Chapter 11 - Burns

The initial approach is SABCDE.

Burns are classified according to the depth:

Superficial: involves the outer layer of skin (epidermis), requires prompt first aid preventing blistering.

Partial-thickness: are very painful damaging the epidermis resulting in the skin being red and blistered.

Full thickness burns are painless, they may look waxy, pale or charred and require urgent medical treatment.

The priority is to cool the burn as soon as possible, continuing cooling for 20 minutes or until the pain is relieved.

1. Flood the burn with plenty of water, help the patient to sit or lie down, but keeping the burn clean.
2. Call for help
3. Keep cooling for 20 minutes, Keep observing the casualty’s vital signs.
4. Avoid touching the burn. Gently remove rings, watches, jewellery, belts, shoes and any burnt, smouldering clothing before swelling forms.
5. One cooled cover the burned area with kitchen film to prevent infection and secure with a bandage.
6. Reassure the casualty and keep them warm. Record and monitor the casualties vital signs.
7. Do not break blisters, apply adhesive dressings, apply ointments, or specialised dressings.

Burns to airways – any burn to the face, mouth or throat requires emergency care with the risk of airway loss due to swelling. Always suspect airway burns if a burn is sustained in a confined space. Call for emergency help immediately.

Electrical burns may result in burns at the point of contact and may result in entry and exit burns, but also damage to tissues and/or organs along the path the current passed. 

Chemical burns are always serious and the casualty will need hospital treatment. If possible note the name of the burning substance. Ensure the area is safe before approaching in case of poisonous fumes. 

1. Ensure the area around the casualty is safe. Ventilate the area to disperse fumes. Wear eye protection and gloves. If safe to do seal the chemical container and move the casualty.
2. Flood the burn with plenty of water for at least 20 minutes to disperse the chemicals and stop the burning. Ensure the contaminated water drains away and does not collect around the casualty.
3. Gently remove contaminated clothing.
4. Send the casualty to hospital monitoring vital signs. 

Chemicals splashed or sprayed into the eyes require immediate treatment.

1. Waer protective gloves and gently pull open the eye lids hold the casualty’s head, affected eye downwards under gently running cold water for at least 20 minutes
2. Ensure contaminated water does splash the non-injured eye or face. If wearing contact lenses ask the casualty to remove them.
3. Ask the casualty to hold a clean pad over their injured eye.
4. Arrange urgent transfer to hospital.