First aid - managing burns and scalds

Nurses should be able to deal with first aid situations, including burns and scalds, from the point of registration (Nursing and Midwifery Council, 2018). Burns and scalds are both caused by heat and are managed in the same way. 

Burns are caused by exposure to dry heat, e.g. candle flames or hot saucepans. Scalds are caused by exposure to a wet source of heat, e.g. steam or hot water. Quick and effective management of burns and scalds (referred to as burns throughout for brevity) through the application of good first aid has been associated with improved outcomes for people affected (Harish et al, 2019).

Staying safe

The nurse should be aware of the potential for coming to harm themselves if they are exposed to the same source of injury. It is important therefore that the nurse assesses the safety of the area before approaching the patient.

Identifying burns and scalds

Burns and scalds can be very painful and are characterised by:

• red skin, which may be peeling
• blisters
• swelling
• white or black skin

The appearance of a burn or scald is dictated by the severity of the burn which relates to the depth of damage done to the skin.

A superficial burn will cause the skin to be reddened and swollen but not blistered. Such injuries only affect the epidermis and are painful.

A superficial dermal burn is characterised by pinkness and maybe some small blisters. Superficial dermal burns affect the epidermis and the dermis and are painful.

A deep dermal (partial thickness) burn causes the skin to become red, blotchy and either dry or moist. The injury will be swollen and blistered. A partial thickness burn may be painless or painful.

Full thickness burns impact the epidermis, dermis and subcutis which is burnt away revealing

Managing burns and scalds

The first aid advice for all types of burns and scalds is the same:

• remove the person from the heat source or the heat source from the person. This may include turning off electricity if the burn is electrical.
• within the first 20 minutes, cool the burn under lukewarm running water for up to 30 minutes.
• avoid using:
  • ice
  • cream
  • butter
• if unable to use running water, use wet towels
• remove any clothing or jewellery from the area of the wound (unless it is stuck to the wound)
• keep the person warm, especially when running the affected area under water
• cover the burn with clingfilm:
  • it is a good idea to discard the first couple of turns of clingfilm to ensure what is used is clean
  • ensure the cling film is not applied tightly
  • apply length ways and not around the burns to avoid compressing the injury
  • if

Complications

People with severe burns can quickly go into shock, so it is important the nurse monitors them until more advanced help arrives. Signs of shock might include the patient becoming:

• pale, cold and clammy
• sweaty
• tachycardic
• tachypnoeic
• cyanosed
• nauseous
• restless
• unresponsive

During the cooling of the burn, it is possible that the patient may become cold and be affected by hypothermia. It is a good idea to monitor for this and to keep the person warm and where possible dry. Any blankets etc. used should not rub the burn.

A more medium-term complication of any burn is infection. Trying to keep the wound clean and dressing it as soon as possible with clingfilm will help prevent infection entering the wound (British Burn Association, 2018; McLure et al, 2021).

References

British Burn Association. First Aid Clinical Practice Guidelines. 2018. https://www.britishburnassociation.org/wp-content/uploads/2017/06/BBA-First-Aid-Guideline-24.9.18.pdf (accessed 19 April 2022).

British Red Cross. Learn first aid for someone who has a burn. 2022.  https://www.redcross.org.uk/first-aid/learn-first-aid/burns (accessed 19 April 2022).

Harish V, Li Z, Maitz PKM: First aid is associated with improved outcomes in large body surface area burns. Burns. 2019;45:1743-8. https://doi.org/10.1016/j.burns.2019.05.006.  

McLure M, Macneil F, Wood FM et al. A Rapid Review of Burns First Aid Guidelines: Is There Consistency Across International Guidelines? Cureus. 2021;13(6): e15779. https://doi.org10.7759/cureus.15779. 

NHS. Burns and scalds. 2018. https://www.nhs.uk/conditions/burns-and-scalds/ (accessed 19 April 2022).

National Institute for Health and Care Excellence. Burns and scalds. 2020. https://cks.nice.org.uk/topics/burns-scalds/ (accessed 12 April 2022)

Nursing and Midwifery Council. Future nurse: Standards of proficiency for registered nurse. 2018.  https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 12 April 2022).

St John Ambulance. Severe Burns - Adult. 2021. https://www.sja.org.uk/get-advice/first-aid-advice/effects-of-heat-and-cold/serious-burns/ (accessed 19 April 2022).

World Health Organisation. Burns. 2018. https://www.who.int/news-room/fact-sheets/detail/burns (accessed 19 April 2022).