Winter is here, and with this chilly season comes hot chocolate, bonfires, electric blankets and (sadly) an increased risk of burns. Having recently sustained a partial thickness burn thanks to a rogue cup of tea, I though it would be timely to cover some of the important elements of thermal burn management (note: don’t do what I did and think ‘it’ll be fine, it’s only a cup of tea!’)
What is a thermal burn?
A thermal burn is a burn to the skin caused by any source of heat. Other causes of burns include chemical, radiological and electrical.
I’ve been burned! What should I do?
The best thing you can do for a thermal burn is to run it under cold water for twenty minutes. This reduces both the size and depth of the burn and can also reduce the pain experienced. It is recommended that this is done within the first hour, but can be effective for up to three hours after the injury is sustained.
Before or during the application of water, surrounding clothing and jewellery should be removed as they can retain heat (unless the clothing is stuck to the skin, then the adherent cloth should be left in place and the rest cut away). However if too much skin is burned or uncovered, especially in infants and the elderly, then hypothermia can become a risk. To prevent this from occurring, the parts of the body that aren’t being treated with cold water should be kept covered.
Cold running water is the gold standard and should not be substituted. As convenient as it may be, ice should never be applied to a burn; it can cause the injuries to become deeper and can lead to hypothermia. Additionally, while hydrogels like Burnaid can be useful for reducing pain, they are still nowhere near as effective as cold running water.
I’ve finished first aid. Should I see a doctor?
The rule of thumb is that if a burn is greater than the size of a twenty-cent piece (or if it is smaller but deeper), then a doctor needs to see it. They will determine how severe the burn is by assessing both the depth of the burn and the area of the body affected.
A minor burn covers less than 10% of an adult’s total body surface area, or less than 5% of a child’s total body surface area. These sorts of burns can generally be managed in the community by a GP, although consultation with a burns unit may be appropriate.
For a superficial burn where the skin is intact and there are no blisters, applying a simple moisturiser may be all that is needed to stop the skin becoming dry and itchy. On the other hand, a partial thickness burn where the skin is blistered or broken is likely to require dressings to keep it clean and moist during the healing process. In the first 24-48 hours an absorptive dressing is needed, as this is the time burn wounds produce the most exudate. After this, a non-adherent occlusive dressing (i.e. one that is air and water tight) or a ‘hydrocolloid’ dressing is more appropriate. Silver dressings can also be used to help prevent infection.
Other adjuncts that may be helpful in burn management include analgesia for pain, antihistamines to relieve itchiness and rest and elevation to minimise swelling.
Severe burns (i.e. deep and/or those that cover a large surface area) will need urgent management by a specialist burns unit. According to The Education Committee of the Australian and New Zealand Burns Association, the burns (thermal or otherwise) that require referral to a burns unit include:
- Burns affecting more than 10% of the total body surface area
- Full thickness burns affecting more than 5% of the total body surface area
- Paediatric burns affecting more than 5% of the total body surface area
- Burns to the face, hands, feet, genitalia, perineum or major joints
- Chemical burns
- Electrical burns including lightning injuries
- Burns with associated trauma
- Burns with inhalation injury
- Circumferential burns of the limbs or chest
- Burns in patients with pre-existing medical conditions
- Burns with suspected non-accidental injury, assault or self-inflicted
- Burns during pregnancy
- Burns in the extremes of age (infants and elderly)
Although not an Australian and New Zealand Burn Association criterion, infected burns should also be referred to a burns unit.
What sort of follow-up will I need?
Burns should be followed-up by a medical practitioner within 48 hours after the injury. This allows the initial dressing to be changed, and the depth of the wound to be reassessed in those cases where it was initially unclear. Following this, the burn should be reviewed regularly to monitor how the wound evolves and heals. If the burn does not appear to have healed after fourteen days, then referral to a burns unit should be considered.
Burns are also prone to tetanus, so if you aren’t up to date with your tetanus vaccinations it is worth getting one from your doctor.
Where can I find more information?
There are some great burns resources out there, but the Victorian Burns Unit website is, I think, one of the most useful. Their section on minor burns can be found here, and information about severe burns can be found here.
Additionally, for burns in children, you can’t go past the recommendations from The Royal Children’s Hospital Melbourne.
Your GP can also provide you with extra information.
Interested in reading more about burns ? You can read my interview with Professor Fiona Wood here.