Body Surface Area Burn Chart: Accurately Determining Total Body Surface Area in Burn Injuries
How do medical professionals assess burn surface area. What is the gold standard for burn assessment. Which methods are used to estimate total body surface area in burns. How accurate are different burn assessment techniques. Why is determining burn surface area crucial for patient care.
The Importance of Assessing Total Body Surface Area in Burn Injuries
Accurately determining the total body surface area (TBSA) affected by burns is a critical step in managing burn injuries. This assessment guides treatment decisions, fluid resuscitation protocols, and overall patient care. Let’s explore the various methods used to calculate TBSA and their significance in burn management.
The Rule of Palm: A Quick Estimation Technique
One simple method for estimating burn surface area is the Rule of Palm. This technique uses the patient’s palm as a reference point.
- The patient’s palm (including fingers) represents approximately 1% of their total body surface area.
- Medical professionals can use this as a quick visual guide to estimate smaller burn areas.
- While not as precise as other methods, it provides a rapid initial assessment in emergency situations.
Is the Rule of Palm accurate enough for all burn assessments? While useful for quick estimates, it’s generally not considered accurate enough for larger burns or when precise calculations are needed for fluid resuscitation.
The Wallace Rule of Nines: A Systematic Approach
The Wallace Rule of Nines is a more structured method for assessing burn surface area, particularly useful for adults.
- It divides the body into sections, each representing 9% (or a multiple of 9%) of total body surface area.
- Head and neck: 9%
- Each arm: 9%
- Chest and abdomen: 18% (9% each)
- Back: 18%
- Each leg: 18%
- Genitals: 1%
How accurate is the Wallace Rule of Nines? While more precise than the Rule of Palm, it has limitations, particularly for children and individuals with different body proportions. It’s generally considered a good starting point but may be supplemented with more detailed assessments.
The Lund and Browder Chart: The Gold Standard in Burn Assessment
The Lund and Browder Chart is widely regarded as the most accurate method for determining burn surface area across different age groups.
- It provides a detailed breakdown of body surface areas, accounting for age-related differences in body proportions.
- The chart includes separate calculations for adults, children, and infants.
- It offers more precise percentages for different body parts, allowing for a more accurate TBSA calculation.
Why is the Lund and Browder Chart considered the gold standard? Its ability to account for age-related differences in body proportions makes it highly accurate across all patient populations, from infants to adults.
Key Features of the Lund and Browder Chart
- Detailed body region breakdown
- Age-specific adjustments
- Separate calculations for anterior and posterior surfaces
- Ability to mark partial and full-thickness burns
Digital Solutions: The Mersey Burns App
In the digital age, technology has provided new tools for burn assessment. The Mersey Burns app is a CE-certified digital solution for calculating burn surface area.
- Allows medical professionals to input burn areas on a digital body map
- Automatically calculates TBSA percentages
- Provides fluid resuscitation guidelines based on the assessment
- Offers a user-friendly interface for quick and accurate calculations
How does the Mersey Burns app compare to traditional methods? While it offers speed and convenience, it’s important to note that digital tools should be used in conjunction with clinical judgment and expertise, not as a replacement for thorough assessment.
Challenges and Considerations in Burn Surface Area Assessment
Accurately determining TBSA can be challenging due to various factors:
- Irregular burn patterns
- Varying depths of burns within the same area
- Patient body type variations
- Time constraints in emergency situations
How do these challenges impact burn management? Inaccurate TBSA calculations can lead to under- or over-resuscitation, affecting patient outcomes. It’s crucial for medical professionals to be aware of these potential pitfalls and use multiple assessment methods when possible.
The Role of TBSA in Fluid Resuscitation Protocols
Total body surface area calculations play a vital role in determining fluid resuscitation needs for burn patients.
- The Parkland Formula, a common fluid resuscitation guideline, relies heavily on accurate TBSA percentages.
- Fluid requirements are typically calculated as 4 ml x patient’s weight in kg x %TBSA burned.
- Accurate TBSA assessment helps prevent complications from over- or under-resuscitation.
Why is precise fluid resuscitation crucial in burn care? Proper fluid management helps maintain organ perfusion, prevent shock, and reduce the risk of complications such as renal failure or compartment syndrome.
