Burns and Scalds

A burn is caused most commonly by fire  (dry heat). It can also be caused by friction, chemicals, electricity or radiation. A scald is a burn by "wet heat" such as hot liquids, e.g. water, fat or steam.

Friction -  occurs when skin is scraped off by contact with a surface such as roads, carpets, or other hard floor surfaces.

Chemical - Most chemicals that cause burns are either strong acids or bases. Chemical burns can be deceiving, however. Some agents can cause deep tissue damage not readily apparent when you first look at it.

Electrical - often cause serious injury inside the body. Look for an entry and exit point as this is often a characteristic of this type of injury.

Depth of burns.

Complications
Inhalation burns -- there may be burned lips, mouth, and throat.
  1. Face may be reddened or burned.
  2. Patient may have difficulty breathing or coughing. (consider the use of Salbutamol)
  3. Soot around mouth and nose
  4. Nose hairs, eyelashes, eyebrows may have singeing 
  5. Airway oedema

Electrical burns with high voltage (>1000 V) or high amperage commonly damage multiple organ systems, and may be associated with cardiac arrest.

In the case of severe burns the patient may be in shock (falling blood pressure, severe fluid and blood loss) and possibly will be hysterical. 

Burns are at increased risk of being infected.

Assessing the area of burns - Rule of Nines

The rule of nines is a method used to rapidly estimate the percent of total body surface area affected by a burn.

The rule of nines derives its name from the fact that an adult body may be conveniently divided into anatomic regions that have surface area percentages that are all multiples of nine percent. In small children the rule of nines is slightly modified, this can be seen in the diagram below

Infant rule of nines

Adult rule of nines

In burn victims, the percent of total body surface area (tbsa) affected is a strong predictor of the patient's overall prognosis. The area burnt is worked out by the patients palm size (Not yours) as this is said to be 1%.

Management

GO DR SHAVPU ‹C› ACBC 

Safety:  

Cool the burn with water. (Ensure that the cooling process does not become excessive as this can cause shivering and possibly hypothermia), Administer entonox for pain relief, Remove items of clothing or jewellery that are hot and wet and not stuck to the skin, Cover the burn with a sterile dressing (cling film is good as it provides an air free environment which stops the nerves becoming stimulated, thus reducing pain), Do not apply creams or lotions, Do not burst blisters, treat for shock if necessary, cover unburned areas with a blanket to prevent the patient becoming too cold. 

When dealing with chemical burns - Remove the patient from the affected area (If safe to do so, otherwise wait for the fire service), Remove any contaminated clothing while preserving the patients dignity, Brush off any powdered chemical, Wash the contaminated body part with water for 20 minutes (be aware not to get chemical onto an unaffected part of the body). Phosphorus burns should be kept continually wet.

Secondary survey

ASHICE (consider)

Transport to hospital Consider transporting to a burns unit if a local one is available

Professional handover 

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