Burn Management

General Health & Wellness • Sep 03, 2019

Burn Management in the Emergency Department

Burn injuries are, unfortunately, a common reason for visits to the pediatric Emergency Department (ED).  St. Louis Children’s Hospital is a local pediatric burn referral center, and children are often sent to our Emergency Department for initial evaluation and management of burns or chemical exposures.  There are several types of burn injuries that children can sustain:

Thermal Burns

These are by far the most common types of burn injuries that we care for in the ED. Thermal burns can be caused by exposure to direct flame or scald injuries from hot objects or liquids. Scald injuries from hot liquids are most common.  Ways to prevent thermal burns in children include:

  • Set the thermostat on your hot water heater to below 120° F. (It takes five minutes for a third-degree burn to occur in children at 120° F and 30 seconds at 130° F).
  • Check the temperature of the water before placing your children in and never leave them unattended near a hot water source.
  • Don’t cook, drink or carry hot beverages or foods while holding a child. Keep hot foods and liquids away from table and counter edges.  Don’t use tablecloths or placemats that young children can pull down.
  • Turn the handles of pots and pans toward the rear of the stove and use back burners when cooking around small children. Don’t leave the stove unattended while you are cooking.
  • Block access to the stove, fireplace, space heaters and radiators. Don’t leave children unattended in a room while these are in use.
  • Keep hot devices such as clothes irons or curling irons unplugged and out of reach.
  • Test food temperature before feeding babies and young children.
  • Keep matches and lighters out of reach or locked up.
  • Install and maintain smoke alarms in your home and have a fire escape plan for your family.
  • While outside, don’t let children play with fireworks and never leave them unattended near grills, fire pits or camp fires.

Chemical Burns

Children are at risk for chemical burns because they love to explore their environment!  Chemicals can cause injury by direct exposure to the skin, eyes or mucous membranes through ingestion or inhalation, or a combination of these. Children often present after ingesting improperly stored and secured chemicals, or getting chemicals in their eyes.  Both of these exposures can have serious consequences and these children should be evaluated in the emergency department immediately!  Ways to prevent chemical injuries in children include:

  • Safely store and secure all hazardous chemicals and cleaning supplies out of reach or in locked cabinets.
  • Avoid using unlabeled or improperly labeled containers as storage devices.

Electrical Burns

These are uncommon types of burns, but can be worse than they appear due to how electricity travels through the body.  These should always be evaluated by a physician.  Ways to prevent electrical injuries in children include:

  • Cover unused electrical outlets with safety caps.
  • Keep electrical cords and wires out of the way so children don’t pull on or chew on them.
  • Replace frayed, broken or worn electrical cords.

At Home Treatment

Burn care can start at home. For thermal burns, the burning process can be stopped by immediate removal of the object causing the burn (including clothes, if involved), then application of cool water (not ice) to the burned area for 3-5 minutes.  After that, the burned area should be covered with a clean, dry covering.  Do not put anything else on top of the burn.

For chemical burns, contaminated clothing should be removed. If the exposure is to dry, powdered chemicals, these should be brushed off, then the exposed area flushed with copious amounts of running water for a minimum of 20-30 minutes. Chemical exposures to the eye should be irrigated continuously if possible until the child is evaluated by a physician.  The Poison Help Line (1-800-222-1222) can help determine the severity of the exposure and next steps.

Treatment in the Emergency Department

In the ED, physicians will assess the severity of the burn. For thermal burns, we describe burns as superficial, partial thickness or full thickness, which indicates how deeply the burn has injured the skin and underlying structures. Superficial burns appear as red skin and affect the topmost layer of the skin.  Partial thickness burns often appear as blisters or sloughing skin. Full thickness burns involve the entire depth of the skin and often appear as pale tissue. Some burn injuries have areas of various depths.  Burn wounds with blisters or sloughed skin should be evaluated by a physician.  Burns involving the face, hands or feet, genital area or crossing major joints are considered more serious.

For partial or full thickness burns, we usually perform a procedure called “debridement” to remove the damaged skin.  For this procedure, we provide children with sedation – either with oral pain medications and nitrous oxide (“laughing gas”) or medication for sedation through an IV.  The type of sedation provided depends on the extent of the injury and the age of the child.  During the debridement, we remove the damaged skin, then apply antibacterial ointment to the exposed underlying tissue to facilitate the healing process and prevent infection.  We apply a multi-layered protective dressing to help protect the injured area.

Children often go home from the ED after initial burn wound care has been completed.  These children are generally seen in follow-up in our outpatient Pediatric Acute Wound Service department for dressing changes and ongoing wound assessments.  Occasionally children will have to get admitted if the burn is severe and pain control and more frequent procedures are necessary.