• Mottled red/white patchy appearance
• Blisters may be present, white in appearance on hands/feet
• Capillary return is sluggish or absent
• Reduced sensation or no sensation

• To protect from infection
• To absorb exudate
• To assess depth for conservative management or surgical management

• Initial first aid - cold water, about 15° for 20 minutes. Do not use ice or iced water. If longer than 3 hours since time of injury cold water will have no beneficial effect (EMSB 1996)
• Apply simple conservative dressing of either paraffin impregnated gauze, eg Jelonet (where larger volumes of fluid are exuding), or Vaseline Petrolatum Gauze (where smaller volumes of fluid are exuding) and gamgee padding plus bandage
• Change outer padding as required leaving paraffin gauze intact for 2 days
  DO NOT APPLY SILVER SULFADIAZINE 1% CREAM (FLAMAZINE) BEFORE ASSESSMENT AT 48 HOURS, POST INJURY

  After 48 hours, reassess:

• If sensation and blanching treat as for superficial
• If no blanching, refer to Regional Burns Unit at St John's Hospital (adults) or Royal Hospital for Sick Children (children) for full assessment and treatment regime.

Comment

• If in any doubt as to depth of burn, please refer to Regional Burns Unit at St John's Hospital (adults) or Royal Hospital for Sick Children (children) to prevent delay in preparing for surgery if this is required
• Apply simple emollient 2 x daily when healed, washing off with water before reapplying emollient
• Avoid wearing nylon next to recently healed areas
• Will need protected from sunlight/UV light for up to a year with factor 25+ sun screen