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Burns can be caused by flame/fire, hot liquids, hot objects such as irons and heaters, ultraviolet radiation, electricity and certain chemicals. Scalds are burns from hot liquids, hot food or steam.
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First aid, including safety rules
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The immediate treatment of burns, especially for smaller areas, is immersion in cold running water such as tap water, for a minimum of 20 minutes. Do not disturb charred adherent clothing but remove wet clothing.
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Stop the burning process and remove any source of heat, if possible.
Flames: Smother with a blanket (preferably a ‘fire blanket’ if available).
Direct flames away from the head or douse with water.
Roll person on ground if clothing still burning.
Remove clothes over the burnt area IF not stuck to skin.
Scalds: Remove clothing that has been soaked in boiling water or hot fat.
Chemical burns: Remove affected clothing.
Electrical: Disconnect the person from the electrical source.
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It is best to cut clothing with sharp scissors especially from limbs.
Remove possible constricting items, e.g. bracelets, watches, rings.
Cover the burn with plastic cling wrap (not the first 6 cm). Apply this in strips and not wrapped circumferentially.
A burnt hand can be placed in a plastic bag.
Give basic analgesics for small burns e.g. paracetamol.
Cool running water is useful for 3 hours after a burn.
Cool the burn; warm the patient.
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Prick blisters (leave this to medical attendants).
Apply creams, ointments, grease, lotions.
Apply adhesive, sticky or fluffy cotton dressings.
Put butter, oils, ice or ice water on burns to children.
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There are three levels of burns.
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Superficial—affects only the top layer of skin. The skin will look red and is painful.
Partial thickness—causes deeper damage. The burn site will look red, blistered, peeling and swollen with yellow fluid oozing and is very painful.
Full thickness—damages all layers of the skin. The burn site will look white or charred black. There may be little or no pain.
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Consider your own safety as you stop the burning process:
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if on fire—stop–drop–roll
if chemical—flush with copious water
if electrical—turn off power.
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Refer the following burns to hospital:
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> 9% surface area, especially in a child
> 5% in an infant
all deep burns
burns of difficult or vital areas (e.g. face, hands, perineum/genitalia, feet)
burns with potential problems (e.g. electrical, chemical, circumferential)
suspicion of inhalational injury
suspicion of non-accidental injury in children or vulnerable people
burns in the elderly, children < 12 months and pregnant women.
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Always give adequate pain relief. During transport, continue cooling by using a fine mist water spray.
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A major burn is an injury to more than 20% of the total body surface for an adult and more than 10% for children. As a guiding rule, one arm is about 9%, one leg 18%, face 7% in adults and 16% in toddlers. The surface area of burns for a child is shown in Figure 9.14, which includes the useful Lund–Browder chart for estimating the extent of the burn.
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Major burns are a medical emergency and require urgent treatment: call triple zero (000) or your local emergency number.
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Guidelines for going straight to hospital (burns unit)
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Full thickness burns—adults over 10% and children over 5% of body surface
Burns including partial thickness burns to difficult and vital areas—hands, feet, face, joints, perineum and genitalia
Circumferential burns—those that go right around a limb or the body
Respiratory/inhalation burns (effects may be delayed for a few hours)
Electrical burns
Chemical burns
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Commonly used appropriate burns dressings
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Open weave retention stretch adhesive material (e.g. Acticoat™, Fixomull®, Mefix®). Requires daily or twice daily cleansing of the serous ooze and reapplication of outer bandage. Leave 7 days
Semipermeable transparent (e.g. OpSite®, Tegaderm™)
Hydrocolloids (e.g. Comfeel®, Duoderm®)
Paraffin impregnated gauze (e.g. Jelonet™, Unitulle)
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Very superficial—intact skin: Can be left with an application of a mild antiseptic only. Review if blistering.
Superficial—blistered skin: Apply a dressing to promote epithelialisation (e.g. hydrocolloid sheets, hydrogel sheets) covered by an absorbent dressing (e.g. paraffin gauze or Melolin™)
or
a retention stretch adhesive material (e.g. Fixomull®, Mefix®, OpSite®) with daily or twice daily cleaning of the serous ooze and reapplication of outer bandage. Leave 7 days.
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A silver impregnated dressing favoured by several burns units including Royal Perth Hospital. Preferred for deeper superficial wounds. Main indications—acute burns, partial thickness and infected or contaminated wounds.1
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Method for acute burns—after first aid
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Apply Acticoat™ dressing over cleansed burnt area with dark side facing wound
Apply two layers of Jelonet™, followed by dry gauze or padding
Secure with loose bandages or loose stretch netting
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If wound bed is dry, apply gel (e.g. Intrasite® gel) over the wound before applying Acticoat™.
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Rule: Wound must be kept moist otherwise skin damage and delayed healing occurs.
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Guidelines to patient for retention dressings
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First 24 hours: keep dry. If there is any ooze coming through the dressing, pat dry with a clean tissue.
From day 2: wash over dressing twice daily. Use gentle soap and water, rinse then pat dry. Do not soak. Rinse only. Do not remove the dressing as it may cause pain and damage to the wound. If the wound becomes red, hot or swollen or if pain increases, return to the clinic.
From day 7: return to the clinic for removal of the dressing. Two hours prior to coming into the clinic, soak the dressing with olive oil then cover with cling wrap.
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Note: Dressing must be soaked off with oil (e.g. olive, baby, citrus or peanut). Debride ‘popped blisters’. Only pop blisters that interfere with dermal circulation.
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Deep burns. If considerable ooze, apply the following in order.
Solosite® gel, Solugel® or similar
non-adherent neutral dressing (e.g. Melolin)
layer of absorbent gauze or cotton wool (larger burns).
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Change every 2 to 4 days with analgesic cover. Surgical treatment, including skin grafting, may be necessary.
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Exposure (open method)
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Keep open without dressings (good for face, perineum or single surface burns).
Renew coating of antiseptic cream every 24 hours.
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Dressings (closed method)
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Suitable for circumferential wounds.
Cover creamed area with non-adherent tulle (e.g. paraffin gauze).
Dress with an absorbent bulky layer of gauze and wool.
Use a plaster splint if necessary.
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For superficial blistered burns to the hand or similar ‘complex’ shaped parts of the body apply strips of the retention stretch adhesive dressings as described above. They conform well to digits. Apply an outer bandage. At 7 days soak the dressings in oil for 2 hours prior to coming into the clinic.