Thermal Burns (Flame, Hot Surface) and Treatments.

Recently on a long weekend away with the family we were a good 2 hours from Brisbane staying at a bush campsite that had limited to no mobile phone coverage. One morning when I was up at the shower block I met a gentleman who after saying hello explained to me he had fallen into the fire at his campsite. I doing so he had managed to burn his left leg quiet severely.

These types of burns when camping unfortunately are not uncommon and happen more often then you realise. The Gentleman had done his best with self-treating the burn with cool water for a period of time and then applying bandage to the burnt area to help protect it.

I offered to inspect the burn for him and provide some further care to help prevent the burn from becoming infected. I proceeded clean the burn the best I could to remove the oil based ointment he had used to help with the pain. I then advised that his burn was most likely a Deep Partial Thickness and full thickness burn and that he should seek medical attention with the burn do to the size of the burn.

I redressed his burn with Hydrogel Dressings as this would provide a moist barrier to help prevent infection and help with the pain relief. This decision was made as the patient had advised he would not go to the hospital today but will be leaving tomorrow and will present to his local hospital to have the burn looked at.  Hydrogels are not generally used in first aid treatment of burns but because this was going to be a prolonged period before medical treatment my main concern was infection and pain management. The burn was then lightly wrapped with a bandage to help hold dressing in place.

So what is a Thermal Burn?

thermal burn is a type of burn resulting from making contact with heated objects, such as boiling water, steam, hot cooking oil, fire, and hot objects. Scalds are the most common type of thermal burn suffered by children, but for adults thermal burns are most commonly caused by fire.

How do we classify these Burns?

 

There are three levels of burns:

  • Superficial (1st Degree) – these burns cause damage to the first or top layer of skin only. The burn site will be red and painful.
  • Partial thickness (2nd Degree) – these burns cause damage to the first and second skin layers. The burn site will be red, peeling, blistered and swelling with clear or yellow-coloured fluid leaking from the skin. The burn site is very painful.
  • Full thickness (3rd Degree) – involves damage to both the first and second skin layers, plus the underlying tissue. The burn site generally appears black or charred with white exposed fatty tissue. Very deep burns may damage the underlying muscle or bone. The nerve endings are generally destroyed and so there is little or no pain at the site of the full-thickness burn. However, surrounding partial thickness burns will be very painful.It can be difficult to tell the difference between partial and full-thickness burns. The depth of a burn is not critical in the initial treatment of burns. An assessment of the extent of the burn is more important initially.

Burns depth assessment

  • Burns depth assessment may be difficult, the table below aids accurate estimation of burn depth.
  • Deep Partial Thickness and Full Thickness Burns would seek medical assistance ASAP by calling 000
Depth Cause Surface/colour Pain sensation
Superficial Sun, flash, minor scald Dry, minor blisters, erythema, brisk capillary return Painful
Superficial Partial thickness -(superficial dermal) Scald Moist, reddened with broken blisters, brisk capillary return Painful
Deep Partial thickness –     (deep dermal) Scald, minor flame contact Moist white slough, red mottled, sluggish capillary return Painless
Full thickness Flame, severe scald or flame contact Dry, charred whitish. Absent capillary return Painless

First aid for burns

  • Consider your Own Safety and Bystanders Safety First
  • Remove the person from danger and further injury.
  • If Unconscious follow the standard DRSABCD procedure and call 000.
  • Hold the burn under cool running water for 20 minutes. If necessary, prevent heat loss by covering unburnt areas with a blank or space blanket.
  • Burnt clothing should only be removed if it does not stick to the burn.
  • Do not remove clothing that is stuck to the burn.
  • Do Not bust and blister.
  • Do Not apply ointments or creams
  • Superficial burns require pain relief, dressings, and regular review to make sure they have not become infected.
  • Do not apply anything other than water to second or third degree burns until they are fully cooled and medically assessed.A major burn is defined as a burn of any depth that involves more than 20 per cent of the total body surface area for an adult and more than 10 per cent of the total body surface area for a child.

Major burns are a medical emergency and require urgent treatment. Immediately apply cool water to all affected areas and then call triple zero (000) for an ambulance. A cool or lukewarm shower is ideal try not to submerge a child in a bath as can case Hypothermia.

Use of Hydrogel products

Hydrogel products should be considered for first aid when there is no access to clean water or there may be a prolong period before getting medical assistance.

They are cooling and often analgesic

There are several hydrogel products on the first aid market. Some hydrogel products contain 90% water and melaleuca oil in a proprietary gel. It is postulated that tea tree oil has useful antibacterial, antifungal and anti-inflammatory properties, and this product is included in some formulations.

Hydrogel products can be used in adults with burns as a temporary dressing for up to 24 hours as long as the burn has been cooled prior to its application.

Do not use hydrogel products in children.

In adults with extensive burns, do not leave hydrogel products on for longer than 20 minutes due to their increased risk of hypothermia and reassess the burns before re applying a new dressing.

 

Cover the Burn

Where the surface is blistered and/or raw, the wound should be covered with a non-adhesive dressing.

In the absence of any wound dressings, cover the wound with plastic film wrap or clean cloth to keep the burn wound clean until definitive management can occur.

Plastic film wrap is a suitable dressing for patients being transferred to the burns services within 6 hours

Avoid wrapping affected area circumferentially with plastic film wrap as this can have a tourniquet effect as oedema worsens.

 

What complications can present with a Major Burn?

 

Some of the potential complications of major burns include:

  • injury to lungs and Air Wayfrom smoke inhalation, you may require to place them in recover position to help maintain and open airway.
  • hypovolaemia– loss of fluid from burnt skin. This may lead to shock.
  • heat loss(hypothermia) – since burnt skin is unable to properly regulate body temperature, cover the non-burnt areas with a blanket or shock/space blanket to help keep them warm.
  • infection.

What Should I Have in My First Aid Kit for Burns?

It would be recommended that you have in your first aid kit the following items.

  • Burns Dressing Small 75cm x 75cm (this can be soaked in water and applied no stick side done on burn to protect and cool burn.
  • Some clear cling wrap ( always apply this long ways not circumfrence of burn as needs to allow for swelling)
  • Some assorted sizes of Non Adhesive Dressings
  • A couple of crepe bandages tp help hold dressings in place
  • I also carry a bottle of watter in my kit for just in case.

References:

http://www.vicburns.org.au/first-aid/cool-with-running-water.html

http://www.mydr.com.au/first-aid-self-care/burns-how-to-treat

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/burns

http://www.rch.org.au/clinicalguide/guideline_index/burns/

ARC Guideline 9.1.3 – Burns – January 2016 (144.3 KiB)