Stop the burning pro​cess

• In flame burns, extinguish the flame by rolling patient on the group using the "Stop, Drop, Cover (face) and Roll" technique

• Remove burned or hot clothing as quickly as possible

• Remove jewellery

Cool the burn wound

• Cool running water, ideally 15°C (effective range ​8-25°C), for 20 minutes within the first 3 hours

• Reduces inflammatory reaction and stop progression of necrosis in zone of stasis

• Ice or iced water should not be used

• Prevent hypothermia by increasing ambient temperature to over 30°C

• Cooling may be continued for analgesic effects

• Except elemental sodium, potassium or lithium burns

Chemical burns​

• Neutralise pH with cool running water​ - longer for alkali burns

• Regularly check pH even after initial neutralisation of wound - particularly alkali burns

Hydrofluoric acid burns​

• Topical calcium gluconate burn gel​

• Local injection with 10% calcium gluconate 0.1-0.2ml at a time with 30G needle into burn wound monitored by pain resoponse

• IV ischaemic retrograde infusion (Biers block) of calcium gluconate

• Early excision may be required

Wash burn wound with 0.9% NaCl, soap and water or Chlorhexadine 0.1% solution

Wrap burn wound in cling film for transfer

Alternatively, Jelonet or Bactigras held on by a light bandage for longer transfers

Elevation to limit swelling

Special areas

• Perineal burns require early urinary catheterisation​

• Head and neck burns should have head elevation

Pain relief

• Small burns - oral paracetamol with codeine​

• Consider admission for appropriate analgesia until the pain of the burn wound has decreased

• Oral sedatives and analgesics can be given 30 to 45 minutes before dressings

• Intranasal opioids have a quicker onset

Wound management

• Epidermal burns​

  • Moisturising cream and pain relief​

• Dermal burns​

  • Deroof and remove blisters​

  • Silicone (Mepitel), hydrocolloid (Duoderm or Comfeel) or silver dressings (Acticoat, Mepilex Ag or Aquacel Ag)

  • Skin substitutes (Biobrane, Suprathel, Matriderm, pig skin or preserved human cadaveric skin) usually only applied in a burn service

  • Repeat wound inspection after approximately 3 days

    • Ensure initial burn depth assessment was correct and complications have not occurred​

• Infected burns​​

  • Usually no antibiotics required on presentation​

  • Topical antimicrobial agent for burns which appear infected or likely to have been contaminated (silver dressings or SSD)

    • SSD (Flamazine) will convert burn wound into moist wound with khaki coloured exudate that makes the base of the burn difficult​

  • May require IV antibiotics​ or surgery

Follow up​

• Usually at 3-7 day intervals​ provided home circumstances are suitable

Physiotherapy​​​​​ and occupational therapy

• For splinting or mobilisation burns to the hands, limbs and around joint​

• Scar management using elasticated garments, contact media or adhesive tape

Education post healing​

• Sun protection using sunscreens and appropriate clothing​

• Time off work to allow normal thickening of the healed area

• Frequent application of moisturising creams and massage

• Antihistamines and cold compress for itch

Functional impairment​

• Initial scar management​

• Secondary burns reconstruction

Cosmetic disability​

• Due to colour match​ or hypertrophic scarring

• Assessment by psychologist specialised in body image problems

• Skin camouflage

• Excision of scar and skin grafting may not improve the original scar appearance