis.
Identify deep partial thickness
Paler, drier, less blanching, less painful tissue suggests deeper dermal injury and a higher risk of delayed healing and scar.
Identify full thickness
Dry leathery white, brown, black, or variable tissue with absent pinprick sensation indicates full-thickness destruction and requires burn expertise.
Quick check
Lesson
Estimate Total Body Surface Area Precisely
TBSA includes partial-thickness and full-thickness burns. Small or scattered burns use the patient's palmar surface, adults use the rule of nines, and children need age-adjusted proportions.
- TBSA
- Palmar method
- Rule of nines
- Lund and Browder
- Pediatrics
Exclude superficial erythema
About one percent
Rapid initial estimate
Adjust for body proportions
Count the correct depth
Include partial-thickness and full-thickness burn. Do not count simple superficial erythema in TBSA resuscitation calculations.
Use the palmar method
The patient's entire palmar surface approximates about one percent and is useful for small or irregular burns. State the convention used.
Use the adult rule of nines
Rapidly estimate head and neck, arms, legs, anterior and posterior torso, and perineum, then refine irregular areas to avoid double counting.
Adjust for children
Children have proportionally larger heads and smaller legs. Use an age-adjusted Lund and Browder chart and consider specialized pediatric care.
Quick check
Lesson
Cool the Burn Without Cooling the Patient
Effective thermal first aid stops exposure, uses cool running water, removes constricting items, protects blisters and viable tissue, covers cleanly, controls pain, and prevents hypothermia.
- Running water
- No ice
- Jewelry
- Blisters
- Nonstick cover
Protect the rescuer
Never ice
Leave adherent material
Keep the patient warm
Stop the heat source
Extinguish flame, separate the hot object, and remove loose hot clothing without tearing away material stuck to skin.
Cool with running water
Use cool, not cold or icy, running water. Avoid ice, prolonged whole-body cooling, and any approach that causes shivering or hypothermia.
Remove constriction early
Remove rings, watches, belts, shoes, and tight items before edema develops, unless they are adherent or removal would damage tissue.
Cover and reassess
Use a clean nonstick dressing or cloth, keep the patient warm, avoid casual blister rupture, and reassess depth, pain, infection, and referral criteria.
Quick check
Lesson
Treat Mechanism as a Hidden Compartment
Chemical and electrical burns can progress beneath limited visible skin injury. Decontamination, source control, rescuer safety, eye and airway exposure, cardiac risk, muscle injury, and trauma shape care.
- Decontamination
- Dry powder
- Electrical source
- Arrhythmia
- Hidden injury
Call poison or emergency support
Avoid activating the agent
Hidden internal injury matters
Emergency evaluation
Decontaminate chemical exposure
Protect the rescuer, remove contaminated clothing, blot or brush dry material when appropriate, irrigate copiously, and contact Poison Control or emergency services.
Protect eyes and airway
Flush exposed eyes promptly and move inhalational exposure to fresh air when safe. Breathing difficulty, vision change, persistent pain, or significant exposure requires urgent care.
Disconnect electricity safely
Never touch an energized patient. Shut off the source or use a safe nonconductive separation method only when appropriate and trained.
Look beyond the skin
Electrical injury can cause arrhythmia, muscle necrosis, nerve injury, compartment syndrome, falls, fracture, and pregnancy concerns despite small entry and exit marks.
Quick check
Lesson
Match Severity to Burn-Center Expertise
Current ABA referral guidance uses burn depth, TBSA, critical location, inhalation, chemical or electrical mechanism, pain, trauma, comorbidity, pediatric needs, and local resources.
- Burn center
- Ten percent TBSA
- Critical area
- Inhalation
- Pediatrics
Any size can matter
Count correctly
Function changes urgency
Special expertise is needed
Refer by depth and extent
Full-thickness burn, partial-thickness burn at least ten percent TBSA, and any potentially deep burn deserve burn-center consultation.
Refer by critical location
Deep partial or full-thickness burns of the face, hands, feet, genitalia, perineum, or over joints threaten airway, function, identity, and mobility.
Refer by mechanism and patient
Suspected inhalation, all chemical injuries, high-voltage electrical injury, lightning, major comorbidity, concomitant trauma, and poorly controlled pain require specialized assessment.
Use pediatric consultation broadly
All pediatric burns may benefit because pain, dressing care, rehabilitation, caregiver needs, and possible nonaccidental trauma require specialized systems.
