Burns

A burn is an injury caused by heat, cold, electricity, chemicals, gases, friction or radiation. It causes damage by killing the cells of the skin. Scalds are caused by contact with wet heat such as boiling fluids or steam. Electrical burns are less common, but have the potential to be more serious as the depth of the burn is usually greater than is initially apparent, and may cause heart irregularities.

Types of Burns

Thermal: flames, steam and/or hot liquids.

 Electrical: damaged/faulty electrical cable, power points or lightning.

Chemical: acids, caustic soda etc.

Friction: any friction generating heat e.g. rope or carpet.

Radiation: sun, industrial equipment.


Serious Burns

A burn is considered to be serious when any of the following apply:
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Burns greater than 10% of total body surface area.

Burns of special areas – face, hands, feet, genitalia, perineum and major joints.

Full-thickness burns greater than 5% of total body surface area.

Electrical burns.

Chemical burns.

Burns with an associated inhalation injury.

Burns encircling limb/s or chest.

Burns in the very young or very old.

Burns in people with pre-existing medical disorders.

Burns with associated trauma.


Assessing Burns

There are two methods used to determine the severity of a burn:

The total body surface area that has been burnt.
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The depth of the burn.
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Both of these methods need to be considered in conjunction to accurately calculate the extent of the injury.

Total Body Surface Area of Burns

You can estimate the total body surface area on an adult that has been burned by using multiples of nine (see chart below).

For an adult who has been burnt, the percentage of the body involved can be calculated as follows:

Head = 9%

Chest (front) = 9%

Abdomen (front) = 9%

Upper/mid/lower back and buttocks = 18%

Each arm = 9%

Each palm = 1%

Groin = 1%

Each leg = 18% total (front = 9%, back = 9%)

Example
If an adult casualty received:
Burns to both legs – 18% x 2 = 36%
the groin = 1%
front of the chest = 9%
abdomen = 9%
Therefore, the extent of the burn would involve a total of 55% of the casualty’s body.
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Another method of assessment is the Palm Method:

If a burn is larger in size than the palm of the casualty’s hand medical assistance should be sought.


Always seek medical assistance for burns in infants and children.

Depth of Burns

Burns are classified based on the severity of the tissue damage.

Superficial Burns

A common cause of superficial burns is sunburn, with only the outside layers of the skin being affected.

Reddening of the skin e.g. light sunburn.

Damage to the outer layer of skin only.

Pain

If sunburn, remove the casualty from direct sunlight into a cool shady environment.

Cool the burnt area with gently running, clean, cool water for a minimum of 20 minutes.

Hold the injured area close to the stream of water to avoid further pain.

Give casualty sips of cool water to hydrate.

Monitor for shock in young children. If signs of shock do appear, treat and seek medical assistance.


Partial Thickness Burns

Skin is red and blistering.

Maybe clear fluid weeping from the burn.

Damage to the outer layer of skin only.

Severe pain

 

Follow the DRSABCD emergency action plan.

 Cool the burnt area with gently running, clean, cool water for a minimum of 20 minutes. Water is always the first choice to cool a burn; if water is not available hydrogel products may be used.

Hold the injured area close to the stream of water to avoid further pain.

Carefully remove any clothing that is wet with hot liquid. Be aware of injury to yourself and take special care removing clothing over a casualty’s head to avoid injuring the face and eyes.

Immediately remove any tight clothing, watch, rings or jewellery from the injured area because of the risk of swelling.

If possible elevate the limb to reduce swelling.

Cover with a loose sterile non-stick dressing or kitchen wrap.

Minimise shock by placing casualty in the shock position.

Monitor the casualty.

 Seek medical assistance.


Full Thickness Burns

White or blackened/charred areas may have a waxy centre with reddening on the edges.

Possible blistering.

There may be very little or no pain due to nerve damage. However, it may be painful at the edges of the burn.

There may be clear fluid weeping from the burn.

Pale, cold, clammy skin.

Feeling faint and giddy.

Nausea and/or vomiting.

Swelling may begin to appear

Damage to all layers of the skin, including underlying structures, tissue, muscle and bone.

Follow the DRSABCD emergency action plan

If the casualty is on fire, drop them to the ground, if available cover with a fire blanket starting at the head, and roll the casualty on the ground to extinguish any flames. If a blanket is not available and water is, use water. Move away from the burn source.

Cool the burnt area with gently running, clean, cool water for a minimum of 20 minutes.

Hold the injured area close to the stream of water to avoid further pain.

Immediately remove any tight clothing, watch, rings or jewellery from the injured area because of the risk of swelling.

Cover with a loose sterile non-stick dressing or kitchen wrap.

If possible elevate the limb to reduce swelling

Continue running cool water over the dressing if pain persists.