Monitoring and Adjusting Fluid Resuscitation
While initial calculations are based on TBSA, ongoing monitoring is essential:
- Urine output
- Vital signs
- Electrolyte balance
- Overall clinical picture
Beyond TBSA: Other Critical Factors in Burn Assessment
While TBSA is crucial, a comprehensive burn assessment involves several other factors:
- Burn depth (superficial, partial-thickness, full-thickness)
- Location of burns (e.g., face, hands, genitals)
- Presence of inhalation injury
- Patient age and pre-existing medical conditions
- Mechanism of injury (thermal, chemical, electrical)
How do these factors influence treatment decisions? Each of these elements can significantly impact the overall treatment plan, potential complications, and long-term prognosis for burn patients.
The Importance of Multidisciplinary Care
Effective burn management often requires a team approach:
- Emergency medicine specialists
- Burn surgeons
- Critical care physicians
- Nurses specialized in burn care
- Physical and occupational therapists
- Psychologists or psychiatrists
Emerging Technologies in Burn Assessment
As medical technology advances, new tools are being developed to enhance burn assessment accuracy:
- 3D scanning and imaging technologies
- Artificial intelligence-assisted burn area calculation
- Thermal imaging for depth assessment
- Spectral imaging for more precise burn characterization
How might these technologies change burn care in the future? While promising, these emerging tools will likely complement rather than replace clinical expertise, offering additional data points to inform treatment decisions.
The Future of Personalized Burn Care
Advancements in burn assessment may lead to more personalized treatment approaches:
- Genetic markers for healing potential
- Individualized fluid resuscitation protocols
- Tailored wound care based on precise burn characteristics
- Predictive models for complications and outcomes
In conclusion, accurate assessment of total body surface area in burn injuries remains a cornerstone of effective burn management. From simple estimation techniques like the Rule of Palm to the gold standard Lund and Browder Chart and emerging digital solutions, medical professionals have a range of tools at their disposal. Understanding the strengths and limitations of each method, along with considering other critical factors in burn assessment, is crucial for providing optimal care to burn patients. As technology continues to advance, the future of burn assessment and management holds the promise of even more precise, personalized approaches to improve patient outcomes.
Assessment of burn surface area | Burns (OSH Surgery)
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Whitaker, Iain S. and others (eds), ‘Assessment of burn surface area’, in Iain S. Whitaker, Kayvan Shokrollahi, and William A. Dickson (eds), Burns (OSH Surgery), Oxford Specialist Handbooks in Surgery (
Oxford, 2019; online edn, Oxford Academic, 1 Mar. 2019), https://doi. org/10.1093/med/9780199699537.003.0009, accessed 3 July 2023.
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Abstract
Assessment of total body surface area of a burn injured patient is a crucial step in managing burn injury. The chapter describes a number of techniques from using the size of the patient’s palm as an estimate of 1% to the gold standard Lund and Browder Chart. Key caveats are explained, copies of the charts included as well as the use of the CE certified app Mersey Burns.
Keywords:
burns assessment, TBSA, Lund & Browder, Wallace Rule of Nines, Mersey Burns
Subject
SurgeryDermatology
Series
Oxford Specialist Handbooks in Surgery
Collection:
Oxford Medicine Online
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Appendix VI – Burn and Burn Fluid Charts – CHEMS Field Treatment Guidelines
Table of Contents
A – Adults. B – Children
Percentage of Total Body Surface Area by Age, Anatomic Structure, and Body Habitus
Adult | |
Anatomic Structure | Surface Area |
Anterior head | 4. 5% |
Posterior head | 4.5% |
Anterior torso | 18% |
Posterior torso | 18% |
Anterior leg, each | 9% |
Posterior leg, each | 9% |
Anterior arm, each | 4.5% |
Posterior arm, each | 4.5% |
Genitalia, perineum | 1% |
Adult – Obese 80 kg | |
Anatomic Structure | Surface Area |
Head and neck | 2% |
Anterior torso | 25% |
Posterior torso | 25% |
Leg, each | 20% |
Arm, each | 5% |
Genitalia/perineum | 0% |
Child | |
Anatomic Structure | Surface Area |
Anterior head | 9% |
Posterior head | 9% |
Anterior torso | 18% |
Posterior torso | 18% |
Anterior leg, each | 6. 75% |
Posterior leg, each | 6.75% |
Anterior arm, each | 4.5% |
Posterior arm, each | 4.5% |
Genitalia/perineum | 1% |
Infant 10 kg | |
Anatomic Structure | Surface Area |
Head and neck | 20% |
Anterior torso | 16% |
Posterior torso | 16% |
Leg, each | 16% |
Arm, each | 8% |
Genitalia/perineum | 1% |
Parkland Formula
For patients who require fluid resuscitation, consider use of the Parkland formula to calculate the volume of normal saline or lactated Ringer’s solution that should be administered intravenously to ensure hemodynamic stability.
