Clinical Review

Emergency and early management of burns and scalds

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1037 (Published 08 April 2009) Cite this as: BMJ 2009;338:b1037
  1. Stuart Enoch, specialty registrar in burns and plastic surgery1,
  2. Amit Roshan, specialty registrar in burns and plastic surgery2,
  3. Mamta Shah, consultant burns and plastic surgeon3
  1. 1University Hospitals of Manchester, Manchester M23 9LT
  2. 2Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge CB2 8QE
  3. 3Central Manchester and Manchester Children’s Hospitals NHS Trust, Manchester
  1. Correspondence to: M Shah, Regional Paediatric Burns Unit, Booth Hall Children’s Hospital, Manchester M9 7AA mamta.shah{at}cmmc.nhs.uk

    Summary points

    • Most minor burns can be managed in primary care

    • Appropriate first aid limits progression of burn depth and influences outcome

    • Assessment of area and depth is crucial to formulating a management plan

    • Burn depth may progress with time, so re-evaluation is essential

    • All major burns require fluid resuscitation, which should be guided by monitoring of the physiological parameters

    • A multidisciplinary approach is crucial for a successful clinical outcome

    Burn injuries are an important global health problem. Most simple burns can be managed by general practitioners in primary care, but complex burns and all major burns warrant a specialist and skilled multidisciplinary approach for a successful clinical outcome. This article discusses the principles behind managing major burns and scalds using an evidence based approach and provides a framework for managing simple burns in the community.

    Sources and selection criteria

    We searched Medline, Ovid, Burns, and the Cochrane Library until June 2008 for randomised controlled trials, systematic reviews, evidence reports, and recent evidence based guidelines from international burn associations.

    What is the burden of burns injuries?

    Annually in the United Kingdom, around 175 000 people attend accident and emergency departments with burns from various causes (box 1).1 This represents 1% of all emergency department attendances, and about 10% of these patients need inpatient management in a specialist unit.2 A further 250 000 patients are managed in the community by general practitioners and allied professionals. Of patients referred to hospital, some 16 000 are admitted, and about 1000 patients need active fluid resuscitation. The number of burns related deaths average 300 a year.1

    Box 1 Some important causes of burns and scalds

    • Flame burns

    • Scalds (hot liquids)

    • Contact burns (hot solid)

    • Chemicals (acids or alkalis)

    • Electrical burns (high and low voltage)

    • Flash burns (burns resulting from brief exposure to intense radiation)

    • Sunburns

    • Friction burns

    • Radiation burns

    • Burns from lightning strike

    Globally, the World Health Organization estimates that 322 000 people die each year from …

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