what to do in case of a burn
BMJ. 2004 Jun 19; 328(7454): 1487–1489.
ABC of burns
Start aid and treatment of minor burns
Sukh Rayatt, specialist registrar, plastic and reconstructive surgery
West Midlands Grooming Scheme, Birmingham.
Some 250 000 burns occur annually in the Great britain. About ninety% of these are minor and can exist safely managed in main intendance. Most of these will heal regardless of treatment, just the initial care can have a considerable influence on the cosmetic consequence. All burns should be assessed by taking an adequate history and examination.
First aid
The aims of first aid should be to terminate the called-for process, absurd the burn, provide hurting relief, and cover the fire.
Effigy one
A superficial scald suitable for management in primary care
Terminate the called-for procedure—The heat source should be removed. Flames should be doused with h2o or smothered with a coating or by rolling the victim on the ground. Rescuers should take care to avert burn injury to themselves. Clothing tin retain estrus, even in a scald burn down, and should exist removed as soon equally possible. Adherent material, such as nylon habiliment, should exist left on. Tar burns should be cooled with water, but the tar itself should not be removed. In the case of electrical burns the victim should exist disconnected from the source of electricity before start assist is attempted.
Cooling the burn—Active cooling removes oestrus and prevents progression of the burn. This is effective if performed within 20 minutes of the injury. Immersion or irrigation with running tepid water (xv°C) should be continued for upwards to 20 minutes. This also removes noxious agents and reduces hurting, and may reduce oedema past stabilising mast cells and histamine release. Iced water should not be used every bit intense vasoconstriction can cause burn down progression. Cooling big areas of skin tin lead to hypothermia, particularly in children. Chemical burns should be irrigated with copious amounts of h2o.
Effigy 2
Burnshield is a cooling gel used to cover burn and reduce hurting
Analgesia—Exposed nerve endings will cause hurting. Cooling and only covering the exposed burn will reduce the pain. Opioids may be required initially to control pain, merely once first help measures have been constructive non-steroidal anti-inflammatory drugs such as ibuprofen or co-dydramol taken orally will suffice.
Covering the burn—Dressings should cover the fire expanse and keep the patient warm. Polyvinyl chloride film (cling film) is an ideal first aid embrace. The commercially bachelor roll is essentially sterile as long as the kickoff few centimetres are discarded. This dressing is pliable, non-adherent, impermeable, acts as a bulwark, and is transparent for inspection. It is important to lay this on the wound rather than wrapping the fire. This is peculiarly important on limbs, as after swelling may lead to constriction. A blanket laid over the elevation will keep the patient warm. If cling film is not available then whatsoever make clean cotton wool sheet (preferably sterile) can be used. Manus burns tin be covered with a clear plastic bag so every bit not to restrict mobility. Avoid using wet dressings, as oestrus loss during transfer to hospital can be considerable.
Utilise of topical creams should be avoided at this phase equally these may interfere with subsequent assessment of the burn. Cooling gels such as Burnshield are often used by paramedics. These are useful in cooling the burn and relieving hurting in the initial stages.
Table 1
Benefits of cooling burn down injuries with water
| • Stops burning procedure | • Reduces pain |
| • Minimises oedema | • Cleanses wound |
Tabular array 2
Cling film for dressing burn wounds
| • Essentially sterile |
| • Lay on wound—Do non wrap around |
| • Non-adherent |
| • Pliable |
| • Transparent for inspection |
Management of minor burns
The cause of injury and depth and extent of burn should be assessed in the same fashion as for more than major burns and recorded. Similarly, associated disease or injuries must exist considered (such as small burns as a result of fits, faints, or falls). Burns suitable for outpatient management are usually small and superficial and not affecting disquisitional areas. Home circumstances should be considered, as even small injuries to the feet will progress if the legs are not elevated for at least 48 hours; this is rarely possible at home. E'er consult a burns unit if in incertitude most direction
Large blister on thenar eminence restricting movement of paw (pinnacle). Cicatrice is de-roofed using aseptic technique (lesser)
Table 3
Minor burns suitable for outpatient direction
| • Fractional thickness burns covering < 10% of total body surface area in adults |
| • Fractional thickness burns covering < 5% of torso surface surface area in children |
| • Total thickness burns covering < 1% of torso surface |
| • No comorbidity |
Tabular array four
Dressing changes for burns
| • Apply aseptic technique |
| • First change after 48 hours, and every 3-5 days thereafter |
| • Criteria for early dressing modify: |
| Excessive "strike through" of fluid from wound |
| Evil-smelling wound |
| Contaminated or soiled dressings |
| Slipped dressings |
| Signs of infection (such every bit fever) |
Once the decision has been taken to care for a burn patient as an outpatient, analgesia should be given and the wound thoroughly cleaned and a dressing practical (except on the confront). Ensure that a follow up date is made.
