Burns- assessment and management
The severity of a burn is measured by the:
• Area of the burn relative to the total body surface area (TBSA)
• Depth of the burn
• Location of the burn
A burn is considered to be severe if:
• It involves the hands, feet, genitals or face.
• It covers more than 10 percent of the TBSA for adults or 5 percent for children.
• The patient has other significant injuries or illness.
• The airway is burnt due to inhalation burns.
• The patient is very young or elderly (under 6 or over 65).
SURFACE AREA OF BURN
There are two methods of assessing the surface area of a burn.
• Rule of nines: The body is divided into 11 areas of 9 percent.
• Hand method: The surface area of a person’s palm is approximately 1 percent of their TBSA.
For example, a burn the size of 5 palms is approximately 5 percent of their TBSA. It is useful to calculate the percentage of the TBSA burnt as this is the largest factor in determining the degree of shock that is likely to be associated with the burn. If more than 20 percent of the TBSA is burnt, every organ in the body is affected and the patient can take months to recover.
MANAGEMENT
• Stop the burning.
• Remove the patient from the burning or the burning from the patient.
• Treat any airway, breathing and circulation problems.
• Quickly remove anything that retains heat, such as watches, rings, clothing and boots.
• Cool the burn area with water (cool, not ice cold) for 20 minutes. This prevents the heat penetrating further into the skin layers, causing more damage. You may need to cool the area for longer. Check with the patient that the area no longer feels hot.
• Try to avoid immersing the patient or getting un-burnt areas wet – you do not want to cause hypothermia.
BURNS
If the only water supply is unclean, cover the burn with cling film or a plastic bag before pouring the water over it. Infection is a major problem with burns.
• If water is in short supply, recycle it by collecting in a raincoat or plastic bag.
• If the only way you can cool the burn is by using cold, wet cloths, remember that they will heat up quickly and need to be replaced frequently.
• After cooling, cover the burn area lightly with a sterile dressing or clean absorbent coverings. Cling film is an effective covering, but do not wrap film right around a limb, as it may become tight as the area swells.
• Burns can be very painful due to the nerves being exposed to the air. The patient may think that the area is still burning, even if it has been sufficiently cooled. Immediate covering of the area will help.
Swelling is not limited to the burn area so remove rings from fingers when legs are burnt.
• Place padding between burnt fingers and toes.
• Elevate burnt limbs above heart level to help relieve swelling.
• Treat the patient for shock.
• Give the patient sips of fluid to help replace lost fluid and to prevent dehydration and kidney failure.
• Give the patient pain relief.
• If you are 24 hours or more away from medical assistance, place paraffin gauze between the patient’s fingers and toes to prevent the skin sticking together. Also use paraffin gauze on surfaces where skin layers have been removed and you do not want a dry dressing to stick to or become embedded in the burn.
What not to do:
• Do not remove clothing stuck to a burn – cut around it.
• Do not apply creams or ointment – they trap bacteria on the burnt skin and will have to be scrubbed off if the area becomes infected.
• Do not break burn blisters – they create a barrier to infection.
• Do not use up all your water if it is limited – dehydration will be a safety consideration for all the party members. Recycle the water you are using to cool the burn.
• Do not put ice directly on the burn as this can cause more swelling and/or frostbite.