Quick check
Lesson
Build a Clean Moist Protected Healing Environment
Selected minor superficial burns can be managed with gentle cleaning, plain petroleum jelly, nonstick coverage, pain control, blister protection, and a dated return rule.
- Cleansing
- Petroleum jelly
- Nonstick dressing
- Analgesia
- Return rule
Avoid repeated tissue injury
No routine topical antibiotic
Do not pop blisters casually
Escalate an abnormal course
Clean gently
After cooling, wash gently with mild soap and water. Avoid repeated alcohol, peroxide, scraping, or contaminated home remedies.
Use simple moisture support
Plain petroleum jelly can support a moist healing environment for appropriate minor burns without routine topical antibiotic exposure.
Protect with a nonstick dressing
Cover loosely, change as directed or when wet or dirty, and avoid tearing adherent material from new epithelium.
Control pain and define return
Use patient-appropriate acetaminophen or ibuprofen after medication review. Escalate worsening pain, infection, delayed healing, functional loss, or uncertain depth.
Quick check
Lesson
Use Topical Antimicrobials by Indication
Topical therapy follows burn depth, contamination, wound goals, product labeling, patient risk, dressing strategy, and monitoring. A topical route does not guarantee only local effects.
- Stewardship
- Silver sulfadiazine
- G6PD
- Leukopenia
- Pregnancy
Minor superficial care
Home remedies can harm
Second and third degree label
Exposure can become systemic
Avoid routine home remedies
Ice, butter, grease, toothpaste, contaminated plant products, and unverified ointments can worsen heat retention, tissue injury, or contamination.
Use antibiotics only by indication
Minor clean burns do not automatically need topical antibiotics. Diagnose infection and select treatment by depth, organism, area, host, and current guidance.
Place silver sulfadiazine precisely
Current labeling describes it as an adjunct for prevention and treatment of wound sepsis in second- and third-degree burns, not as the default for every minor burn.
Monitor systemic safety
Review hypersensitivity, severe skin reactions, blood counts, G6PD deficiency, renal and hepatic function, age under two months, pregnancy near term, treated area, and duration.
Quick check
Lesson
Calculate an Estimate and Then Treat Physiology
Major burns create capillary leak and burn shock. Current ABA adult guidance starts with a lower crystalloid estimate for burns at least twenty percent TBSA, then titrates to urine output and whole-patient physiology.
- Two mL per kg per percent
- Twenty percent TBSA
- Time of burn
- Urine output
- Fluid creep
Adults at least twenty percent TBSA
Delay changes delivery
Formula is only a start
More fluid is not always better
Use the current starting estimate
For adults with at least twenty percent TBSA burn, consider two milliliters of crystalloid per kilogram per percent TBSA over the first twenty-four hours as the initial estimate.
Anchor time correctly
Resuscitation time starts at the burn, not hospital arrival. Account for elapsed time and all prehospital fluid without delivering a dangerous catch-up bolus blindly.
Titrate to physiology
Use urine output, perfusion, mental status, hemodynamics, lactate trend, respiratory mechanics, renal function, and burn-team targets rather than a fixed formula alone.
Prevent fluid creep
Excessive resuscitation can worsen pulmonary edema, extremity and abdominal compartment pressure, tissue edema, and graft or wound problems.
Quick check
Lesson
Measure Healing, Function, and Recovery
Burn recovery follows wound depth and closure while tracking infection, tetanus protection, pain, nutrition, mobility, contracture, itch, scar, pigment, sleep, trauma, and return to daily life.
- Infection
- Tetanus
- Mobility
- Scar
- Psychological recovery
Trajectory matters
Prevent contracture
Large burns are systemic
Recovery continues for months
Recognize infection and failure
Progressive pain, warmth, swelling, drainage, odor, fever, systemic illness, delayed healing, or deepening appearance requires reassessment.
Close tetanus protection
Treat burns with devitalized tissue as dirty or major wounds and apply current CDC vaccine and TIG rules by series status and immune risk.
Preserve movement and role
Positioning, splinting, edema control, range of motion, nutrition, protein, sleep, pain control, and occupational rehabilitation can begin before final closure.
Support scar and psychological recovery
After closure, address sun protection, clinician-directed scar care, itch, pigment, body image, trauma symptoms, sleep, school, work, relationships, and community support.
Quick check
Module test
Check the connections.
Each attempt draws 10 questions from the complete 116 question bank.
Each attempt draws a fresh set and rearranges the answer choices.
References
Current clinical foundation.
Lecture material was synthesized with the following contemporary guidance. Verify local policy and current guidance before applying clinical information.