Burn Care Guidelines for 2nd & 3rd Degree Burns

This handout explains how to care for 2nd and 3rd degree burns.

What are 2nd Degree Burns?

Second degree burns appear open, shiny, moist, blistered, and pink or red. These burns are painful and sensitive to touch. They may be treated at home, in the clinic or in the hospital. Second degree burns often take 1-3 weeks to heal.

What are 3rd Degree Burns?

Third degree burns appear dry or leathery, white, brown, maroon, dark red or black. These burns are not sensitive to pain. Third degree burns often take greater than 3 weeks to heal or need skin grafting. These burns are treated at home only if they are quite small.

Follow the burn care treatment that is checked below. Remember, never use ice on a burn. It decreases blood flow and prevents healing.

 Bacitracin or Silvadene® Dressing
Remove the dressing. Do not soak it to remove it. Take off the dressing when it is dry. This cleans away dead tissue.

Wash burns gently once a day with unscented, antimicrobial soap. Do not use baby soap or soaps with lotion in it. Wash off the antibiotic cream/ointment, blisters, and loose skin. Rinse well. A small amount of bleeding is normal.

Facial burns should be washed twice daily.

Remove the antibiotic cream/ointment from jar with gloves or washed hands so germs do not get in the jar.

Apply a thin layer of Bacitracin or Silvadene® antimicrobial cream or ointment to the burn as directed.

• _____ For face burns – Apply Bacitracin antibiotic ointment twice a day, and more often if your face gets dry. No gauze is needed on the face. Shave facial hair once a day.

• _____For ear burns – Apply Bacitracin antibiotic ointment twice a day. Do not get cream/ointment in the ear canal. It may build up and plug the ears.
  

Apply a non-stick gauze called Cuticerin.

Wrap all burns except the face and ears with non-stretch roller gauze. You may need extra layers of gauze if the wound is weepy.

Apply Dermafit, compression stockings, or glove.

 Mepilex® AG Dressing
Mepilex® AG is a protective silver foam dressing that helps your burn heal, prevent infection, and control pain.

Do not remove your dressings. Your dressings may stay in place for many days and will be removed by the nurse at your scheduled visit.

Keep your dressing clean, dry, and in place. Do not soak dressings in water during shower or bath. Consider sponge bathing.

Contact the burn providers if your dressings get wet, soiled, or displaced.

Pain Control

Take prescribed pain pills 1 hour before dressing changes. Between dressing changes you can use Tylenol® (acetaminophen or extra strength acetaminophen) to treat pain. As your
burn heals, you will have less pain. It may feel stiff or like it is being pulled as it heals. Only use ibuprofen if your burn doctor approves.

Prevent Swelling

Compression and elevation are very important to help prevent swelling, promote healing and help with pain.
_____ For face or head burns — elevate your head when you sleep.

_____ For hand or arm burns — rest your hand or arm on pillows above the level of the heart as much as you can.

_____ For foot and leg burns — keep feet and legs up on pillows when you sit or are in bed. Keep your heels off the edge of the pillow.

Exercise

Even though you have a burn, it is important to exercise. Be sure to:

• Exercise to keep joints moving and to stretch new skin.

• Keep moving and walk often.

• Use your burned arm or leg.
  

Smoking

If you smoke, we strongly encourage you to stop. Smoking decreases blood flow and oxygen to new and healed burns. It slows down the healing process.

Diet

Drink plenty of fluids with extra protein, 8-10 (8 oz.) glasses in 24 hours, to prevent dehydration.

It is also important to eat a well-balanced diet that is high in protein to help wounds heal.

Healed Skin

Use moisture creams to prevent drying and cracking. Healed skin appears shiny pink. Apply moisture creams that are perfume and dye-free such as Lubriderm®, Eucerin® or Nivea® as often as needed to keep the skin moist and soft. Avoid creams with alcohol or numbing agents.

When to Call

Call the doctor if you have any signs and symptoms of infection such as:

• Redness (about 1 inch in width) and swelling around the burn.

• Foul smelling drainage from the wound.

• Flu-like symptoms (temperature greater than 100.4ºF or 101.5ºF for children by mouth for two readings taken 4 hours apart, chills, nausea, vomiting, or muscle aches).

• Increasing burn pain not helped by prescribed pain medicine.
  

Who to Call

Burn and Wound Clinic
Monday – Friday, 8:00 am – 5:00 pm
(608) 264-8040 or (800) 323-8942

For urgent questions or needs after hours or on weekends, contact the Burn Unit nurses at:
(608) 263-1490

Or call the paging operator at (608) 262-2122 and ask to have the Burn resident paged.
For non-urgent questions or needs after hours or on weekends, leave a message for the

General Surgery triage nurse at:
(608) 890-9542