FIGURE 104.2 Skin burns are classified as superficial, partial thickness, or full thickness A: Superficial burns affect only the outer layer of epidermis B: Partialthickness burns affect the lower layers of dermis C: Full-thickness burns destroy the entire layer of dermis (From Lippincott Williams & Wilkins Comprehensive Dental Assisting , 2012: Lippincott Williams & Wilkins/Jones & Bartlett Learning, Burlington, MA www.jblearning.com Reprinted with permission.) Management First Aid Early cooling is accomplished by running cold water over the injured area If performed in the first 60 minutes after injury, it stops ongoing thermal damage and minimizes edema, reducing progression to full-thickness injury Applying ice directly to the wound is often painful, and the extreme cold can worsen the injury Parents should be instructed not to put grease, butter, or any ointment on the burn because these substances not dissipate heat well and may contaminate the area Intact blisters should not be broken prior to medical evaluation Burns should be covered with a clean cloth or bandage Prehospital Prehospital care providers should focus initially on airway, breathing, and circulation, as they would for any other patient Rapid transport to a hospital setting is crucial Oxygen should be administered The patient should be intubated if there are signs of upper airway compromise or impending obstruction If transport time is likely to be prolonged, intravenous fluids should be started