Volume of Intravenous Fluid required in the first 24 hours (in mL) = (4 X patient weight in kg) X (Percentage of total body surface area burned)
The first half of the volume of fluid should be administered over the first 8 hours following the burn with the remaining fluid administered over the following 16 hours.
For pediatric patients, a weight-based assessment tool (length-based tape or other system) should be used to provide a more accurate estimate of the patient’s weight. Likewise, the total body surface area (BSA) estimates are different for pediatric patients compared to adults due to larger head and trunk size. For children, the palmar surface of the hand (not including the fingers is approximately equal to 1% BSA. The guidelines listed above will provide assistance during the estimation of the percentage of total body surface area burned for patients of various ages and body habitus.
Burn Injury IV Fluid Rates
Infusion Rate Weight > 30 KG
Infusion Rate Weight < 30 KG
Source: Used with permission, University of Utah Burn Center (https://crisisstandardsofcare.utah.edu).
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Information
- Vacancies
- Details of the institution
- Composition of employees
- Patient’s rights
- Hospital stay rules 50 percent discount.
- Information about the standards of medical care
- List of vital drugs
- List of paid services
- Making an appointment with a doctor
- Processing personal data
- Decree of the Government of the Russian Federation No. 95 dated 20.02.2006 900 14
- Epidemiological Service
Health Development Program
- Territorial program of state guarantees for 2022-2024
Supervisory organizations
- Ministry of Health of the Karachay-Cherkess Republic
- Territorial Compulsory Medical Insurance Fund for the KChR
- Department of Roszdravnadzor
- Insurance company ZAO MAKS-M
For residents of the Karachay-Cherkess Republic added the possibility of another way to independently make an appointment with a doctor through the Telegram messenger . Telegram has implemented the @MedicineOnlineBot chatbot to make an appointment with medical institutions and call a doctor at home.
In the process of making an appointment, users can view a list of specialists of a medical organization, their work schedule. Recording for in-depth medical examination is also available for patients who have undergone COVID-19. Making an appointment and calling a doctor at home are carried out in several steps, user data (call address, contact information) is stored in the database to reduce the amount of information for repeated entries.
at the Consultative and Diagnostic Center of the Republican Children’s Multidisciplinary Hospital (at the address: Cherkessk, Griboyedova St., 81), children will be consulted by specialists (cardiac surgeon, arrhythmologist,) . Moscow.
Pre-registration is carried out by calling the reception:
8(8782) 25-01-27
April 20-21-22, 2023. in the Consultative and Diagnostic Center of the Republican Children’s Multidisciplinary Hospital (at the address: Cherkessk, Griboedov St. , 81), children will be consulted by specialists from the Research Institute named after. G.N. Turner, St. Petersburg.
Specialists of the federal center:
Maxillofacial surgeon: Stepanova Yu.V.
Dear parents!
Children’s polyclinic in Cherkessk
received a vaccine against a new coronavirus infection Gam-Covid-VAK-M for vaccination of children from 12 to 18 years old. Registration for vaccination by phone: 250105. You can also contact the children’s clinic for vaccination. Vaccination is carried out after examining the child with thermometry and the informed written consent of the parent (guardian), or the child himself, who has reached the age of 15 years.
Chief freelance pediatrician of the Ministry of Health of Russia Alexander Baranov: If a child falls ill but goes to school, he will not be able to study normally, and he will infect others
— We are again in a whirlwind of infections, primarily respiratory infections. They strike thousands of our compatriots every day. Children are especially vulnerable,” he said.
❕If a child starts sneezing, coughing, complains of feeling unwell, sore throat, you should not take him to school, it is better to stay at home so as not to infect other children and cope with the disease faster.
