Burns in the Emergency Department
Katie Leonard M.D discusses burns in the emergency department. She shares home treatment methods, when it is vital you take your child to the ER and great tips for what parents can do to prevent burns at home.
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Learn more about Katie Leonard, MD
Katie Leonard, MD
Katie Leonard, MD is an Assistant Professor, Emergency Medicine.Learn more about Katie Leonard, MD
Transcription:
Katie Leonard, MD (Guest): Hi I'm Dr. Katie Leonard and I'm a Washington University pediatric emergency medicine physician at St. Louis Children’s Hospital and a Mom Doc.
Melanie Cole, MS (Host): This is Mom Docs, the podcast from St. Louis Children’s Hospital. I'm Melanie Cole and today we’re talking about burns in the emergency department. Dr. Leonard, I'm so glad to have you join us today. What are the different types of burns? For parents listening, tell us what types of burns that you see every day.
Dr. Leonard: Yeah so there are a couple different kinds of burns that we see. I would say probably the most common are thermal burns, and that’s what people most thing about when they think about burn injury. We generally see scald injuries, which is when children are exposed to scalding liquid or hot objects.
Host: How are burns so common? Why are they so common? We’ve heard about them for years. We know to take precautions, but they still keep happening.
Dr. Leonard: Because kids are sneaky. I think that it can be easy to forget kind of basic safety measures when you're going about your day to day activities with children. Some things that we continue to remind families to help minimize risk because prevention is the best thing that we can do for these type of injuries is to remind parents not to cook, drink, or carry hot beverages or food while they're holding a child, especially when they're at that grabby age. Keeping hot foods and liquids away from table and counter edges, avoiding using tablecloths or placemats that young children can reach up and grab and pull hot things down on themselves. Obviously turning the handles of pots and pans towards the rear of the stove when you're cooking and using back burners when you can. Not leaving the stove unattended when you're cooking, not letting kids microwave their own food when it involves liquid. We see a lot of injuries due to ramen noodles and those little bowls of mac and cheese. When using irons and curling irons, making sure they're unplugged and out of reach. Testing food and water temperature before exposing kids to those. Then a big one too is setting your thermostat on your hot water heater to below 120 degrees is the safest temperature to have that set at to avoid water getting too hot and exposing kids to potential injury.
Host: What great advice. So important for parents to hear. So if a child does get burned, Dr. Leonard, it’s common, it’s scary. Parents done know what to do. How do we know the severity of it and whether it requires an ER visit?
Dr. Leonard: Yeah so the first thing to do is you can stop the burning process. So we say do a cool—not cold and no ice—but just cool rag on the burn would area. Then if it’s blistering or the skin is peeling, it definitely needs to be evaluated. Then the other areas that always concern us are if it’s on the face, the hands, or the feet, in the genital region, those should always be evaluated. Then if it’s a large percentage of the surface area, so a large burn.
Host: If it’s something that we can treat at home, what do we do? Because we don’t know whether we should put ice on it or wrap it. We used to think we’re supposed to put Vaseline then we heard we’re not. What do we do doctor?
Dr. Leonard: Yeah so if it’s not blistering and the skin isn’t peeling and it’s just an area of redness, after you’ve put your cool cloth on it for three to five minutes you can remove it. Then really the best recommendation is just a clean, dry dressing. So depending on the size that could be a piece of gauze with medical tape, it could be a band aid. It’s fine to put antibiotic ointment on it. Then just kind of reassess it. If the skin ever does start to peel away and you have questions about whether it should be looked at, always erring on the side of caution is appropriate.
Host: What do you do in the emergency department if we have a child that gets burned? What's the treatment available?