There are a vast range of adequate options in the outpatient direction of minor burns. The following should exist used as a guide
Cleaning the burn
It is important to realise that a new fire is substantially sterile, and every attempt should be made to go along it so. The fire wound should be thoroughly cleaned with soap and water or mild antibacterial wash such as dilute chlorohexidine. Routine use of antibiotics should be discouraged. There is some controversy over direction of blisters, only large ones should probably be de-roofed, and expressionless skin removed with sterile scissors or a hypodermic needle. Smaller blisters should be left intact.
Dressings
Many different dressings are in employ, with footling or no data to support any individual approach. Nosotros favour covering the clean burn with a elementary gauze dressing impregnated with paraffin (Jelonet). Avoid using topical creams as these will interfere with subsequent cess of the burn. Apply a gauze pad over the dressing, followed by several layers of absorbent cotton fiber. A firm crepe bandage applied in a figure of eight manner and secured with plenty of adhesive tape (Elastoplast) volition prevent slippage of the dressing and shearing of the wound.
Superficial scald burn on side of neck (top left) is cleaned and then a layer of Jelonet practical over it (top right). Gauze square dressings on top of the Jelonet (bottom left) are held in place with a Netelast type of dressing (bottom correct)
An elastic net dressing (Netelast) is useful for securing awkward areas such equally the head and cervix and chest. Limb burns should be elevated for the duration of treatment.
Dressing changes
The practice of subsequent dressing changes is varied. Ideally the dressing should be checked at 24 hours. The burn wound itself should exist reassessed at 48 hours and the dressings changed, as they are probable to be soaked through. At this phase the depth of burn should be apparent, and topical agents such as Flamazine can exist used.
Depending on how healing is progressing, dressing changes thereafter should be every three to v days. If the Jelonet dressing has become adherent, information technology should be left in place to avoid damage to delicate healing epithelium. If Flamazine is used it should be changed on alternate days. The dressing should exist inverse immediately if the wound becomes painful or evil-smelling or the dressing becomes soaked ("strike through").
Any fire that has not healed within two weeks should be seen past a burn surgeon.
Specialist dressings
Many specialist dressings are available, some adult for specific cases, but most designed for their ease of use. The following are among the more widely used.
Flamazine is silver sulfadiazine cream and is applied topically on the burn wound. It is effective against gram negative leaner including Pseudomonas. Infection with the latter will cause the dressing to turn green with a distinctive odor. Apply the cream in a three-5 mm thick layer and cover with gauze. It should be removed and reapplied every 2 days. There is a reported 3-v% incidence of reversible leucopenia.
Granulflex is a hydrocolloid dressing with a thin polyurethane foam sail bonded onto a semipermeable film. The dressing is adhesive and waterproof and is therefore useful in awkward areas or where normal dressings are not suitable. It should be practical with a 2 cm border. By maintaining a moist atmosphere over the wound, it creates an environment suitable for healing. It normally needs to exist inverse every three or four days, but it can be left for seven days. A thinner version (Duoderm) is also available.
Mepitel is a flexible polyamide cyberspace coated with soft silicone to give a Jelonet-blazon of dressing that is not adhesive. It is a useful but expensive alternative to Jelonet when like shooting fish in a barrel removal is desirable, such as with children.
