Keep the casualty warm at all times.
(10) Dress any wounds and provide psychological support by reassuring the
casualty that he will be all right.
NEVER USE ointments, butter, cream, salves, sprays, or any other
covering on any type of burn. These will have to be scrubbed off later
and will further irritate the burn and cause the patient pain.
3-18. SPECIALIZED TREATMENT
a. First-Degree Thermal Burns. Immerse these burns in cold water if you
reach the burn within the first hour of injury. A cool compress can also be applied to a
first-degree burn that is less than 20 percent of the TBSA. Burned hands and feet may
be soaked directly in cold water. Towels soaked in cold water are particularly effective
when applied to burns of the face or trunk. The coolness will decrease the pain. If
possible, continue applying wet dressings all the way to the hospital. Note these
precautions. If the burn is over a large TBSA, submerging the patient in cold water
could cause cardiopulmonary distress and vascular constriction. DO NOT apply ICE to
a burn-injured casualty under any circumstances.
b. Second-Degree Thermal Burns. These burns are treated very much the
same as first-degree burns. Immerse the burn in cold water or apply cold, wet
compresses if you reach the burn within the first hour. This reduces edema and gives
the patient relief from pain. Additionally, leave blisters intact. Start an IV if the second-
degree burns cover more than 15 percent of the patient's body accompanied by first-
degree burns covering more than 30 to 50 percent of the body.
c. Third-Degree Thermal Burns. DO NOT immerse such burns in cold or luke-
warm water. First, cleanse the burn with antiseptic solution and cover the area with a
dry sterile dressing. Then, cover the casualty with a blanket that will not stick to the
burn area. Anticipate problems if the patient has face burns, has been exposed to
smoke or hot gases, has been unconscious in a burning area, coughs up sooty sputum,
or has hoarseness, stridor, or a brassy cough. Evacuate the casualty immediately. If
evacuation is delayed, it may be necessary to cleanse the burn area and remove any
foreign particles. Apply a topical antibacterial ointment; silver sulfadiazine is preferred.
A major problem in the severely burned patient is acute gastric distention. If
the patient is intubated, insert a nasogastric tube to decompress the stomach.
DO NOT attempt to insert a nasogastric tube if the patient is comatose or
stuporous and not yet intubated or in a patient who has had severe thermal
injury involving the nasopharynx.