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Contents
Introduction .....................................................................................................................................................3
Guideline development process ........................................................................................................................3
Algorithm 1: Initial assessment and management of burns and scalds ..............................................................4
Notes to Algorithm 1 .........................................................................................................................................5
Note 1: First aid, emergency examination and treatment ............................................................................. 5
Note 2: Burn assessment ............................................................................................................................ 6
Note 3: Considerations for referral for hospital care ..................................................................................... 9
Note 4: Referral criteria for regional burns unit care ..................................................................................... 9
Algorithm 2: Ongoing assessment and management of burns and scalds in primary care ................................10
Notes to Algorithm 2 .......................................................................................................................................11
Note 5: Management of blisters and oedema ............................................................................................11
Note 6: Pain management for adults and children .....................................................................................11
Note 7: Signs of infection ..........................................................................................................................11
Note 8: Psychological consequences of burn injury ...................................................................................11
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Introduction
The purpose of this guideline is to provide a summary of the most up-to-date New Zealand and overseas
evidence about assessing and managing burn injuries in the primary care setting.
The guideline has been developed for New Zealand health care practitioners who care for adults and children
with burn injuries, as well as health service providers and funders. Key messages, together with algorithms,
have been provided to guide decision-making.
Accident Compensation Corporation (ACC) data on burn injuries, which is based on claim numbers for burn
injuries covering a three-year period (1 July 2001 to 30 June 2004), shows that there were 65,089 new claimants
of burn injury in all age groups. Children under ve years were the most vulnerable to burn injuries.
Burns can be divided into ve categories classied by the depth of the burn: epidermal, supercial dermal,
mid dermal, deep dermal and full thickness. The management of large, full thickness burns is beyond the
scope of this guideline as these burns are more likely to be managed in secondary care. Similarly, the issue of
scar management and the associated specialist services provided in secondary care, such as physiotherapy,
occupational therapy and speech language therapy, are not a focus of this guideline.
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Algorithm 1:
Initial assessment and management of burns and scalds
Child or adult with a new burn injury
No
No
Yes
Yes
No
Yes
Immediate referral to nearest
regional burns unit
4
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Notes to Algorithm 1
Note 1: First aid, emergency examination and treatment
First aid
1.
Reproduced from: Australian and New Zealand Burn Association Limited. Emergency Management of Severe Burns.
8th Edition; 2004.
2.
Ministry of Health. Immunisation Handbook 2006. Wellington: Ministry of Health; 2006. http://www.moh.govt.nz/moh.nsf/
pagesmh/4617/$File/2006-immunisation-handbook-all.pdf.
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sensation
healing time
scarring
sensation
example
healing time
scarring
sensation
healing time
scarring
Adapted from: Australian and New Zealand Burn Association Limited. Emergency Management of Severe Burns.
8th Edition; 2004.
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Treat all chemical burns to the eye with copious irrigation of water
Ensure contact lenses have been removed
All signicant chemical injuries to the eye should be referred acutely to
ophthalmology services
Electrical injuries:
Small entry and exit wounds may be associated with severe deep tissue damage
An electrocardiogram (ECG) should be carried out to detect arrhythmias
All electrical injuries should be referred to a burns unit
Non-accidental injuries
Indicators of possible non-accidental burns or scalds include the following:
delay in seeking help
historical accounts of injury differ over time
history inconsistent with the injury presented or with the developmental capacity of a child
past abuse or family violence
inappropriate behaviour/interaction of child or caregivers
glove and sock pattern scalds
scalds with clear-cut immersion lines
symmetrical burns of uniform depth
restraint injuries on upper limbs
other signs of physical abuse or neglect.
Refer to a regional burns unit if non-accidental injury is suspected.
Continued
3.
Adapted from: PRODIGY Knowledge. Burns and scalds. Revised November 2004. Sowerby Centre for Health Informatics at
Newcastle Ltd. (SCHIN); 1998. http://www.prodigy.nhs.uk/burns_and_scalds [accessed Aug 2005].
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A
1
13
2
region
1B/c
1B/c
partial
thickness loss
full
thickness loss
13
1B/c
Head
1B/c
Neck
1B/c
1B/c
1B/c
Ant. trunk
2B/c
2B/c
1D/e
1D/e
Post. trunk
1B/c
Right arm
Left arm
Buttocks
Genitalia
Right leg
Left leg
1D/e
1D/e
total burn
area
age 0
10
15
adult
A = B/c of head
9 B/c
8 B/c
6 B/c
5 B/c
4 B/c
3 B/c
2 D/e
3 B/e
4 B/c
4 B/c
4 D/e
2 B/c
2 B/c
2 D/e
3 B/e
3 B/c
Reproduced with permission from: Hettiaratchy S, Papini R. Initial management of a major burn: II assessment
and resuscitation. BMJ 2004;329;1013.
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4.
Australian and New Zealand Burn Association Limited. Emergency Management of Severe Burns. 8th Edition; 2004.
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Algorithm 2:
Ongoing assessment and management of burns and scalds in primary care
Child or adult with a burn injury that can be managed in primary care
Epidermal
Supercial/Mid dermal
Moisturising cream
Review after 48 hours
Antimicrobial dressing
Blister and oedema
management (Note 5)
Pain relief (Note 6)
Daily review
Day 3: Reassessment
Day 3: Reassessment
Intact skin?
Reassess
burn depth (Note 2). Is it
signicantly worse (likely to
be full thickness)?
Yes
Healed,
continue
moisturiser
and sunblock
No
No
Yes
No
Yes
Refer acutely
as appropriate
(Notes 3 and 4)
Days 57:
Change to moist woundhealing product
No
Is healing
progressing?
No
Days 1014
Is healing likely within
seven days?
Yes
Yes
10
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Notes to Algorithm 2
Note 5: Management of blisters and oedema
Management of blisters
Preferably leave small blisters intact unless likely to burst or interfere with joint movement
If necessary, drain uid by snipping a hole in the blister.
Management of oedema
Where possible, elevate affected area
Remove jewellery or constricting clothing.
11
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12
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13
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Referral
Considerations for referral for hospital care
Burns of lesser severity than those meeting the criteria for regional burns unit care but with
one or more of the following risk factors:
ongoing requirement for narcotic analgesia or failure to manage dressing-change pain
intravenous uids required
where oedema may be a problem
social and/or psychosocial indicators
suspected non-accidental injury
frequent or complex dressing issues
signicant comorbidities
request for other specialist services, eg, physiotherapy.
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