Introduction

Some 250 000 burns occur annually in the United Kingdom. About 90% of these are minor and can be safely managed in primary care. Most of these will heal regardless of treatment, but the initial care can have a considerable influence on the cosmetic outcome. All burns should be assessed by taking an adequate history and examination.

First aid

The aims of first aid should be to stop the burning process, cool the burn, provide pain relief, and cover the burn.

A superficial scald suitable for management in primary care

Stop the burning process—The heat source should be removed. Flames should be doused with water or smothered with a blanket or by rolling the victim on the ground. Rescuers should take care to avoid burn injury to themselves. Clothing can retain heat, even in a scald burn, and should be removed as soon as possible. Adherent material, such as nylon clothing, should be left on. Tar burns should be cooled with water, but the tar itself should not be removed. In the case of electrical burns the victim should be disconnected from the source of electricity before first aid is attempted.

Cooling the burn—Active cooling removes heat and prevents progression of the burn. This is effective if performed within 20 minutes of the injury. Immersion or irrigation with running tepid water (15½C) should be continued for up to 20 minutes. This also removes noxious agents and reduces pain, and may reduce oedema by stabilising mast cells and histamine release. Iced water should not be used as intense vasoconstriction can cause burn progression. Cooling large areas of skin can lead to hypothermia, especially in children. Chemical burns should be irrigated with copious amounts of water.

Burnshield is a cooling gel used to cover burn and reduce pain

Analgesia—Exposed nerve endings …