Very often parents send their children to school even if they have a temperature, even if it is small, because they are afraid to miss classes – the school program is very busy. If a child gets sick, but goes to school, he himself will not be able to study normally, and he will infect others. in children with respiratory infections, cognitive abilities deteriorate, especially cognitive functions decrease with a cold.
— I would like to appeal to the common sense of moms and dads. But it’s better to skip 2-3 days and treat an incipient cough or a reddened throat than to get seriously ill and, possibly, face complications after the illness, – said the chief freelance pediatrician of the Russian Ministry of Health.
❌ It’s easier to send the child to school;
⭕️ It is wiser to stay at home, help you recover faster and return to learning.
If your family has not yet been vaccinated against influenza and pneumococcal disease, doctors advise getting vaccinated. This will help to avoid many health and learning problems.
Schedule of reception of citizens of the administration of the children’s hospital: Chief physician – Laipanova Tamara Akhmatovna Wednesday 12:00 – 14:00Tel:. 20-81-59cab. chief physician (administration)Deputy Chief Physician for Surgery Bakhtiyar Makseiovich Kalniyazov Monday from 10:00 – 12:00Friday from 10:00 – 12:00phone: 8-928-385-08-93Surgical building, 2nd floor, office deputy heads doctor. Isabella Zalimovna Tlyabicheva Tuesday from 10:00 – 12:00Thursday from 10:00 – 12:00tel:. 26-12-40Room 507 |
Round-the-clock “Hotline” for receiving citizens’ appeals on all issues of medical care by phone: 8 (8782) 20-23-93 department with a department of emergency advisory medical care and medical evacuation (air ambulance): 8 (8782) 20-29-66; 20-35-81
Already today you can get an electronic prescription at the appointment of your doctor in RSBLPU “RDMB”. Install the My Prescription app by downloading it from the App Store, Google Play or the My-prescription.rf website. With the app, you can store all prescriptions, select medicines by active ingredient, information about availability and current prices in pharmacies of the city.
To buy a medicine at a pharmacy, you just need to show the QR code to the pharmacist. You can also add a profile of a relative or child in the My Prescription application through authorization on the Public Services. An electronic prescription is now more than just a prescription!
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Contacts
For feedback please contact by e-mail
RSBLPU “RDMB”: [email protected]
we ask you to inform the head physician of our institution, Laipanova Tamara Akhmatovna, about this
(with the exact indication of the full name of the doctor and types of studies) by e-mail. mail [email protected]
or by phone
RSBLPU “Republican Children’s Multidisciplinary Hospital” has 3 actual addresses:
Hospital – Cherkessk, st. Griboedova 77a
Polyclinic – Cherkessk, st. Krasnoarmeyskaya 68. – Umar-Aliyeva 12A.
Teenage department – Cherkessk, st. Gagarina 24
do’s and don’ts, types and degrees of burns
Content:
What is a burn
Burn degrees
First aid for burns
Types of burns and features of first aid
Steamboiling water
Oil painting
Sunbeams
chemicals
electricity
hogweed
iron, hot object
What not to do when getting burns
What burns and how can be treated at home
How to relieve pain from a burn
In what cases you need to seek medical help
Burn Treatment Methods
medical devices
Pharmacy means
folk recipes
How long will it take to live
What is a burn
A burn is an injury to the body resulting from exposure to heat, chemicals, electric current, or radiation. With such an injury, the skin and tissues under it are damaged and destroyed. Injuries occur at home and at work, so it does not hurt everyone to know about the rules for first aid for burns before the arrival of doctors. It is important to quickly navigate and know which remedies can be used for burns, and which are unacceptable. The right actions will slow down the destructive process, which will speed up the healing process.
Burn degrees
The choice of what to do for a burn will depend on the extent of the injury. There are four degrees of severity of burns:
- I degree – superficial damage to the epidermis and dermis;
- II degree – borderline burns, when the skin is deeply affected, but the sebaceous and sweat glands, hair follicles are not damaged;
- III degree – deep lesions with complete skin lesions (necrosis), often with spread to subcutaneous fatty tissue, muscle and bone tissue;
- IV degree – necrosis of the skin, muscles and tendons, down to the bones. Destroyed tissue melts and is gradually torn away over several weeks. The healing process is very long.
The following table shows the correlation of the classification of burn degrees according to ICD-10 with the classification of the XXVII Congress of Surgeons of the USSR in 1960.