Monitor the casualty’s vital signs; pulse, breathing and level of consciousness.

Reassure the casualty.

Minimise shock by placing casualty in the shock position.

Monitor the casualty.

Call 000 immediately.


DO NOT remove clothing that is stuck to the skin.

DO NOT pull burning, smouldering clothing over a casualty’s head.

DO NOT over-cool the casualty. If the casualty shivers or gets goosebumps, the body naturally starts to produce heat and we do not want this to happen!

DO NOT break any blisters.

DO NOT use cotton wool or any adhesive tapes/plasters.

DO NOT underestimate burns, especially when the airway is involved.

DO NOT apply lotions, oils or butter (only use water-soluble burn creams).

DO NOT use ice or ice water to cool the burn as further tissue damage may result.


Inhalation Burn

An inhalation burn should be suspected when a casualty has been trapped in an enclosed space with hot or toxic gas or fumes. An inhalation burn may result from irritant fumes producing a chemical burn and an inflammatory response.

Following an inhalation burn if the casualty is breathing normally, talking and able to move around, do not assume that they are stable. Some poisons produce delayed respiratory inflammation which may develop over a 24 hour period.

Burns to the face, nasal hairs, eyebrows, eyelashes.

Coughing with black particles in sputum.

Hoarse voice or dry cough.

Breathing difficulties.

Follow the DRSABCD emergency action plan.

Give the casualty sips of cool water, but do not give ice.

Apply cold compresses to the neck area.

Call 000 for an ambulance urgently.

Allow casualty to adopt a position of comfort.

Monitor airway, breathing and circulation.

Be prepared to commence CPR.


Electrical Burn

Electrical burns are often associated with other injuries including involvement of the cardiac and respiratory systems, loss of consciousness and trauma.

Follow the DRSABCD emergency action plan.

ALWAYS make the area safe by switching off the power supply before touching or assisting the casualty.

Call 000 for an ambulance urgently.

Look for and treat both entry and exit wounds as per burns management listed above.

Monitor the casualty’s airway, breathing and circulation closely.

Be prepared to commence CPR, as the heart can stop at any time.

Be aware that the casualty could have internal injuries caused by the electricity.

Complete a head to toe secondary survey if the casualty has been thrown, looking for other injuries. If struck by lightning check the soles of the feet for burns.


Electrical Storms

During an electrical storm find shelter for yourself and the casualty that is not a high point for a bolt of lightning.
Avoid sheltering under trees, and if there is no alternative stay away from the trunk.
If possible seek shelter indoors or in a vehicle where any further lightning strike will be carried to “earth” in the structure.

Cold Burn

A cold burn is an injury to the skin caused by exposure to extreme cold or by touching a very cold surface. It may also be due to exposure to gas i.e. oxygen or L.P.G.

Treat as per burn management listed above.

Use warm water to try and bring the cold burn back up to normal skin temperature (ensure water is only warm NOT hot).


Chemical Burn

A chemical burn is an injury to the skin caused, usually, by alkali (e.g. ammonia, caustic potash, lime, sodium hydroxide) or acid (e.g. hydrochloric, sulphuric).

Follow the DRSABCD emergency action plan.

Be careful not to become contaminated yourself, avoid contact with any chemical or contaminated material e.g. use gloves.

Within the workplace, if available, refer to Material Safety Data Sheets (MSDS) for specific treatment.

Refer to instructions on the container for specific treatment.

If safe to do so, take the poison container to the telephone. Alternatively, if the poison container is contaminated, note down the product name and any ingredients listed. Take this note with you to the telephone.

Call the Poisons Information Centre of 13 11 26 for further advice.

Remove the chemical and any contaminated clothing immediately, taking care to avoid contact with the poison.

Brush powdered chemicals from the skin.

IMMEDIATELY run cool tap water directly onto the area for at least 20 minutes.

If a chemical enters the eye, open and flush the affected eye(s) thoroughly with water for at least 20 minutes.

Seek medical assistance urgently.


Radiation Burn

A radiation burn may be caused by sunburn, welder’s arc (flash burn), lasers, industrial microwave equipment or nuclear radiation.

The most common type of radiation burn is sunburn.

Treat as per burn management listed above.


Bitumen Burn

Bitumen is a general term describing petroleum-derived substances that includes true petroleum, mineral tars and asphalt. Hot bitumen, which is an essential part of the road pavers and roofers profession, is a potential source of contact burn, with its removal often posing a messy problem.

Bitumen should not be removed from the casualty’s skin as this may cause more damage.

Bitumen continues to hold heat therefore irrigation with cool water should continue for at least 30 minutes.

Consider scoring or cracking the bitumen if it is encircling a limb or digit.

Treat as per burn management listed above.

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