Burns and Scalds

Data gathering

  • History
    • Type of burn – flame, scald, electrical, chemical
    • Inhalation injury – singed nasal hair, black carbon in sputum
    • PMH
    • Evidence of NAI – see below
    • Social circumstances
  • Examination
    • Assess extent of burn – Lund and Browder chart
    • Assess depth of burn
Depth Former terminology Appearance
Superficial epidermal First degree Red and painful

Normal cap refill

e.g. flash burns, sunburn
Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered

Slower cap refill

e.g. scalds
Partial thickness (deep dermal) Second degree Blotchy, cherry red, may be painless

Non-blanching cap refill

e.g. flames
Full thickness Third degree White/brown/black in colour, no blisters, no pain

Non-blanching cap refill

e.g. contact, chemical, electrical

NB:

  • assess capillary refill by pressing a sterile cotton bud
  • baseline skin colour can cause confusion e.g. white skin may mask full thickness burns, dark skin may mask superficial/partial thickness burns

Clinical management

  • Treatment
    • Heat
      • within 20 minutes of injury, irrigate burn with cool water for 10-30 minutes
      • cover the burn using cling film (layer rather than wrap)
      • Analgesia
    • Electrical
      • Refer to A+E
    • Chemical
      • Irrigate with water for an hour
      • Refer to A+E
    • Consider early advice from local burns unit if uncertainty
  • Follow-up / Safety net
    • Immediately refer
      • All deep dermal and full-thickness burns
      • All circumferential burns (burns that go all the way around the surface of a limb or body)
      • Superficial dermal burns of more than 3% total burn surface area in adults or more than 2% in children (<16yo)
      • Superficial dermal burns involving the face, hands, feet, perineum, genitalia, any flexure (esp neck or axilla)
      • Inhalation injury
      • Electrical, friction, cold or chemical burn injury
      • Burns associated with other injuries – crush injuries, fractures, head injury, penetrating injury
      • Any burn with suspicion of NAI or self harm (for expert assessment within 24 hours)
      • Any significant infection
    • Consider referral
      • Superficial dermal burns other than those mentioned above
      • Age <5 or >60
      • Co-existing medical problems – cardiorespiratory, hepatic, diabtes, immunocompromised, pregnant
      • Require admission for social reasons, pain control or if dressings are difficult to manage

Non accidental injury

    • Suspect if
      • History – evasive, changing, inadequate, poor previous compliance with healthcare
      • Child not independently mobile
      • Unusual area of burn
      • Unusual shape of burn
      • Evidence of forced immersion
      • Delayed presentation or inconsistency between age of burn on examination and history
      • No splash marks
      • Signs of restraint on limbs
      • Sparing of flexion creases (i.e. child in the foetal position when burnt)
      • Other signs of physical abuse