<b>Mild/moderate burns – First aid</b><br>ffStop the burning process and move the patient to safety ffRoll on the ground if clothing is on fire ffSwitch off electricity ffCool the burn by pouring or showering or soaking the affected area with cold water for 30 minutes, especially in the first hour after the burn (this may reduce the depth of injury if started immediately), ffRemove soaked clothes, wash off chemicals, remove any constrictive clothing/rings ffClean the wound with clean water ffCover the wound with a clean dry cloth and keep the patient warm}<b>At health facility</b><br>ffGive oral or IV analgesics as required ffIf TBSA <10% and patient able to drink, give oral fluids otherwise consider IV ffGive TT if not fully immunised ffLeave small blisters alone, drain large blisters and dress if closed dressing method is being used ffDress with silver sulphadiazine cream 1%, add saline moistened gauze or paraffin gauze and dry gauze on top to prevent seepage ffSmall superficial 2nd degree burns can be dressed directly with paraffin gauze dressing ffChange after 1-3 days then prn ffPatient may be exposed in a bed cradle if there are extensive burns ffSaline bath should be done before wound dressing ffIf wound infected dress more frequenly with silver sulphadiazine cream until infection is controlled}<b>Severe burns</b><br>ffFirst aid and wound management as above PLUS ffGive IV fluid replacement in a total volume per 24 hours according to the calculation in the box below (use crystalloids, i.e., Ringer’s lactate, or normal saline) ffIf patient in shock, run the IV fluids fast until BP improves (see section 1.1.2) ffManage pain as necessary ffRefer for admission ffMonitor vital signs and urine output ffUse antibiotics if there are systemic signs of infection: benzylpenicillin 3 MU every 6 hours +/- gentamicin 5-7 mg/kg IV or IM once a day ffBlood transfusion may be necessary ffIf signs/symptoms of inhalation injury, give oxygen and refer for advanced life support (refer to regional level)}<b>Surgery</b><br>ffEscharotomy and fasciotomy for circumferential finger, hand, limb or torso burns ffEscharectomy to excise dead skin ffSkin grafting to cover clean deep burn wounds}<b>Eye injury</b><br>ffIrrigate with abundant sterile saline ffPlace eye pad over eye ointment and refer}<b>Additional care</b><br>ffNutritional support ffPhysiotherapy of affected limb ffCounselling and psychosocial support ffHealth education on prevention (e.g. epilepsy control)