Each year approximately 50,000 burns related hospital admissions occur in Australia – over 1,000 of these are children in Victoria, with children aged 0-4 years at greatest risk.
When you think of burn and scald injuries, most likely the first thing that comes to mind is sunburn, however, this is just one of the many types of injuries that occur.
Interestingly, scalds – caused by something wet, such as hot water or steam – are more common than dry heat injuries such as sunburn. In a recent study, it was found scalds were the most common cause of burn injury in older adults, with older adult patients most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Over the nine-year study period, 17,821 burn injury admissions were recorded, of these 13.4% were older adults. The study discovered, with increasing age, the percentage of women affected and the incidence of scalds both increased, and the amount of flame burns decreased. So, with that being said, let’s explore why this may be the case. One thing we do know is that the home is the most common location burns occur. This is because a lot of household items are high-risk for burns and scalds, including kettles, hot water bottles, pots, hot drinks, heaters, fireplaces, and irons. The majority of these items are used every day which means the risk of acquiring an injury is significantly higher. Take hot water bottles for example, frequently used to ease pain or in winter for warming a bed or parts of the body. This product is made from either rubber or polyvinyl chloride and if used incorrectly can leave nasty scalds. Recently, there has been a significant increase in cases whereby people have suffered scalds from hot water bottles, mainly due to using boiling water instead of hot water from the tap (which is instructed to use) and then placing directly on the skin. These burns are serious and happen gradually, often the user cannot feel these burns until it is too late and it can often lead to third degree burns which may require skin grafts. To ensure these injuries do not occur, it is important to always follow user instructions.
Burns can be caused in four ways: Friction (flame), ultraviolet (UV radiation), hot liquids, electricity and certain chemicals. There are three different types of burns that can occur: Superficial burns (first-degree burns)These burns cause damage to the first or top layer of skin only. The burn area will be red and painful. E.g. sunburn Partial thickness burns (second-degree burns)These burns cause damage to the first and second skin layers. The burn area will be red, peeling, blistered and swelling with clear or yellow-coloured fluid leaking from the skin. Full thickness burns (third-degree burns)This involves damage to both the first and second skin layers, plus the underlying tissue. The burn site generally appears black or charred with white exposed fatty tissue. The nerves are destroyed and the pain will not be as strong with a full thickness burn.
When it comes to burn injuries, major burns are considered a medical emergency and require urgent treatment. For minor burns, the following first aid treatment should be applied immediately. First Aid for BurnsThe management of burns can depend on the type and extent of the injury. While most minor burns can be treated at home using cool running water for 20 minutes, more serious burns may require medical treatment and medication. The main aim when managing a burn is to control pain, remove dead tissue, prevent infection and reduce scarring. If a burn or scald does occur and requires treatment, first aid for burns is the same for all types:
Do not use ice to cool the burn as this may make the burn worse. Never apply any lotions, creams or food items (including egg whites, butter, toothpaste, potato). Cool running water is best.
Fortunately, the majority of burns are preventable and by just taking a few minutes to make your home and environment as safe as possible, you could prevent a life-changing injury. Learn more about the different types of burns and how to effectively treat them in this interactive online course.
Reviewed by: Kate M. Cronan, MD
Scald burns from hot water and other liquids are the most common burns in early childhood. Because burns range from mild to life threatening, some can be treated at home, while others need emergency medical care. What to DoIf your child is severely burned, call 911 right away. While you wait for help, begin these treatments:
Get Emergency Medical Care if:
Think Prevention!
