Burns: Immediate management and treatment

Thermal burns (or burns from a high-temperature source – as opposed to electrical or chemical burns) are fairly common, and we all have a story of touching something a lot hotter than we expected.

But when a burn is significantly painful, or the contact time was longer, immediate management and assessment are important to prevent further injury and help the healing process begin immediately.

If you suffer a burn – the first thing to do after getting away from the source of heat is to place the burn under cool running water. A cold tap turned on will run at around 15 degrees, and this is perfect. Have the wound under this for at least 20 minutes.

It is important to NEVER APPLY ICE TO A BURN.

Although it may seem like it makes things better, ice can constrict blood flow to a burn after the thermal injury has already disturbed the blood supply. In some cases, this can cause even more damage to the skin.

Analgesia

Simple analgesia like paracetamol and anti-inflammatories can be very helpful.

Sometimes you may need a stronger analgesic in the short term.

Cold water initially works as an excellent analgesic. As does covering the wound with an appropriate dressing.

Dressing a burn

Gone are the days of letting a wound dry up. We’ve found that this can increase the chance of infection, delay wound healing (not only the time to heal, but the type of healing), and causes significantly more pain.

Once a wound is deemed to be partial thickness or superficial thickness, it can be dressed with a non-stick, absorptive dressing that will soak up all the ooze.

This wound needs to be reviewed in 24-48 hours for two reasons. Firstly, to change the soaked dressing, and secondly to assess the full damage of the burn.

If the burn is still deemed partial thickness, then a less absorptive dressing can be applied.

While silver dressings are popular for burns – they don’t need to be used unless there are signs of infection. Silver-impregnated dressings or silver sulfasalazine cream can significantly delay an otherwise healing burn.

Blisters

No one seems to agree on what to do here. Large blisters at the time of the burn can be removed by a doctor to fully assess the burn underneath, while smaller blisters <6mm tend to remain without growing or spontaneously rupturing.

If there looks like infected material in a blister, it should be removed, and the roof (dead epithelium) removed with it.

Healing time

Superficial burns take about 7 days to heal, and often leave no trace.

Superficial dermal burns take about 7-14 days, and have a small risk of a hypertrophic scar, and sometimes a colour mismatch with the surrounding skin.

Deep dermal burns often take over 21 days to heal and have a high risk (up to 80% risk) of hypertrophic scarring.

Full thickness burns – which go through all layers of the skin, and are often painless, do not heal spontaneously and need medical review.

When to go to hospital/burns unit

Any burn that appears particularly severe or large should be reviewed in a hospital setting. However, if any of the following apply – call an ambulance

• Burns with associated inhalation injury
• Burns >10% of total body surface area
• Burns to special areas – face, hands, major joints, feet and genitals
• Full thickness burns >5% total body surface area
• Electrical burns
• Chemical burns
• Circumferential burns of limbs or chest
• Burns with associated trauma
• Burns in patients with pre-existing illnesses or disabilities could adversely affect patient care and outcomes
• Suspected nonaccidental injury in children or vulnerable people
• Burns in the elderly and children <12 months of age
• Small area burns in patients with social problems, including children at risk
• Burns occurring in pregnant women