What is the emergency treatment for a circumferential burn of the forearm from a pot of boiling water?

Emergency Treatment for Circumferential Burns of the Forearm

For circumferential burns of the forearm from boiling water, immediate cooling with clean running water for 5-20 minutes is the essential first step, followed by assessment for signs of compartment syndrome and appropriate referral to a burn center. 1, 2

Initial Management

1. Stop the burning process:

   • Remove any contaminated clothing and jewelry immediately before swelling occurs 1, 2
   • Cool the burn with clean running water (15-25°C) for 5-20 minutes 1, 2
   • Monitor for signs of hypothermia, especially in children 1

2. Assess burn severity:

   • Determine depth (partial vs. full thickness)
   • Calculate total body surface area (TBSA) affected
   • Circumferential burns of the forearm are considered high-risk due to potential for compartment syndrome 1, 2

3. Monitor for compartment syndrome:

   • Check for the 6 Ps: Pain, Pallor, Paresthesia, Paralysis, Pulselessness, and Poikilothermia 3
   • Assess distal circulation, sensation, and motor function every 15-30 minutes 1

Wound Care

• After cooling, cover the burn with a clean, non-adherent dressing 1, 2
• Do not apply ice directly to the burn as it can cause tissue ischemia 1
• Do not break intact blisters 1
• Do not apply topical antibiotics prophylactically as they show no clear benefit and may select for resistant bacteria 2

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs 1, 2
• For severe pain, consider stronger analgesics if available 2

Referral Criteria

Immediate medical attention/transfer to a burn center is required for:

• All circumferential burns of the extremities 1, 2
• Full-thickness (third-degree) burns 1, 2
• Burns involving >10% TBSA in children or >20% in adults 1, 2
• Signs of compartment syndrome 1

Management of Compartment Syndrome

If signs of compartment syndrome develop:

• Elevate the extremity
• Urgent transfer to a burn center is essential 1
• Escharotomy may be required but should only be performed at a burn center 1

Important Considerations

• Direct admission to a burn center is preferred as it reduces morbidity and mortality 1, 2
• Circumferential burns can lead to constriction and increased pressure inside the anatomical compartment, potentially causing acute limb ischemia 1
• Recent evidence suggests enzymatic debridement may be an alternative to surgical escharotomy in specialized burn centers, but this is not a first aid intervention 4, 5, 3

Pitfalls to Avoid

• Do not apply home remedies or butter to burns
• Do not use pressure points or elevation alone to control bleeding 1
• Do not delay transfer to a burn center for circumferential burns 1
• Do not perform escharotomy in the field; this procedure should only be done at a burn center by specialists 1
• Do not underestimate the severity of circumferential burns, as they can rapidly progress to compartment syndrome 1, 3

Remember that circumferential burns of the forearm represent a serious injury that requires prompt professional medical attention due to the high risk of compartment syndrome and potential for long-term functional impairment.