In a few words 7: Cooling and dressing a burn
Jeff Kenneally – www.Prehemt.com
It is arguable that few injuries are worse than severe burns. There are a few rules when managing acute burns. The core mantra is to cool the burn but keep the patient warm. With the skin layer gone, the next rule is to cover the burn to keep fluid in, bugs out and reduce pain.
The evidence for the best way to cool a burn is surprisingly little. Consensus is to use cool running water for a period of twenty minutes. At this point the burn is cool. Further cooling only risks unnecessary heat loss and hypothermia. Showers, taps or hoses all work. If there is no cool running water, soaking in cool still water is acceptable. In this case the water must be changed over several times to avoid the burn heating it. Dirty dam water should be avoided due to infection risk. If it is used it must be reported. Beware over cooling large burns.
Cooling can remove heat from the burn and restrict injury. Hydrogel dressings also cool burns. However they don’t cool as quickly as cool water can. They can be used where no water cooling option is available but should not be first line. Once cool, a dressing must cover the burn to reduce fluid and heat loss, block infection entry and stop air stimulating exposed nerve endings. Cling wrap does this effectively. Apply it loosely to allow for swelling. Hydrogels also do this but will continue to cool and lead to hypothermia, particularly in children. Water and cling wrap is best.