Reviewed by: Kate M. Cronan, MD Date reviewed: February 2019 /content/kidshealth/misc/medicalcodes/parents/articles/burns-sheet Some 250 000 burns occur annually in the United Kingdom. About 90% of these are minor and can be safely managed in primary care. Most of these will heal regardless of treatment, but the initial care can have a considerable influence on the cosmetic outcome. All burns should be assessed by taking an adequate history and examination. The aims of first aid should be to stop the burning process, cool the burn, provide pain relief, and cover the burn. Stop the burning process—The heat source should be removed. Flames should be doused with water or smothered with a blanket or by rolling the victim on the ground. Rescuers should take care to avoid burn injury to themselves. Clothing can retain heat, even in a scald burn, and should be removed as soon as possible. Adherent material, such as nylon clothing, should be 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 be disconnected from the source of electricity before first aid is attempted. Cooling the burn—Active cooling removes heat and prevents progression of the burn. This is effective if performed within 20 minutes of the injury. Immersion or irrigation with running tepid water (15°C) should be continued for up to 20 minutes. This also removes noxious agents and reduces pain, and may reduce oedema by stabilising mast cells and histamine release. Iced water should not be used as intense vasoconstriction can cause burn progression. Cooling large areas of skin can lead to hypothermia, especially in children. Chemical burns should be irrigated with copious amounts of water. Analgesia—Exposed nerve endings will cause pain. Cooling and simply covering the exposed burn will reduce the pain. Opioids may be required initially to control pain, but once first aid measures have been effective non-steroidal anti-inflammatory drugs such as ibuprofen or co-dydramol taken orally will suffice. Covering the burn—Dressings should cover the burn area and keep the patient warm. Polyvinyl chloride film (cling film) is an ideal first aid cover. The commercially available roll is essentially sterile as long as the first few centimetres are discarded. This dressing is pliable, non-adherent, impermeable, acts as a barrier, and is transparent for inspection. It is important to lay this on the wound rather than wrapping the burn. This is especially important on limbs, as later swelling may lead to constriction. A blanket laid over the top will keep the patient warm. If cling film is not available then any clean cotton sheet (preferably sterile) can be used. Hand burns can be covered with a clear plastic bag so as not to restrict mobility. Avoid using wet dressings, as heat loss during transfer to hospital can be considerable. Use of topical creams should be avoided at this stage as 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 pain in the initial stages. Benefits of cooling burn injuries with water
Cling film for dressing burn wounds
The cause of injury and depth and extent of burn should be assessed in the same way as for more major burns and recorded. Similarly, associated illness or injuries must be 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 critical 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. Always consult a burns unit if in doubt about management Minor burns suitable for outpatient management
Dressing changes for burns
Once the decision has been taken to treat a burn patient as an outpatient, analgesia should be given and the wound thoroughly cleaned and a dressing applied (except on the face). Ensure that a follow up appointment is made. There are a vast range of acceptable options in the outpatient management of minor burns. The following should be used as a guide It is important to realise that a new burn is essentially sterile, and every attempt should be made to keep it so. The burn 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 management of blisters, but large ones should probably be de-roofed, and dead skin removed with sterile scissors or a hypodermic needle. Smaller blisters should be left intact. Many different dressings are in use, with little or no data to support any individual approach. We favour covering the clean burn with a simple gauze dressing impregnated with paraffin (Jelonet). Avoid using topical creams as these will interfere with subsequent assessment of the burn. Apply a gauze pad over the dressing, followed by several layers of absorbent cotton wool. A firm crepe bandage applied in a figure of eight manner and secured with plenty of adhesive tape (Elastoplast) will prevent slippage of the dressing and shearing of the wound. An elastic net dressing (Netelast) is useful for securing awkward areas such as the head and neck and chest. Limb burns should be elevated for the duration of treatment. The practice of subsequent dressing changes is varied. Ideally the dressing should be checked at 24 hours. The burn wound itself should be reassessed at 48 hours and the dressings changed, as they are likely to be soaked through. At this stage the depth of burn should be apparent, and topical agents such as Flamazine can be used. Depending on how healing is progressing, dressing changes thereafter should be every three to five days. If the Jelonet dressing has become adherent, it 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 be changed immediately if the wound becomes painful or smelly or the dressing becomes soaked (“strike through”). Any burn that has not healed within two weeks should be seen by a burn surgeon. Many specialist dressings are available, some developed 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 bacteria including Pseudomonas. Infection with the latter will cause the dressing to turn green with a distinctive smell. Apply the cream in a 3-5 mm thick layer and cover with gauze. It should be removed and reapplied every two days. There is a reported 3-5% incidence of reversible leucopenia. Granulflex is a hydrocolloid dressing with a thin polyurethane foam sheet 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 applied with a 2 cm border. By maintaining a moist atmosphere over the wound, it creates an environment suitable for healing. It usually needs to be changed 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 net coated with soft silicone to give a Jelonet-type of dressing that is non adhesive. It is a useful but expensive alternative to Jelonet when easy removal is desirable, such as with children. 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 face. The wound should be cleansed twice daily with mild diluted chlorohexidine solution. The burn should be covered with a bland ointment such as liquid paraffin. This should be applied every 1-4 hours as necessary to minimise crust formation. Men should shave daily to reduce risk of infection. All patients should be advised to sleep propped up on two pillows for the first 48 hours to minimise facial oedema. Burns that fail to heal within three weeks should be referred to a plastic surgery unit for review. Healed burns will be sensitive and have dry scaly skin, which may develop pigmental changes. Daily application of moisturiser cream should be encouraged. Healed areas should be protected from the sun with sun block for 6-12 months. Pruritis is a common problem. Physiotherapy—Patients with minor burns of limbs may need physiotherapy. It is important 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 about disfigurement and ugliness, at least in the short term, and parents of burnt children often have feelings of guilt. It is important to address these issues with reassurance.
Management of facial burns
This is the third in a series of 12 articles 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 be published as a book in the autumn. Competing interests: See first article for series editors' details.
Articles from The BMJ are provided here courtesy of BMJ Publishing Group |
What is the first and most important step to treat a burn after you check to make sure the scene is safe?
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