Dr. Leonard: Yeah that’s a great question. It depends on the severity of the burn, which is difficult for a lay person to truly assess, which is why I say to err on the side of caution and seek medical advice for that. If the skin is significantly blistered or the burn is deep enough that the skin is sloughing off and peeling, we will generally do what is called a debridement, which is we kind of pull all of the damaged burned skin off using wet gauze and then do sort of a fancier version of the dressing that you would do at home, which is using antibiotic ointment, nonstick gauze, and then kind of a bulky dressing to protect the area. Often because the burned skin is so sensitive and painful, we will have to give children pain medication or even sedation to do that procedure.
Host: Wow. It is really scary. So what about things like sunburn? I know that’s kind of a different topic, but it can be pretty severe and have so many of the same symptoms and then treatments that are needed.
Dr. Leonard: Yes. So sunburn I think the biggest things are pain control with Tylenol and ibuprofen. Then I think it’s good practice to keep the skin lubricated to just sort of help it with the healing process. So Vaseline would be fine for that. If the skin is blistering and peeling because the burn was so significant, it would be reasonable to have it be seen by a medical provider. Usually we don’t see sunburns that are to the degree that we need to do debridement procedures the way we do with other thermal burns.
Host: It’s a good point. So as we wrap up, what can parents do to prevent burns at home? You’ve given us some really great advice. Expand on it a little more and summarize it for us Dr. Leonard.
Dr. Leonard: Well yes. To prevent thermal burns, keeping hot objects unplugged and out of reach of children. Then really limiting their exposure and availability of hot liquids while cooking, keeping bowls of soup, cups of coffee/tea on the edges of tables and countertops where they could be grabbed and pulled down and not letting children cook for themselves on the stove or in the microwave when it’s liquid food is important. The other thing that I didn’t mention that I should is chemical burns. Again, children can get into chemicals and suffer from chemical burns. So making sure that all of your cleaning supplies and other chemicals are locked up and out of reach.
Host: That’s great information. Thank you so much Dr. Leonard for joining us and sharing your expertise today. That concludes this episode of Mom Docs with St. Louis Children’s Hospital. For more advice and articles on children’s burn management, please check out the Mom Doc’s website at childrensmd.org for more information and to get connected with one of our providers. Please share this show on your social media and with your friends because that’s how we all learn from the Mom Doc experts at St. Louis Children’s Hospital together. I'm Melanie Cole.
Katie Leonard, MD (Guest): Hi I'm Dr. Katie Leonard and I'm a Washington University pediatric emergency medicine physician at St. Louis Children’s Hospital and a Mom Doc.
Melanie Cole, MS (Host): This is Mom Docs, the podcast from St. Louis Children’s Hospital. I'm Melanie Cole and today we’re talking about burns in the emergency department. Dr. Leonard, I'm so glad to have you join us today. What are the different types of burns? For parents listening, tell us what types of burns that you see every day.
Dr. Leonard: Yeah so there are a couple different kinds of burns that we see. I would say probably the most common are thermal burns, and that’s what people most thing about when they think about burn injury. We generally see scald injuries, which is when children are exposed to scalding liquid or hot objects.
Host: How are burns so common? Why are they so common? We’ve heard about them for years. We know to take precautions, but they still keep happening.
Dr. Leonard: Because kids are sneaky. I think that it can be easy to forget kind of basic safety measures when you're going about your day to day activities with children. Some things that we continue to remind families to help minimize risk because prevention is the best thing that we can do for these type of injuries is to remind parents not to cook, drink, or carry hot beverages or food while they're holding a child, especially when they're at that grabby age. Keeping hot foods and liquids away from table and counter edges, avoiding using tablecloths or placemats that young children can reach up and grab and pull hot things down on themselves. Obviously turning the handles of pots and pans towards the rear of the stove when you're cooking and using back burners when you can. Not leaving the stove unattended when you're cooking, not letting kids microwave their own food when it involves liquid. We see a lot of injuries due to ramen noodles and those little bowls of mac and cheese. When using irons and curling irons, making sure they're unplugged and out of reach. Testing food and water temperature before exposing kids to those. Then a big one too is setting your thermostat on your hot water heater to below 120 degrees is the safest temperature to have that set at to avoid water getting too hot and exposing kids to potential injury.