Characteristic | Classification of the XXVII Congress of Surgeons of the USSR | ICD-10 classification | Burn depth |
Skin hyperemia | І degree | І degree | Superficial burn |
Blistering | II degree | ||
Partial skin necrosis | III-A degree | II degree | |
Complete skin necrosis | III-B degree | III degree | deep burn |
Necrosis of the skin and underlying tissues | IV degree |
The severity of a burn wound is characterized by its depth and area. The first depends on the duration and temperature of the aggressive impact, as well as the timeliness of providing assistance to the victim.
When a person with severe burns is admitted to the hospital, doctors evaluate the damaged area according to the “Rule of nines”, dividing the body into zones, each of which is equal to 9 in percentage terms, respectively:
- head and neck -9%;
- each hand – 9%;
- each leg – 18%;
- front + back torso – 36%;
- and the perineum accounts for the remaining 1%.
First aid for burns
First aid for burns to a person must be provided as soon as possible, already at the scene. First of all, it is important to stop the action of an aggressive agent, if possible, remove clothing and jewelry from the affected area. It is strictly not allowed to remove and pierce blisters, forcibly separate foreign bodies adhering to the skin (splashes of molten metal and plastic, fragments of clothing, etc. ).
During the first 10-15 minutes, cool the damaged skin with running cold water. This will prevent the burn from deepening. In addition, cooling reduces pain and swelling. The victim is given an anesthetic and an antihistamine. Before the arrival of emergency help, he needs to drink non-carbonated mineral water or ordinary, with 1 tsp previously dissolved in it. salt and 0.5 tsp. soda per 1 liter of water.
Types of burns and first aid
Depending on what caused the burn, the steps to provide first aid for burns will differ.
Boiling water steamer
With a small but deep injury, you need to place the burned area under running cold water for 10 minutes and call a doctor. Do not use ointments or other external agents.
Oiled
Usually these are small but deep burns (I-II degrees). Cool the damaged area under a tap with cold water, wait for the doctor to determine the depth and extent of the lesion. There is no need to treat burns of this type.
Sunlight
These are usually 1st degree burns, very rarely 2nd degree burns. Act similarly to the first two points: cool with water for 10 minutes, drink an antihistamine to avoid swelling and painkillers. Do not use ointments and traditional methods of treatment.
Chemicals
Remove the chemical agent from the skin, remove interfering clothing. Rinse under tap for 10 minutes. It is not recommended to wipe with wet wipes, it is forbidden to use ointments and homemade recipes without consulting a doctor. Currently, antidotes are not used to treat such burns.
Electricity
Traces remain at the points of entry and exit of electric current from the body. The burns are small but very deep. First, the current source is de-energized, then immediately turn to a specialist. Damage cannot be repaired.
Hogweed
A plant with caustic sap causes burns of the first or second degree, resembling damage from chemicals. The juice of the plant should be removed from the skin, rinsed under a tap, do not smear the injury site with anything and consult a doctor.
Iron, hot object
Usually these are thermal burns of the II-IV degree. Place the damaged area under running cold water for 10 minutes, apply a dry bandage. It is forbidden to apply ointments, apply ice, use folk remedies.
In each of the above cases, it is recommended as an effective first aid to apply a Branolind dressing to the burn site, and on top of it – a Medicomp non-woven napkin, followed by fixation with a Peha-haft bandage.
Definitely not to do if you get burned
Trying to provide first aid for a burn, out of ignorance, some aggravate the nature of the damage and harm the victim. Doctors strongly advise against doing the following:
- smear the damaged area with fat, as the resulting film will not allow the wound to cool;
- remove clothing stuck to the burn;
- treat the wound with baking soda or vinegar;
- lubricate the burned area with iodine, brilliant green, alcohol-containing compounds;
- apply ice as this will cause vasoconstriction and impair blood flow;
- apply ointments from burns before cooling tissues;
- puncture blisters that form;
- dress the wound with plaster;
- give the victim alcoholic drinks, strong coffee and tea.
What kind of burns and how can be treated at home
Burns of any degree are treated only by a doctor! At home, it is only allowed to provide first aid for first-degree skin burns. We are talking about situations where the area of the wound is not more than 5 percent, while the genitals and head are not affected.
