Early management

Management of the major burn wound in the first few hours entails:

• first aid - see submenu; however:
  • if first aid by water cooling has not been instituted within 3 hours it does not have any benefit
  • in the latter case, wash the burn with either:
    • saline
    • soap and water
    • 0.1% chlorhexidine solution
• elevate the burnt part in an attempt to reduce swelling
• do not:
  • remove adherent clothing
  • break blisters unless directed by the burns unit to assess the depth of injury
  • cover with wet dressings as the thermoregulatory functions of skin are impaired and there will be a tendency to hypothermia
• dressings for transport:
  • cover with a sterile, warm, non-adherent dressing whilst awaiting definitive care
  • a layer of clingfilm sheeting covered by a dry sheet and blanket is often effective; this limits evaporation and heat loss. However, in hot climates with long transit times, this can encourage the growth of bacteria with risk of systemic sepsis - consult burn unit.
  • an alternative if transport time is prolonged is tulle gras soaked in dilute chlorhexidine held in place with crepe bandage or loose, elasticated netting
• be alert to the need for escharotomy and warn the receiving unit