Burn injuries

The following information about burn injuries is taken from 3D Regional HealthPathways, NZ, accessed June 2020:

Background

About burn injuries

Burns are a common form of trauma which regularly present to primary care. Only 10% of patients who suffer a burn which requires medical treatment are hospitalised each year, and the remainder are managed in primary care.

Appropriate first aid and burn wound management in primary care is essential to help minimise further tissue damage and maximise healing potential. 

Assessment

1. Before attending to the burn, assess airway, breathing, circulation, and neurological status.
2. History:
   • Ask about injury details.
   • Consider:
        ◊ past medical history.
        ◊ allergies to medications and dressings.
        ◊ tetanus immunisation status.
        ◊ inflicted (non-accidental) injury.
        ◊ factors that may affect healing.
3. Examination:
   • With a gloved finger, assess sensation and capillary refill throughout the burn wound. Burn wounds are often a mixture of depths.
   • Identify burn depth.
   • Estimate total body surface area (TBSA).
   • Assess for any associated injury to the eyes. For chemical burns to eyes, see Trauma in Eyes.
4. Consider taking photos of the burn wound. Photos are useful to monitor progress and may be helpful when referring to specialist services.

Management

1. Provide appropriate first aid treatment. If a serious burn, phone an ambulance on 111 for immediate transfer.
2. Manage any associated injury to the eyes:
   • Do not underestimate ocular injury. Request acute ophthalmology assessment or seek ophthalmology advice for all ocular burn injuries.
   • For chemical burns to eyes, see Trauma in Eyes.
3. Give adequate pain relief. Burn injuries can be extremely painful. If morphine is needed in acute burns, preferably give intravenous morphine rather than intramuscular or oral. See:
   • Analgesia in Adults with Acute Pain.
   • Analgesia in Children with Acute Pain.
4. Manage swelling. Significant swelling can develop in the first 48 to 72 hours:
   • Elevate all burnt limbs on pillows as soon as possible.
   • If the face, head, or neck is burnt, elevate the head of the bed.
5. Clean wounds with normal saline or aqueous chlorhexidine 0.1%. Burn wounds are initially sterile and routine use of systemic antibiotics is not advised.
6. Provide tetanus-prone wound management.
7. Complete an ACC form.
8. If specialised burns management is indicated:
   • request acute plastic surgery assessment.
   • dress wound appropriately before transfer. If circumferential burns to limbs, monitor the colour, warmth, and capillary refill of the extremities hourly.
9. If specialised burns management is not indicated, treat burn wounds further according to the burn depth:
   • Epidermal (superficial)
   • Superficial dermal
   • Mid-dermal
   • Deep dermal or full thickness
   • Mixed depth burns – if the burn is mixed depth, use a dressing appropriate to the deepest portion of the wound.
10. If the burn is over a joint, request early physiotherapy assessment.
11. If concerns about wound care, pain relief, or need for additional therapies and supports, seek plastic surgery advice.
12. Manage any other factors that may affect healing.
13. Review:
    • at 48 to 72 hours.
    • at 7 days.
    • at 14 days.
14. Once the burn is healed:
    • Recommend scar management. Start scar management early rather than waiting for a scar to mature as outcomes are better.
    • Consider giving the patient this handout on post-burn skin care.
    • Consider requesting occupational therapy assessment or advice from the Wellington Regional Burns Centre Occupational Therapist if:
          ◊ there has been delayed wound healing.
          ◊ the patient is prone to scarring.
          ◊ advice on scar management is required.

Learn more

Initial management of small burns Australian & New Zealand Burn Association (ANZBA)
Initial assessment and management of burn injuries guideline National Burns Service, NZ
Lund and Browder Chart National Burns Service, NZ

References

1. Burn injuries 3D Regional HealthPathways, NZ, 2020