If you list all the procedures briefly, first aid for burns at home consists of the following steps:
- Cooling the damaged area with water.
- Branolind dressing.
- Over the dressing, the imposition of a non-woven cloth Medicomp.
- Fixation of the lesion site with Peha-Haft bandage.
It should be remembered that only a doctor can determine the severity of the lesion and say exactly how to treat burns at home. If necessary, the victim is hospitalized.
How to relieve the pain of a burn
Since no one is safe from the danger of getting burned, it is necessary to clearly understand what to do with a burn and what first aid to provide. Actions to provide first aid will depend on the causes of the burn.
As a first aid for burns that cause severe pain, you can give him a painkiller tablet to alleviate the suffering of the patient. For minor injuries, accompanied only by reddening of the skin or the formation of small transparent bubbles no larger than 5 cm in diameter, it is recommended to cool the injured area by placing it under running cold water for 10 minutes to prevent damage to deeper tissues. After cooling the affected tissues, the necessary first aid should be provided by treating the burn site with a special agent. It is also advisable to consult a general practitioner to get professional advice on treatment methods that contribute to the rapid healing of the burn.
In more severe cases, medical help should be sought as soon as possible, since delay is fraught with serious complications for the body, up to a threat to the life of the victim.
When to seek medical help
Immediate treatment for first aid for burns is required in the following cases:
- a child or an elderly person has been injured;
- for burns of the face, respiratory tract, inguinal region;
- first-degree burns, if the affected area is large enough – more than 10% of the body;
- with the second degree of damage, if the injured area occupies about 1% of the body surface;
- third and fourth degree burns;
- for burns that have a chemical or electrical cause;
- if it is impossible to relieve pain;
- when the wound is contaminated with earth;
- in any case if the patient has lost consciousness;
- with fever and general malaise.
For the treatment of severe burns of severe degrees, the victim should be placed in the burn unit. It is necessary to stop the pain shock in a short time and prevent the occurrence of complications.
First of all, it must be remembered that even mild burns can be deadly if a large surface area of the body is affected.
Burn treatments
Medical devices
Medical care in the treatment of burns is aimed at restoring the affected tissues. In order to relieve pain and speed up the regeneration process, special tools are used. It should be remembered that when providing first aid for a burn, it is important for the victim to thoroughly disinfect their hands first. To do this, you can use the antiseptic for hands “Sterillum”.
After that, the burn site should be covered with a wound-healing antiseptic dressing “Branolind N” with Peruvian balsam. It has a large-celled structure, into which the discharge from the wound is well absorbed, and Peruvian balm will accelerate healing. The bandage can be on the wound for up to three days, which means that the dressings will not cause much concern to the victim. For reliable and careful fixation of the dressing on the wound, a sterile plaster with a soft absorbent vapor-permeable pad “Cosmopor E” is used. It is attached to the body thanks to hypoallergenic glue and reliably protects the injury site from pollution and mechanical stress.
To provide first aid for burns in case of minor injuries, the bandage can also be fixed with a transparent adhesive bandage “Hydrofilm plus”. Its absorbent pad does not stick to the wound. The transparent polyurethane film has water-repellent properties, which means that the bandage will not peel off even during a shower.
To fix the absorbent bandage in the area of the joint or on other rounded parts of the body, a self-locking bandage “Peha-Haft” is used. It does not hinder movement, it is firmly held on the body. Only 1.5-2 turns of the bandage are enough to fix the bandage. The dressing does not stick to the skin and hair, completely hypoallergenic (latex-free). When fixing with a bandage: Branolind N is applied to the wound from above with a sterile absorbent dressing (Medicomp) and then fixed with a Peha-Haft bandage.
Pharmacy products
If the means described above are not at hand, the question arises: how to treat a burn at home? To provide first aid for burns, you can use the tools that are almost always in the home first aid kit: sterile wipes (“Medicomp”), diluted to a concentration of less than 1% with hydrogen peroxide, furacilin, miramistin. A gauze pad can be soaked with hydrogen peroxide solution, which is applied to the wound for a short time. Furacilin has disinfecting properties and can be used to cleanse the wound before applying the anti-burn agent. Be sure to check with your doctor before using any remedy.
Folk recipes
There is an opinion that first-degree burns do not require any treatment, and to treat the affected area, you can use improvised means, for example, treat the skin with oil and sour cream.