Key learning points
Currently the World Health Organisation (WHO estimates that globally 180,000 deaths are caused annually by burns1. Around 1% of the population in the UK each year are affected in some way by a burn2. More than 75% of burns accidents in the UK occur at home2.
Patients do not always seek medical attention or delay in doing so, often trying to self-manage. Subsequently they may present to a pharmacy to assist with their care. Managing simple burns and being able to recognise those that need further medical treatment or monitoring is an important skill. This is a guide for management of simple burns.
Different types of burn
A burn is an injury to the skin caused by heat, electricity, radiation, friction or chemicals. This can affect all or just some of the layers of the skin.
The depth of burn injury describes the anatomical extent of tissue injury and is divided into partial and full thickness skin loss, with partial thickness burns being divided into superficial and deep types.
This classification quantifies the amount of tissue damage into anatomical terms.
Only involve the epidermis. This is described as erythema, due to the release of inflammatory mediators following an injury causing hyperaemia, such as sunburn. Epidermal burns are often very painful, usually healing quickly and no blisters are present.
Moisturise regularly, especially with aloe vera lotion as it has some anti-inflammatory properties.
Superficial partial thickness burns:
Pale pink or red in appearance, the top layer of skin has been lost with blister formation. These injuries are very painful and tender to touch. The capillary refill time is brisk again. These heal within 14 to 21 days with a low incidence of scarring.
The actual depth of the burn is difficult to assess in the presence of blisters. Large blisters should referred on for medical attention. Small blisters can be left intact, the area cleaned and dressed with a non-adherent dressing and a secondary absorbent dressing to soak up any exudate. These should be reassessed at 24 to 48 hours to evaluate any burn depth progression. Burn wounds not healed by 14 days should have medical review.
Recognising deeper burns:
The defining signs are:
Any of these signs mean that the patient should be referred on or encouraged to seek medical attention. Deep partial thickness burns taking longer than three weeks to heal spontaneously have a high risk of unsightly and or disabling scarring.
If there is a small, full thickness burn smaller than a 10 pence piece in size, this is potentially manageable with dressings in the community, as these can be left to heal by secondary intention. Ensure there is a low threshold for onward referral for deeper injury.
What burns can be managed in the community?
The two types of burns seen and managed in the community will be a combination of epidermal and small superficial partial thickness burns. Patients with anything more severe should be advised to seek medical attention.
Initial burn management
Check for signs of infection (redness, increasing pain, feeling unwell) and maintain adequate hydration. If referring to a doctor it is important to apply a simple non-adherent dressing. Silver dressings affect the appearance of the wound and make it difficult to assess. They can also stain clothing.
These are key features that warrant seeking a doctor’s advice; assume a low threshold.
Routine antibiotics are not recommended for burns. It’s important to bear in mind that patient can develop infection and subsequently sepsis from a burn.
If you have any concerns, contact the burns services in your area directly for telephone advice.
Emergency measures: toxic shock syndrome
This is a rare life threatening condition. Children are more at risk, following even a small burn. Symptoms include:
The child or adult must be sent straight to hospital. Call 999 if necessary.
Potential neglect or abuse
Consider this when the injury is un-witnessed:
Justine Sullivan is a registrar in plastic surgery at the Burns & Plastic Surgery Unit, Broomfield Hospital, Chelmsford. Essex. Consultants Mr D Barnes and Mr P Dziewulski are co-authors.