Emergency Medicine

BURNS

254 Surgical Emergencies

(i) Remember the risk of sudden respiratory obstruction during

transit.

(ii) Make sure a senior doctor has assessed the need for endotracheal

intubation in any significant respiratory burn, prior to departure.

MINOR BURNS AND SCALDS

These include full-thickness burns <1% or partial-thickness burns <15% BSA in

a du lt s a nd <10 % i n c h i ld ren. T he a i m i s to m a n a ge t hem a s out p at ient s , a s d i s t i nc t

from patients with major burns, who require admission (see above).

INITIAL MANAGEMENT

1 Irrigate the wound immediately with copious running cold water until the

pain is relieved.

2 Assess the extent and depth of the burn (see p. 251). In general, superficial

partial-thickness burns heal spontaneously, deep dermal partial-thickness

burns heal slowly with scar formation; and full-thickness burns do not heal

at all, unless <1–2 cm in diameter, when epithelium will cover the area from

the edges. Otherwise grafting is required.

3 Clean wit h sterile sa line or an antiseptic such as chlorhexidine.

4 Give adequate analgesia such as paracetamol 500 mg with codeine 8 mg two

tablets orally q.d.s. and/or ibuprofen 200–400 mg orally t.d.s. Give children

15 mg/kg of paracetamol elixir.

5 De-roof large blisters that have broken, or aspirate the f luid if the blister is

tense. Otherwise leave blisters intact to protect the healing epithelium.

6 Apply silver sulfadiazine cream and cover the burn with a non-adherent

paraffin-impregnated gauze dressing.

7 Then apply gauze and an absorbent layer consisting of a cotton-wool and

gauze combine pad, overlapping the paraffin-impregnated gauze dressing by

3 cm at either end.

8 Finally, keep the absorbent layer in place with a firm crêpe bandage, again

overlapping each end by 3 cm, and seal with adhesive tape.

9 Always elevate the limb using a high-arm sling for arm and hand burns.

Tip: burn injuries are always frightening and unexpected, and relatives

(particularly the parents of children) may feel guilty and angry. Special

counselling and reassurance are helpful from the start to aid coming

to terms with the injuries and to allay anxiety, so they are useful as a

support to the victim.

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