Host: What great advice. So important for parents to hear. So if a child does get burned, Dr. Leonard, it’s common, it’s scary. Parents done know what to do. How do we know the severity of it and whether it requires an ER visit?
Dr. Leonard: Yeah so the first thing to do is you can stop the burning process. So we say do a cool—not cold and no ice—but just cool rag on the burn would area. Then if it’s blistering or the skin is peeling, it definitely needs to be evaluated. Then the other areas that always concern us are if it’s on the face, the hands, or the feet, in the genital region, those should always be evaluated. Then if it’s a large percentage of the surface area, so a large burn.
Host: If it’s something that we can treat at home, what do we do? Because we don’t know whether we should put ice on it or wrap it. We used to think we’re supposed to put Vaseline then we heard we’re not. What do we do doctor?
Dr. Leonard: Yeah so if it’s not blistering and the skin isn’t peeling and it’s just an area of redness, after you’ve put your cool cloth on it for three to five minutes you can remove it. Then really the best recommendation is just a clean, dry dressing. So depending on the size that could be a piece of gauze with medical tape, it could be a band aid. It’s fine to put antibiotic ointment on it. Then just kind of reassess it. If the skin ever does start to peel away and you have questions about whether it should be looked at, always erring on the side of caution is appropriate.
Host: What do you do in the emergency department if we have a child that gets burned? What's the treatment available?
Dr. Leonard: Yeah that’s a great question. It depends on the severity of the burn, which is difficult for a lay person to truly assess, which is why I say to err on the side of caution and seek medical advice for that. If the skin is significantly blistered or the burn is deep enough that the skin is sloughing off and peeling, we will generally do what is called a debridement, which is we kind of pull all of the damaged burned skin off using wet gauze and then do sort of a fancier version of the dressing that you would do at home, which is using antibiotic ointment, nonstick gauze, and then kind of a bulky dressing to protect the area. Often because the burned skin is so sensitive and painful, we will have to give children pain medication or even sedation to do that procedure.
Host: Wow. It is really scary. So what about things like sunburn? I know that’s kind of a different topic, but it can be pretty severe and have so many of the same symptoms and then treatments that are needed.
Dr. Leonard: Yes. So sunburn I think the biggest things are pain control with Tylenol and ibuprofen. Then I think it’s good practice to keep the skin lubricated to just sort of help it with the healing process. So Vaseline would be fine for that. If the skin is blistering and peeling because the burn was so significant, it would be reasonable to have it be seen by a medical provider. Usually we don’t see sunburns that are to the degree that we need to do debridement procedures the way we do with other thermal burns.
Host: It’s a good point. So as we wrap up, what can parents do to prevent burns at home? You’ve given us some really great advice. Expand on it a little more and summarize it for us Dr. Leonard.
Dr. Leonard: Well yes. To prevent thermal burns, keeping hot objects unplugged and out of reach of children. Then really limiting their exposure and availability of hot liquids while cooking, keeping bowls of soup, cups of coffee/tea on the edges of tables and countertops where they could be grabbed and pulled down and not letting children cook for themselves on the stove or in the microwave when it’s liquid food is important. The other thing that I didn’t mention that I should is chemical burns. Again, children can get into chemicals and suffer from chemical burns. So making sure that all of your cleaning supplies and other chemicals are locked up and out of reach.
Host: That’s great information. Thank you so much Dr. Leonard for joining us and sharing your expertise today. That concludes this episode of Mom Docs with St. Louis Children’s Hospital. For more advice and articles on children’s burn management, please check out the Mom Doc’s website at childrensmd.org for more information and to get connected with one of our providers. Please share this show on your social media and with your friends because that’s how we all learn from the Mom Doc experts at St. Louis Children’s Hospital together. I'm Melanie Cole.