Let’s discuss burns

Burns are really common. Children under 5 are at real risk of burns because inadvertently they like grabbing and pulling on things. The most common cause is scalds. Pulling down their parents hot cup of newly made tea or coffee on to themselves is a common complaint. So we need to think about what areas of the body are affected by those burns and how we best treat them.

Other common injuries are from hair straighteners. These can be as hot as an iron and little children often reach down to pick them up and burn their fingers. So we need to thinking about initial management of those types of injuries as well.

Firstly we are going to run through the importance of good burn first aid both from a primary and secondary care perspective.

Below are the principles of first aid for all burns, as recommended by the British Burns Association.

Principles of First Aid for Burns

1. Stop the burn continuing by removing the source of the burning
2. Cool wound with cold water from the tap for 20 mins
   • Evidence suggests that cooling the burn with cold water from the tap (<20 degrees – all UK cold tap water) produces better outcomes in regards to healing and appearance at 6 weeks post injury.
   • The cooler the water the better – but in children with burns there is significant risk of hypothermia if using water that is extremely cold.
   • Never apply ice to burns.
   • 20 mins of cold water from the tap produces significantly less damage to the skin when looked at under a microscope. There was no advantage to longer durations.
   • Cooling doesn’t just stop tissue damage but can help with pain control.
   • It has been shown that cooling at any point within the first 3 hours post burn will improve outcomes.
3. Clothing and jewellery to be removed
   • Jewellery should be removed to prevent constriction as burns area swell.
   • Clothes in general should be removed as they retain heat and can continue the burning process.
   • Synthetic materials can melt onto the skin – these should not be removed unless experienced.
4. Covering the wound
   • Cover the burnt wound with cling-film or non-adherent dressing, this reduces pain from air exposure and allows medical assessment without having to remove dressings and disrupting the skin.
   • Do not apply cling film to the face.
   • Apply the cling film in strips and not circumferentially as the wound may swell and the cling film may tighten.
   • “Burn gel wraps” may be applied for analgesia effect, but of note should not be applied until the burn has been cooled as the do not actively remove heat from the burn.

Following these simple first aid principles allows the burning process to be stopped more quickly, which ultimately improves healing time and scarring whilst also reducing pain for the child.

Burns to the face

There is one more very important consideration when dealing with burns and that is, burns to the face. When a child has suffered flame burns to the face you need to think very early about the possibility of damage to the airway. If there is soot in the nostrils, burns to the lips or any evidence of burns to the mouth, the airway should treated as a priority and the child either transported immediately to hospital or (if the team have the experience to do so) an RSI and positioning of a definitive airway should happen as soon as possible. This is less of an issue with scalds to the face as these are less likely to be associated with burns to the airway itself.