Page 21 - World of Irish Nursing April 2018

CPD 37

Managing burns:

An overview

In the latest update in this series,
Catherine Lewis, Stephanie Laidlaw

and Gerry Morrow examine the

treatment of burns and scalds

A burn is an injury caused by exposure to within 14 days with conservative manage- cause of the burn, and the mechanism
thermal (heat), chemical, electrical or radi- ment and do not result in scarring. of injury. Establish the risk of inhalation
ation energy. burns usually affect the skin, Deep burns injury, this could be suggested by:
but may also damage the airways, lungs, Deep dermal burns may need surgi- • Singed eyebrows or nasal hairs
muscles, bones or other internal organs. cal intervention to heal and may result in • Sore throat
A scald is a burn caused by contact with some contraction and scarring. Full thick- • Black carbon in sputum
a hot liquid or steam. Scalds are the most ness burns that are complex usually need • Hoarse voice
common burn type (accounting for 70% of surgical intervention to heal and result in • Stridor
burns in children). In this article the term considerable contraction and scarring. It is • Wheeze/signs of carbon in the oropharynx.
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‘burn’ will be used to include scalds. 1,2 possible to die from a serious burn injury. Symptoms such as pain or itch should
non-complex burns (previously The skin is a barrier to bacteria and be assessed along with any co-morbidities
described as minor burns) are defined as moisture loss; when this is breached, (for example, diabetes mellitus, immuno-
any partial-thickness thermal burn cover- potential complications from burns may compromised state or pregnancy) which
ing less than 15% of the total body surface present, either soon after injury, or later may affect wound healing and increase the
area in adults or less than 10% in chil- during the healing process. Early complica- risk of complications. 2,5
dren, that does not affect a critical area. tions include: An assessment should be made and
non-complex burns also include deep par- • Respiratory distress from smoke inhala- documented about the location, size and
tial-thickness burns covering less than 1% tion or a circumferential chest burn extent of the burn or burns to determine
of the body. 2 • Poisoning from inhalation of noxious the severity of the injury. To determine
Complex burns (previously described as gases this, the total surface area of the body
major burns) are defined as any thermal • Fluid loss affected should be estimated. This can be
burn affecting a critical area such as the • Hypothermia done using the Wallace rule of nines tool
face, hands, feet, perineum or genitalia; also • Wound infection and sepsis for medium to large burns in adults (arm
burns crossing joints and circumferential • Toxic shock syndrome 9%, head 9%, neck 1%, leg 18%, ante-
burns. Any thermal burns covering more • Cardiac rhythm abnormalities rior truck 18% and posterior trunk 18%).
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than 15% of the body surface area in adults • Vascular insufficiency However, this may over-estimate the area
or more than 10% in children are defined • Acute kidney injury affected. For small or scattered burns, or for
as complex burns. All chemical and electri- • Limb loss. assessing the amount of unburned skin in
cal burns are classed as complex burns. 2 Death may result from severe, exten- very extensive burns, the person’s palmar
The exact prevalence of burn injuries is sive burns or electric shock (currents of surface (including fingers extended but
not known, as many people will self-treat more than 70,000 volts may cause cardiac closed together) can be used – the palmar
instead of seeking medical attention. Chil- arrhythmias and paralysis of respiratory surface is representative of about one per-
dren under five years and the elderly are muscles, and are usually fatal). cent of the person’s total body surface area.
most at risk of burn injury – older people Later complications from burns include The depth of the burn should also be
may be at increased risk due to reduced wound infection, chronic nerve pain and assessed and documented. This can be
mobility, sensory impairment and slowed itch, scarring (burns that take more than gauged by examining the skin for colour
reaction times. 2 two to three weeks to heal are more likely change, presence of blisters, capillary
The prognosis and healing time of a burn to result in hypertrophic scarring), con- refill time and pain. If there is any uncer-
injury depend on the extent, depth and tractures, and psychosocial impacts such tainty on the extent or depth of a burn,
location of the burn, and the person’s age as depression, anxiety and post-traumatic arrange immediate referral for specialist
and associated co-morbidities. stress disorder. 3,4 assessment, as distinguishing between
Superficial burns Assessment of burns complex and non-complex burns may not
Superficial epidermal burns typically After giving immediate first aid, all burns be straightforward clinically. 2,5 WIN Vol 26 No 3 April 2018
heal within seven days with conservative need to be assessed rapidly and accurately, Non-accidental injury
management and do not result in scarring. to reduce the risk of progressive injury and When assessing a burn, the possibil-
Superficial dermal burns typically heal complications. Assess the timing, type and ity of non-accidental injury should be