Paediatric burns emergency guidelines | Right Decisions

Announcements and latest updates

Polyfill.io vulnerability

28 june 2024

Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers.

Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.

Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing of the deployment as soon as possible.

In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.

Based on COBIS guidelines 2019.

Initial management

Assess pain score
Weigh child
Assess burn area/depth and cover
Paracetamol 20mg/kg orally or 40mg/kg rectally
Intravenous or intranasal opiates
Consider ketamine IM or IV

Burns dressings

Superficial dermal less than 3%

de-roof blisters and debride loose skin
cleanse with warmed normal saline
obtain wound swabs
apply Mepitel dressings and sterile gauze and crepe bandage
review in 24-48 hrs

Superficial dermal greater than 3%

As above but refer to plastics for consideration of Biobrane dressings

Deep dermal, full thickness less than 1%

as per superficial dermal but dress with Mepitel.
will require follow up by Plastics within 48 hrs for scar management.

Full thickness greater than 1%

Mepitel dressings and admission under care of Plastics.

Criteria for referral to Plastics

All burns requiring specialist input are to be referred to the on call plastic surgeon in Ninewells.

Burns requiring immediate referral:

• Any burn greater than 3% TBSA

• Full thickness burns greater than 1%

• Burns to hands, face, feet, perineum or joint involvement

• High voltage electrical injury

• Chemical injury

• Airway involvement

• Burns with associated significant injury

• Any burn suspected of being non accidental (refer to local child protection policy)

• Circumferential burns

Burns that do not require admission which need prompt review in an appropriate Burns clinic

• Burns less than 3% with doubt regarding depth of injury

• Deep dermal / Full thickness injuries less than 1%

• Burns less than 3% that have not healed within 7-10 days

COBIS guidelines

COBIS guidelines