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M.Jeschke - Handbook of Burns Volume 1 Acute Burn Care - 2013.pdf
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A. Arno, J. Knighton

tion burns, is the fit of the clothes themselves. Clos- er-fitting outfits decrease the incidence and mortality of clothing-related burns. Loose-fitting clothing, particularly if the person is in an upright position, allows for greater airspace between the fabric and skin, allowing to oxygen promote the flame, thereby worsening the burn. These facts explain why the safest sleepwear for children is considered to be a snugfitting cotton, flame-resistant garment. By definition, flame-resistant garments don’t ignite easily and must self-extinguish quickly.

Table 10. Burn prevention tips for impaired people

FLAME

1. Use extreme caution when cooking. Wear

burns

close-fitting and flame-resistant clothes

 

while cooking or near any heat source.

 

2. Avoid throw rugs in the kitchen area and

 

keep the floor clean to avoid falls.

 

3. Use larger astrays. Smoke only while upright.

 

Never smoke in bed or when drowsy.

 

4. Maintain smoke detectors, alarms and

 

prinkler systems in good working order.

 

Check the smoke detector battery once a

 

month.

 

5. Determine emergency exit plans. Practice

 

them routinely with household members.

 

Keep all exit routes clear.

 

6. Have a flashlight, keys, eyeglasses and

 

whistle at the bedside to summon help if

 

needed.

 

7. Ensure that the local fire department is

 

aware of any household members with

 

special needs.

CONTACT

1. With individuals with decreased sensation,

burns

use all heating devices that are placed on

 

or near the skin with caution (e.g., heating

 

pad, hot water bottles, space heaters).

SCALD

1. For people cooking from a wheelchair, a

burns

mirror positioned over the stovetop allows

 

one to see the contents of a pot during

 

cooking. Avoid using heavy, large pans that

 

may be awkward to use especially when

 

filled with hot food.

 

2. Check the temperature on the hot water

 

heater; the recommended setting is 120 ºF

 

(48.8 ºC).

 

3. Install antiscald devices in bathroom

 

plumbing.

Adapted and modified from: Thompson RM, Carrougher GJ (1998) Burn prevention. In: Carrougher GJ (ed) Burn care and therapy. Mosby, St. Louis, pp 497–524 [18]

Prevention of scald burns

Scald burns are responsible for the majority of nonfatal burn injuries in the world. Furthermore, scald burns are the main cause of burn injury in toddlers, involving mostly splash burns from spilled liquids. These injuries are difficult to prevent, and the exact incidence is unknown. These burns are not usually fatal, but unintentional injuries are the leading cause of deaths in children. Other populations at high risk for scald burns, while bathing, are the elderly and people with epilepsy, where there is a heightened risk of seizures and falls and, in the elderly, thinner skin.

Preventive strategies include reducing temperature of hot water heaters to a maximum of 49 – 54ºC (Table 11), installing anti-scald devices to shower heads and faucets or inserting shut-off valves in the water circuit to detect temperatures over a certain level, using large round handles or push-and-turn type handles to prevent young children from turning on the hot water or using liquid-crystal thermometers in bathtubs to alert the caregiver to the water temperature. In some US states, it is imperative, by law, to install appropriate tempering valves in all new domestic dwellings, and water from shower heads and bathtub inlets cannot exceed 46 °C. Small children and disabled people should be constantly supervised when close to hot water. Special caution should also be paid when removing warmed foods – especially liquids – from the microwave oven to avoid steam and scald burns.

Table 11. Time/Temperature relationships in scalds

TEMPERATURE

TIME TO PRODUCE

 

 

FULL-THICKNESS BURN

48.8

ºC = 120 ºF

5 minutes

51.6

ºC = 125 ºF

1.5–2 minutes

54.4

ºC = 130 ºF

30 seconds

57.2 ºC = 135 ºF

10 seconds

60

ºC = 140 ºF

5 seconds

62.9

ºC = 145 ºF

3 seconds

65.5

ºC = 150 ºF

1.5 seconds

68.3

ºC = 155 ºF

1 second

70

Prevention of burn injuries

Table 12. Pediatric burn prevention tips

FLAME burn

1. Store all matches and lighters securely so they are inaccessible to children.

 

2.

Use only child-resistant lighters.

 

3.

Never leave children unattended near a heat source.

 

4.

Infants should wear flame-resistant sleepwear and costumes.

 

5.

Teach children to STOP, DROP and ROLL on the ground if their clothing were to catch

 

 

fire and to place cool water on a burn.

 

6.

Install smoke detectors on each level of the house and outside all sleeping areas. (Be sure

 

 

to read the manufacturer’s instructions). Test the batteries once a month, and allow

 

 

children to hear the alarm so that they will recognize the sound.

 

7. Practice EDITH (Exit Drills In The Home).

 

8.

Install a fire escape ladder in all bedrooms above the first floor.

 

9.

Review the home fire exit plan with all home childcare providers.

 

10.

If a child engages in fire play or fire-setting behaviour, contact the local fire department or

 

 

burn center for educaton and counselling recommendations.

CONTACT burns

1. Use curling irons, irons and glue guns with caution when small children are present.

 

2.

If the outside temperature is high, use caution when placing children in car seats or using

 

 

metal buckles. They should be examined by an adult before use by a child.

 

3.

Caution children about touching heated radiators, space heaters and floor furnace grates.

 

4.

Never leave a child unattended near a campfire. Make sure the child wears shoes to

 

 

prevent injury from contact with hot coals.

SCALD burns

1. Check the temperature on the hot water heater; the recommended setting is 120 ºF

 

 

(48.8 ºC).

 

2.

Install antiscald devices in bathroom plumbing.

 

3.

Never leave young childen unattended in the bathtub or in the kitchen while cooking;

 

 

restrict a child’s access to the kitchen when cooking.

 

4.

Face children away from the bathtub faucet to reduce the likelihood of the child turning

 

 

on the hot water.

 

5.

Double-check the temperature of the bath water before placing a child in the tub

 

 

(recommended temperature is 36.1–37.8 ºC or 97–100 ºF)

 

6.

Review bathtub safety tips with all home childcare providers.

 

7. When carrying or holding children, be sure to keep hot beverages away from the child.

 

8.

When cooking, use the back burners and always turn the pot handles inward.

 

9.

Keep appliances toward the back of the countertop. Wind cords up and out of reach.

 

10.

Avoid using tablecloths with young children present; they can pull them off easily.

 

11. Supervise children closely when hot foods are being served and carried.

 

12.

Never microwave a child’s bottle or allow young children to remove items from the

 

 

microwave.

 

13.

Take extra precautions when removing heated foods from the microwave oven when

 

 

children are around.

 

14.

Use cool mist (not steam) vaporizers.

CHEMICAL burns

1. Keep all chemicals inaccessible to children and in their original container.

 

2.

When finished with a chemical, recap and discard the container appropriately.

ELECTRICAL burns

1. Make sure all electrical outlets are inaccesible to young children. Block outlets with heavy

 

 

furniture and use outlet covers to prevent a child from attempting to insert things into

 

 

them.

 

2.

Never place an electrical appliance near a water source (e.g., bathtub, sink).

 

3.

Use electrical extension cords with caution. Mouth burns have been associated with

 

 

extension cords.

 

4.

Teach children never to extend objects near high-power lines.

RADIATION burns

1. Apply sunscreen to all exposed skin before sun exposure, reapply it as recommended and

 

 

wear protective clothing.

From: Thompson RM, Carrougher GJ (1998) Burn prevention. In: Carrougher GJ (ed) Burn care and therapy. Mosby, St. Louis, pp 497–524 [18]

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