Burns – admission & follow up guidance

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Objectives

The aim is to provide clear guidance on the followup of children that present to hospital following a burn. This may mean admission to hospital, a discussion with a member of the burns team, discharge with follow-up or outpatient management by the paediatric Emergency Department. 

Scope

This guideline should be used by healthcare professional in the paediatric Emergency Department for burns patients. 

Please also refer to the Care Of Burns In Scotland (COBIS) guidelines

 

1) Patients to be admitted
  • ≥ 5% TBSA superficial dermal or deep
  • 1% full thickness
  • Full circumferential burns
  • Chemical burns and electrical burns
  • All inhalational burns – these patients are likely to need PICU admission and should also be discussed with PICU and the medical team on-call.
  • Burns with TBSA >20% will require admission to PICU

These patients should be admitted to ward 2C at RHCG following discussion with the burns team. Contact plastic surgery registrar Monday – Friday 8am-5pm on page 13931. If any difficulty contacting the plastic surgery registrar during these hours call the burns CNS on 84866 or 07984004853. Out of hours contact the plastic surgery registrar on call via switchboard and if you are unable to contact the plastic surgery registrar then contact the paediatric surgical registrar on call.

2) Patients for discussion with the burns team
  • The burn involves hands / face / feet / perineum or lies over a joint
  • Age <1 year
  • Deep burns <1% TBSA
  • Burn cases with child protection concerns (see also local child protection guidelines)

The patients should be discussed with the Burns Team (as above) as they may be a candidate for theatre management +/- Biobrane.

3) Follow up for patients being discharged

All patients with burns should be reviewed within 48hrs of presentation or as near to 48hrs as practically possible. There are 2 options for follow up:

  1. The nurse led burns clinic runs on a Monday afternoon, Tuesday morning and Friday all day.

  2. Patients can be referred to their local CCNT

See below sections to ensure most appropriate service utilised for follow up

 

a) Nurse-led Burns Clinic

Referral to the burns clinic can be made for any patient that does not require admission to ward 2C

To arrange an appointment at clinic:

  • Check with ED reception staff the burns clinic is on for that date.
  • Complete pink form circle ‘Burns clinic’ with date attendance required.
  • Document clearly on the ED card the date they are being followed up.
  • Ensure the parent’s telephone contact number is correct.
  • Give parents the appointments office number (0141 211 4633) and ask them to call the day before their appointment is due to get the time of their appointment .
  • If their appointment is for the following day tell them to come for 2pm for the Monday clinic and 10.30am for the Tuesday and Friday clinic.
  • Ensure the completed ED card goes to ED reception.

If a burns clinic appointment is not available within the appropriate time frame (within 48 hours), children can be referred to the Community Children’s Nursing Team for a dressing change prior to being reviewed in the burns clinic.

 

b) Community Children’s Nursing Team (CCNT)

  • Patients discharged from the ED with burns that require ongoing management beyond 24 hours post injury i.e. dressing changes and education regarding care of newly healed skin
  • Patients requiring a interim dressing change prior to being reviewed in the burns clinic
  • CCN teams are available for patients in Ayrshire, Renfrew, Inverclyde, Lanarkshire, Forth Valley and Dunbartonshire. Patients from Dumfries and Galloway can be referred to the paediatric ward in DGRI for dressing changes

The Community Children’s Nursing Team will visit children in their homes, (or an appointed alternative eg. grandparents), to manage their burns.

They provide a Monday to Friday service, excluding public holidays.

They will liase directly with the Burns Nurse Specialist if there is any concern about the patient.

If they receive a referral within working hours it is possible for them to visit the next working day and they will try to do so if there is a particular concern about the burn or the family’s ability to manage the dressing. However, most visits should be requested for the second working day after their ED attendance eg. patient attending Saturday am – request a visit for Tuesday.

The CCN team in Glasgow will visit the patients between 9am-1pm but will usually call the family prior to the appointment. The other CCN teams will call the family prior to visiting

All patients being referred to the CCNT should be discharged from ED with supplies away with them for 2 dressing changes ie:

  • Dressing pack x 2
  • Saline sachets x 2
  • Urgotul SSD or Urgo silver x 2
  • Any bandages required x 2

Referrals to the Glasgow CCN team are made via TrakCare:

Select "New Request" in top tabs, then , "other" in next set of tabs.  Then in "item" (bottom box on right hand side) type "child" and select magnifying glass.  Select the CCNT option to complete the form and then call to leave a message on their answer machine.

Referrals to the Paisley and Ayrshire teams can be made via a telephone call. Referrals to Lanarkshire, Vale of Leven, Inverclyde and Forth Valley are made via email

 

4) ED Management of patients being managed as an Out-patient

Nursing staff should:

  • Give adequate analgesia prior to commencing the procedure and if during office hours then they should contact the play service to ask a play specialist to attend to offer distraction
  • Deroof the blister and debride the loose skin
  • Take separate microbiology swabs from each area that is burned
  • Dress the burn with Urgotul SSD or Urgo silver
  • Facial burns should have prontosan gel applied and parents should be advised to keep the child indoors and limit visitors to the home and restrict access to pets.
  • Advise parents to give analgesia prior to the next dressing change.

Medical staff should:

Ensure the family have adequate analgesia for the child at home and advise a dose should be given before their next dressing change.
Arrange appropriate follow up as above.
Advise the parents to return to the ED if their child develops any symptoms of infection or Toxic Shock Syndrome. These are fever and/or vomiting and/or diarrhoea and /or rash.
Young children are at risk of developing Toxic Shock Syndrome even from a very small burn.

ALL PATIENTS BEING DISCHARGED FROM ED WITH A BURN SHOULD BE GIVEN THE “EMERGENCY DEPARTMENT ADVICE ON LOOKING AFTER YOUR CHILDS BURN” PARENT INFORMATION LEAFLET.

 

 

 

References
Editorial Information

Last reviewed: 12 December 2019

Next review: 01 December 2022

Author(s): Sharon Ramsay, Burns Nurse Specialist

Version: 2

Reviewer Name(s): Dr Vincent Choudhery (Consultant in Paediatric Emergency Medicine, RHCG)