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considered. Any of the following should clothing and potentially restricting jewel- taking a cool bath or shower, applying top-
raise suspicions of a non-accidental injury: lery (any tar stuck to the skin should not ical emollients, applying cold compresses
• Lack of explanation for the injury be removed). and using simple analgesia. The patient
• The patient not being independently Within 20 minutes of the burn occur- should be advised to maintain adequate
mobile ring it should be irrigated with cool or hydration to reduce the risk of compli-
• The injury on any soft tissue that would tepid running water for 20-30 minutes. cations. Advise the person to arrange an
not usually come into contact with a If water is not available, use wet towels urgent review if blisters develop as this
hot object (for example, the backs of or compresses, ensure the person is kept may suggest a dermal burn. 1,4
the hands, soles of the feet, back and warm to avoid hypothermia. Immediately Superficial dermal burns will require
buttocks) after cooling the burn, it should be cov- appropriate wound cleaning, debridement,
• An injury in the shape of an object (for ered using cling film, layered onto the burn blister management and wound dressing
example, a cigarette or iron) rather than wrapped circumferentially. by a person with appropriate expertise and
• An injury that suggests forced Elevate the affected area if possible to training. Simple analgesia can be used to
submersion. reduce the risk of oedema. Pain relief, such manage pain, with the addition of codeine,
non-accidental injury should also be as paracetamol or ibuprofen, should be if pain is severe.
considered if there is a delay in presenta- given for mild to moderate pain, codeine The wound should be reassessed after
tion, however this may be due to adequate may be added for more severe pain. 1,4 48 hours to check for signs of infection and
first aid measures masking the severity of Electrical burns should be treated by for the dressing to be changed. The wound
the injury. An unrelated adult presenting safely switching off the power supply should then be redressed every three to
a child to healthcare services or a trigger and removing the person from the source five days until the wound is healed. Follow-
event such as soiling, enuresis or minor using a non-conductive material such as ing wound healing the person should be
misbehaviour by the person could also a wooden stick. If the person is connected provided with advice on skin care, includ-
indicate non-accidental injury. Other to a high voltage source (1,000 volts of ing massaging the area daily with emollient
indicators may be present and should be more) they should not be approached. The until the burn is no longer dry or itchy
considered during the assessment of the assistance of emergency services should be (usually three to six months) and using
injury. 7 sought in this situation. Immediate admis- high-factor sunblock over the affected skin
All patients presenting with a burn injury sion to the nearest emergency department for years post healing. 1,4
should have their risk of tetanus assessed, should be arranged. 1,4 If the wound becomes infected, arrange
those deemed at a high risk of tetanus When treating a chemical burn, the for the burn to be cleaned with 0.9%
should be given human tetanus immu- causative chemical should be determined, sodium chloride or lukewarm tap water.
noglobulin for immediate protection, where possible. Any affected clothing A bacteriology swab should be taken
irrespective of their tetanus immunisation should be removed from the person and from the wound and empirical antibiotic
history. burns which are at a high risk of the chemical should be brushed off, if it is treatment started. A follow-up appoint-
tetanus include: in a dry form. The burn should then be irri- ment should be made for the wound to be
• Those that need surgical intervention gated with water for an hour. Immediate re-assessed after seven days. 1,4
which is delayed for more than six hours admission should be arranged to the near- Catherine Lewis is clinical author at Clarity Informatics,
• Those that have a significant degree of est emergency department. 1,4 Stephanie Laidlaw is information specialist at Clarity
devitalised tissue or have been associated After initial first aid measures, referral Informatics and Gerry Morrow is editor and medical
with a puncture-type injury to the nearest emergency department is director at Clarity Informatics. Clarity Informatics is
contracted by the National Institute for Health and Care
• Any burns containing foreign bodies required in the following circumstances: Excellence (NICE) to provide clinical content for the
• Those associated with compound • All complex burns Clinical Knowledge Summaries service available through
fractures • All full thickness burns the Clarity Informatics Prodigy website at: https://
prodigy-knowledge.clarity.co.uk/
• Burns in people with sepsis. 8 • Deep dermal burns affecting more than
Treatment 5% of the body References – full reference list available from the Prodigy
When giving immediate first aid to a • Any high-pressure steam injury Burns and scalds topic. https://prodigy-knowledge.
clarity.co.uk/
person with a burn, avoid personal injury • Any burn associated with suspected 1. Lloyd EC, Rodgers BC, and Michener M et al. Outpatient
by checking the area is safe and wearing non-accidental injury burns: prevention and care 2012 ; 85(1):25-32
personal protective equipment if neces- • Burns affecting the face, hands, feet and 2. Wounds International. Effective skin and wound
sary (for example, when treating chemical genitalia management of non-complex burns. Wounds
International 2014
burns). • Circumferential deep dermal burns 3. National Burn Care Review Committee. National burn
Assess the person’s airway, breathing • Burns associated with inhalation injury care review. British Association of Plastic Surgeons, 2001
and circulation, and for the presence of any • Co-morbidities or significant other inju- 4. Lloyd EC, Rodgers BC, and Michener M et al. Outpatient
ries or trauma
co-existing non-burn injuries or trauma • Burns associated with sepsis burns: prevention and care 2012 ; 85(1):25-32
5. International Society for Burn Injuries. ISBI Practice
that may be life-threatening and require
WIN Vol 26 No 3 April 2018 of the burn. For a thermal burn, the aim Management 1,4 II-assessment and resuscitation. British Medical Journal
guidelines for burn care. Burns 2016; 42(5):953-1021
• All children under 10 years of age or
emergency treatment.
1,4
6. BMJ. Initial management of a major burn:
Initial treatment depends on the cause
adults over 49 years of age.
2004; https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC449823/
is to stop the burning process; this can be
Ongoing management of superficial
7. RCPCH. Child protection evidence. Systematic review
on burns. Royal College of Paediatrics and Child
epidermal burns such as sunburn or scalds
done by extinguishing flames using ‘drop
Health 2017
involves providing advice regarding meas-
and roll’ or smothering the person with
8. PHE. Tetanus: the green book, chapter 30. Public Health
ures to provide symptom relief including
a blanket and removing non-adherent
England 2013