Facial burns
Facial burns should be referred to a specialist unit. However, simple sunburn should be left exposed as dressings can be awkward to retain on the confront. The wound should be cleansed twice daily with balmy diluted chlorohexidine solution. The burn should be covered with a bland ointment such equally liquid paraffin. This should be practical every 1-iv hours equally necessary to minimise chaff germination. Men should shave daily to reduce hazard of infection. All patients should be advised to slumber propped up on two pillows for the first 48 hours to minimise facial oedema.
Follow up
Burns that neglect to heal within three weeks should be referred to a plastic surgery unit for review. Healed burns will be sensitive and accept dry scaly skin, which may develop pigmental changes. Daily application of moisturiser cream should be encouraged. Healed areas should exist protected from the lord's day with sun cake for vi-12 months. Pruritis is a common trouble.
Physiotherapy—Patients with minor burns of limbs may need physiotherapy. It is of import to identify these patients early and start therapy. Hypertrophic scars may benefit from scar therapy such as pressure garments or silicone. For these reasons, all healed burns should be reviewed at two months for referral to an occupational therapist if necessary.
Support and reassurance—Patients with burn injuries often worry nearly disfigurement and ugliness, at to the lowest degree in the curt term, and parents of burnt children often have feelings of guilt. It is important to address these bug with reassurance.
Table 5
Flamazine
| • Silver sulfadiazine foam |
| • Covers gram negative bacteria including Pseudomonas |
| • Needs to exist changed every 24-48 hours |
| • Makes burn down seem white and should be avoided if burn down needs reassessment |
Table half-dozen
Direction of facial burns
| • Clean face twice a day with dilute chlorohexidine solution |
| • Cover with cream such as liquid paraffin on hourly basis |
| • Men should shave daily |
| • Sleep propped upwardly on ii pillows to minimise oedema |
Table 7
Pruritis
| • Common in healing and healed burn down wounds |
| • Aggravated by heat, stress, and physical activity |
| • Worst afterwards healing |
| • Massage with aqueous cream or aloe vera foam |
| • Use antihistamines (such as chlorphenamine) and analgesics |
Tabular array 8
Key points
| • Initial first aid can influence terminal cosmetic outcome |
| • Cooling with tepid tap water is ane of the most of import showtime aid measures |
| • Routine use of antibiotics should be discouraged |
| • Elementary dressings suffice |
| • Aseptic technique should be used for dressing changes |
| • If in incertitude, seek advice from regional burns unit or plastic surgery department |
Notes
The ABC of burns is edited by Shehan Hettiaratchy, specialist registrar in plastic and reconstructive surgery, Pan-Thames Training Scheme, London; Remo Papini, consultant and clinical lead in burns, West Midlands Regional Burn Unit, Selly Oak University Hospital, Birmingham; and Peter Dziewulski, consultant burns and plastic surgeon, St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford. The series will exist published as a book in the autumn.
Competing interests: See first commodity for series editors' details.
Further reading and resource
- • Wilson Thou, French G. Plasticized polyvinylchloride as a temporary dressing for burns. BMJ 1987;294: 556-7 [PMC free commodity] [PubMed] [Google Scholar]
- • Davies JWL. Prompt cooling of the burned area: a review of benefits and the effector mechanisms. Burns 1982;9: 1-six [PubMed] [Google Scholar]
- • Slater RM, Hughes NC. A simplified method of treating burns of the hands. Br J Plast Surg 1971;24: 296-300 [PubMed] [Google Scholar]
- • Herndon D. Total burn down intendance. 2nd ed. London: Harcourt, 2002
- • Settle J, ed. Principles and practice of burns management. Edinburgh: Churchill Livingstone, 1996
- • National Burn down Care Review. National burn injury referral guidelines. In: Standards and strategy for burn intendance. London: NBCR, 2001: 68-9
Articles from The BMJ are provided here courtesy of BMJ Publishing Group
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC428524/
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