PASO (BURNS)

First aid & Treatment

Juan Carlos B. Marzan, MD, DPBS

Plastic Surgeon / Burn Specialist
General Surgeon
Burn Injuries
First aid
First aid
GOALS

• stop the burning process

• cool the burn
• provide pain relief
• cover the burn
Stop the Burning Process

• remove the heat source

• Remove clothing ASAP because it can retain heat
• Adherent material - nylon clothing should be left on
Stop the Burning Process

• Flame —> doused with water or smothered with a blanket or by rolling the victim on
the ground
• Tar Burns —> cool with water, but do not remove TAR
• Electrical Burns - disconnect from the source of electricity before first aid is attempted
Stop the Burning Process

• remove jewelries
• melted jewelries or firmly stuck should not be disturbed
• get the person away from the source of burn
• drop and roll
Cooling the burn

• removes heat and prevents progression of the burn

• removes noxious agents and reduces pain and may reduce edema by stabilizing mast
cells and histamine release
• can cause hypothermia especially in Children
 Cooling the burn

• immerse or irrigate with tepid water

(15°C) for 20 minutes —- scars better
, within 2-3 hours
• Don’t use iced water because it can
cause intense vasoconstriction can
cause burn progression
• Chemical burns — irrigated with
copious amounts of water
Analgesis

• exposed nerve ending will cause pain

• cooling and simply covering the exposed burn will reduce the pain
• Opioids - initially used to control the pain, but once first aid measures have been
effective, NSAID - Ibuprofen taken orally will suffice
Covering the Burn

• Dressing - cover the burn area and keep the

patient warm
• Polyvinyl chloride film ( cling film)
• ideal first aid cover (commercial rolls are
clean as long as first few centimeters are
discarded)
• pliable, non-adherent, impermeable, acts as a
barrier and is transparent for inspection
• just lay and don’t wrap around because
swelling may constrict the wound
Covering the Burn

• Blanket over the top—-> keeps patient warm

• if cling warp not available - any sterile cotton sheet can be used
Covering the Burn

• Hand burns - cover with clean plastic bag - so not to

restrict mobility, avoid wet dressings as heat loss
during transfer to hospital can be considerable
• AVOID topical burns , butter or any creams or pastes-
may interfere with subsequent assessment of the burn
• Cooling gels - cool the burn and relieve pain in the
initial stages
Cool, Call , Cover
British Burn Association
CALL

• Call for Help

Management of minor burns

• cause of injury
• depth and extent of burn
• associated illness or injuries
• feet burns elevate for at least 48 hours - rarely possible at home
• Consult a Burns Unit if in doubt about management
Depth
Extent
Cleaning the Burn

• new burn is essentially sterile - keep it so

• thoroughly cleaned with soap and water or
mild antibacterial wash - dilute
chlorhexidine
• blisters -
• large - unroof and dead skin removed with
sterile scissors or a hypodermic needle
• smaller blister should be left intact
Dressings

• simple gauze dressing impregnated with paraffin

• gauze over a dressing covered by several layers of absorbent cotton wool
• Elastic net dressing to secure awkward areas such as head and neck and chest
Dressings

• Flammazine , dressing would be on alternate days

• change dressing if it becomes painful, smelly or
soaked (strike through)
• any burn that has not healed within two weeks should
be seen by a burn surgeon
Specialist Dressings

• Silver sulfadiazine (Flamazine)

• cream applied topically on burn wound
• effective against gram negative bacteria including Pseudomonas
• Apply 3-5 mm thick layer and core with gauze
• remove and reapply every two days
• 3-5% incidence of reversible leucopenia
Specialist Dressings

• Hydrocolloid dressing (duoderm)

• thin foam sheet in a semipermeable film
• adhesive and waterproof useful in awkward areas
• applied with a 2 cm border
• change every 3-4 days, or unto 7 days
Specialist Dressings

• Facial Burns
• Burn Unit
• simple sunburn - exposed should be left exposed as dressing can be awkward to retain on the face
• cleanse twice daily with mild diluted chlorhexidine solution
• bland ointment such as MEBO every 1-4 hours as necessary to minimize crust formation
• Men should shave daily to reduce risk of infections
• sleep propped up on two pillows for the first 48 hours to minimize facial edema
 Burn Center Referral Criteria
(American Burn Association)

• Partial Thickness Burns >10% of TBSA

• Burns that involve the face, hands, feet, genitalia, perineum or

major joints.

• Third-degree burns in any age group

• Electrical burns, including lightning injury

 Burn Center Referral Criteria
(American Burn Association)

• Chemical burns

• Inhalation injury

• Burn injury in patients with pre-existing medical disorders that could

complicate management, prolong recovery or affect mortality.

• Any patient with burns and concomitant trauma (such as fractures) in which
the burn injury poses the greatest risk of morbidity or mortality. In such
cases, if the trauma poses the greater immediate risk, the patient initially
may be stabilized in a trauma center before being transferred to a burn unit.
 Burn Center Referral Criteria
(American Burn Association)

• Burned children in hospitals without qualified personnel or

equipment for the care of children.

• Burn injury in patients who will require special social, emotional

or rehabilitative intervention.
Follow-up

• Burns that fail to heal within 2-3 weeks should be referred to a plastic surgery unit for
review
• Healed burns will be sensitive and have dry scaly skin, which may develop pigmental
changes.
• Daily application of moisturiser cream should be encouraged.
Follow-up

• Healed areas should be protected from the sun with sun block for 6-12 months. Pruritis
is a common problem.
• Patients with minor burns of limbs may need physiotherapy. It is important to identify
these patients early and start therapy.
Follow-up

• Hypertrophic scars may benefit from scar therapy such as pressure garments or
silicone.
• For these reasons, all healed burns should be reviewed at two months for referral to an
occupational therapist if necessary
Follow-up

• Support and reassurance—Patients with burn injuries often worry about disfigurement
and ugliness, at least in the short term, and parents of burnt children often have
feelings of guilt. It is important to address these issues with reassurance
From every wound, there is a scar, and every scar tells a story. a
story that says,

I have survived…