Initial assessment
- Test sensation, blanching and check tetanus status
- Determine the % body surface area involved using rule of 9’s (head 9%, arm 9%, leg 18%, trunk front 18%, trunk back 18%), palmar surface (patient’s palm and fingers = 0.8%) or a Lund and Browder chart (more accurate, especially in children)
Classes of burns
Class | Characteristics | Management |
Superficial | Red and dry, blanches with pressure (like sunburn) | Simple moisturiser/Aloe vera gel |
Partial-thickness (superficial/deep) Need re-epithelialisation ± granulation to heal | Red and moist, with blisters, does not blanch | See text below |
Full-thickness | White/grey/scalded, insensate, solid, dry | Skin graft |
Initial management for all major burns should begin with an ABCDE approach
- Airway burns: call anaesthetist and intubate patient as soon as possible
- Breathing: give all patients 100% oxygen through a humidified non-rebreather mask; nebulisers for smoke inhalation
- Circulation: site 2 large bore cannulas and commence IV fluid resuscitation
- Disability: check responsiveness, give strong analgesia
- Exposure: examine entire skin and look for other injuries
- Large area burns: cover with sterile sheets or cling film until specialist review
- Minor burns: immerse in cool water for 30 minutes (or cover with cool sterile saline soaked towels)
Further management of partial-thickness burns
- Use systemic (never topical) analgesia if required
- Cleanse with soap and water, then thoroughly rinse
- Scrub off any necrotic tissue
- Dress simple low-exudate burns with multiple layers of low-adherent impregnated tulle gauze. Cover this with a sterile non-adherent absorbent pad dressing and secure with bandages or dressing fixing tape.
- Review in 48 hours to look for signs of infection
- Re-dress every 2 days
Blisters
- Leave intact unless they are open/contaminated (fully debride) or are large/prevent dressing (sterile aspiration)Â
Burns requiring specialist opinion/admission
- Full thickness burns (need skin graft)
- >10-15% body surface area or if elderly/significant comorbidities (risk of significant fluid loss)
- Hands (put in bag with paraffin and keep moving)
- Face (use Vaseline); genitalia/perineum (admit as difficult to dress)
- Burns over major joints; chemical (‘irrigate, irrigate, irrigate!’)
- Electrical (spare skin); inhalation injuries (airway risk)
- Circumferential burns (risk of compartment syndrome)