burns and scalds- Burn- A burn is an injury caused by exposure to thermal (heat), chemical, electrical, or radiation energy. It usually affects the skin, but may also damage the airways, lungs, muscles, bones, or other internal organs. Scald- A scald is a burn caused by contact with a hot liquid or steam.
Category
Complications
Differential
Burns
Non Complex-Partial thickness burn covering ≤ 15% total body surface in adults. ≤ 10% in children, ≤ 5% in children younger than 1 year of age, that does not affect a critical area
Complex- All chemical and electrical burns. Any thermal burns affecting a critical areas (burns to face, hands, feet, perineum, or genitalia; burns crossing joints, and circumferential burns.). Any thermal burn >15% of total BSA in adults, >10% in children, >5% in children younger than one.
Early- respiratory distress, poisoning, fluid loss, hypothermia, wound infection and sepsis, toxic shock syndrome, Cardiac arrhythmias, vascular insufficiency, AKI, limb loss and death
Late- wound infection, neuropathic pain and itch, scarring, contractures, pyschosocial impact, insomnia
Assessment
Prognosis
Deep dermal burns may need surgical intervention to heal and may result in some contraction and scarring.
Full thickness burns that are complex usually need surgical intervention to heal and result in considerable contraction and scarring
Superficial dermal burns typically heal within 14 days with conservative management and do not result in scarring
Red Flags
Blistering skin diseases
Cellulitis
Photodermatitis
hypersensitivity reactions
skin necrosis
congenital curvilinear palpable hyperpigmentation
Consider the possibility of non-accidental injury if there is:- A delay in seeking medical attention, an unrelated adult presenting the child to the healthcare setting, any trigger events present, lack of concern from NOK, lack of supervision of a vulnerable person, any evidence of neglect
Consider the possibility of non-accidental injury if on examination: History is incompatible with examination findings, no splash marks in scald injuries, evidence of restraint in upper limbs, sparring of flexion creases, central sparring of buttocks or associated unrelated injuries.
Suspect non-accidental injury if a child or adult has a burn or scald with any of the following- Unsuitable or lack of explanation for the injury, the person is immobile, unexpected areas affected, injury shape of an implement, injury indicates forced immersion
Management
Assess timing and cause of burn (flame, scald, contact burn, chemical or electrical)
The risk of inhalation injury
Immediate first aid- assess rapidly to reduce complications
The possibility of non accidental injury
Scalds are frequently due to spilling of hot drinks and liquids, and immersion in a hot bath or shower. They usually cause superficial or superficial dermal injuries
Contact burns occur when the skin touches an extremely hot object, or a less hot object for a prolonged time. They usually cause deep dermal or full-thickness burns.
Electrical burns occur when electricity flows through the body from an entry to exit point. Heat energy from the electric current damages tissue along its path of flow. Low-voltage (domestic current) burns typically cause small, deep contact burns at the entry and exit points.
Chemical burns result from corrosive agents such as acids, alkalis (in household cleaning agents, bleaches, and cement), and organic products (such as bitumen). They tend to cause deep dermal or full-thickness burns.
Flash burns occur when a person is exposed to an arc of high voltage current, but it does not enter the body. They typically cause superficial burns to the face, neck, hands, and upper limbs.
Superficial epidermal burns typically heal within 7 days with conservative management and do not result in scarring
Symptoms, co-morbidities, predisposing factors, social support and need for specialist input
tetanus status
The burn: location, size and extent of burn. Estimate total surface body area of burns using Wallace rule of nines, or Lund and Browder chart
Assess depth of burn-by examining the skin for colour change, presence of blisters, capillary refill time, and pain
If uncertainty refer to specialist
Classification
Superficial epidermal-The epidermis is affected, but the dermis is intact. Skin is red and painful, but not blistered. Capillary refill* blanches then rapidly refills.
Superficial dermal -The epidermis and upper layers of dermis are involved. Skin is red or pale pink and painful with blistering. Capillary refill* blanches but regains its colour slowly.
Deep dermal- The epidermis, upper and deeper layers of dermis are involved, but not underlying subcutaneous tissues.The skin appears dry, blotchy or mottled, and red, and typically painful (due to exposed superficial nerves). There may be blisters. Capillary refill* does not blanch.
Full-thickness- The burn extends through all the layers of skin to subcutaneous tissues. If severe, extends into muscle and bone.The skin is white, brown, or black (charred) in colour, with no blisters. It may appear dry, leathery, or waxy and is painless. Capillary refill* does not blanch.
Epidermal burns- provide leaflet, advice-bathing,emollients, cold compress, analgesia, Hydration, Advice if blisters develop
Superficial dermal burns-assess if can be managed in primary care- as above. wound care for blisters, and consider tetanus prophylaxis. Information on signs of complications
Referral
To specialist-any burn that has not healed within 2 weeks
Immediate admission-complex burns, full thickness burns, deep dermal burns, all chemical and electrical burns. see cks notes
Reference
First Aid- cool the burn immediately for 20mins with cool running water within 3 hours of incident. If water limited apply lint free cool damp cloth. Change compress every 20mins. If no water available apply cling film loose longitudinal strips of cling film or any clean lint free cloth or non-adherent dressing and seek assistance. Keep patient warm