What are the red flags for minor burns & scalds in urgent care?

Airway burns, facial burns, soot, hoarse voice → Inhalation injury — ED/anaesthetics now; ≥ 3% TBSA in adults (≥ 2% in children) partial thickness or deeper → Burns service referral; Face, hands, feet, genitals, perineum, major joints → Burns service referral; Full-thickness, circumferential, chemical or electrical burn → Burns service referral; Mechanism inconsistent with history, or delayed presentation in a child → Safeguarding

Which decision rule is used for minor burns & scalds?

National burns referral triggers: ≥ 3% TBSA adults / ≥ 2% children (partial thickness or deeper); Any full-thickness burn; Special areas: face, hands, feet, genitalia, perineum, major joints; Circumferential burns; Chemical, electrical, friction or cold injury; Inhalation injury; suspected non-accidental injury; Not healed in 2 weeks. Photograph (with consent) and discuss with the local burns service. Their referral line can advise.

What should I prescribe for minor burns & scalds?

Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Ibuprofen: 400 mg three times a day with food (3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy)

Minor Burns: First Aid, Dressings & Referral Criteria | Urgent Care Clinic

Q: What safety-netting advice should I give for minor burns & scalds?

Advise the patient to return or seek help if: Increasing pain, redness spreading beyond the burn, smell, pus; Fever, rash, vomiting, diarrhoea or feeling very unwell (toxic shock — especially children); Not healed after 2 weeks.

1Rule out first — red flags

If you find…	…then
Airway burns, facial burns, soot, hoarse voice	Inhalation injury — ED/anaesthetics now
≥ 3% TBSA in adults (≥ 2% in children) partial thickness or deeper	Burns service referral
Face, hands, feet, genitals, perineum, major joints	Burns service referral
Full-thickness, circumferential, chemical or electrical burn	Burns service referral
Mechanism inconsistent with history, or delayed presentation in a child	Safeguarding

2Focused history

Mechanism: scald, flame, contact, chemical, electrical
Time of injury and first aid given (how long cooled?)
Pain level (full-thickness burns may be painless)
Tetanus status
PMH: diabetes, smoking, immunosuppression; safeguarding concerns

3Focused examination

Size: palm of the patient’s hand (incl. fingers) ≈ 1% TBSA; don’t count erythema
Depth: erythema only / blistered pink moist (superficial partial) / pale or mottled (deep partial) / white leathery painless (full thickness)
Capillary refill in the burn
Site and circumferential involvement

4Decide — investigate only if it changes the plan

National burns referral triggers

≥ 3% TBSA adults / ≥ 2% children (partial thickness or deeper)
Any full-thickness burn
Special areas: face, hands, feet, genitalia, perineum, major joints
Circumferential burns
Chemical, electrical, friction or cold injury
Inhalation injury; suspected non-accidental injury
Not healed in 2 weeks

Photograph (with consent) and discuss with the local burns service. Their referral line can advise.

Investigation	Only if…
None for minor burns	Carboxyhaemoglobin / ABG only if smoke exposure

5Treat & send home

Management & advice

Cool with cool running water for 20 minutes (useful up to 3 h after injury)
Clean; de-roof large or tense blisters per local guidance
Non-adherent dressing (e.g. silicone mesh) with absorbent secondary dressing; cling film for transport
Review in 48 h (dressing clinic / GP nurse) — depth can progress
Erythema only: emollient, no dressing needed
Tetanus as for wounds

Refer / follow-up

Any referral trigger → burns service (call their referral line)

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Ibuprofen	400 mg three times a day with food	3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy

6Safety-net

Say it like this

This is a small burn that should heal on its own in about 1 to 2 weeks. Keep the dressing clean and dry, and the nurse will check it in 2 days. Come back straight away if it gets more painful or red around the edges, smells, oozes, or you or your child get a fever, rash or diarrhoea and vomiting.

Come back / call 111 — or 999 if severe — if:

Increasing pain, redness spreading beyond the burn, smell, pus
Fever, rash, vomiting, diarrhoea or feeling very unwell (toxic shock — especially children)
Not healed after 2 weeks

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Burns and scaldsnhs.uk/conditions/burns-and-scalds

8Document

Minor burns & scalds — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — MINOR BURNS & SCALDS PRESENTING COMPLAINT: HISTORY Mechanism: scald, flame, contact, chemical, electrical: Time of injury and first aid given (how long cooled?): Pain level (full-thickness burns may be painless): Tetanus status: PMH: diabetes, smoking, immunosuppression; safeguarding concerns: RED FLAGS (record present / absent) [ ] Airway burns, facial burns, soot, hoarse voice [ ] ≥ 3% TBSA in adults (≥ 2% in children) partial thickness or deeper [ ] Face, hands, feet, genitals, perineum, major joints [ ] Full-thickness, circumferential, chemical or electrical burn [ ] Mechanism inconsistent with history, or delayed presentation in a child PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Size: palm of the patient’s hand (incl. fingers) ≈ 1% TBSA; don’t count erythema: Depth: erythema only / blistered pink moist (superficial partial) / pale or mottled (deep partial) / white leathery painless (full thickness): Capillary refill in the burn: Site and circumferential involvement: DECISION RULE — National burns referral triggers: result ______ INVESTIGATIONS: none required / None for minor burns — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Burns and scalds Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Increasing pain, redness spreading beyond the burn, smell, pus - Fever, rash, vomiting, diarrhoea or feeling very unwell (toxic shock — especially children) - Not healed after 2 weeks Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More wounds, burns & skin

Lacerations & wound careClose it right, check tetanus, and know which wounds aren’t yours.Human & animal bitesWho gets prophylaxis, rabies risk and the fight bite.Insect bites, stings & tick bitesBig local reactions vs infection vs anaphylaxis — and Lyme.CellulitisOral antibiotics at home or IV? Mark the edges and safety-net.