Burns, Scalds, Electric Shock & Poisoning

A toddler pulls a mug of hot tea over his arm at snack time. What should you do first?

• ACover the arm with an ice pack from the freezer
• BRub butter over the reddened skin
• CHold the arm under cool running water✓
• DStick a large plaster over the red area

Answer: Cooling under cool running water for 20 minutes is the immediate treatment for a scald and should start as soon as possible. Butter and other greasy substances trap heat, ice damages the burnt skin further, and a plaster or sticky dressing should never be put on a burn.

For how long should a burn or scald be held under cool running water?

• A20 minutes✓
• B45 minutes
• C2 minutes
• D5 minutes

Answer: NHS guidance is 20 minutes of cool running water, which draws the heat out of the tissue and limits the depth of the burn. Two or five minutes is far too short to be effective, and 45 minutes is unnecessary and risks making a small child cold.

A child arrives at nursery with a scald from breakfast that was never cooled. Within how long of the injury does the NHS say cooling can still be worthwhile?

• A24 hours
• B1 hour
• C3 hours✓
• D12 hours

Answer: The NHS advises cooling as soon as possible and within 3 hours of the burn, so a scald from breakfast may still benefit. One hour is too narrow a window, and after 12 or 24 hours the heat has long since dissipated and cooling no longer helps.

A child's sleeve is stuck to a scald on her arm. How should you deal with the clothing?

• ACut away the fabric including the stuck part
• BSoak the fabric in oil so it slides off
• CLeave the stuck fabric where it is and cool over it✓
• DPeel the fabric away slowly under the running water

Answer: Clothing and jewellery near a burn are removed unless stuck to the skin, in which case the fabric is left alone and cooling continues through it. Peeling or cutting away stuck fabric tears the burnt skin, and oil traps heat and should never go on a burn.

You have cooled a scald on a child's hand for 20 minutes. How should you cover it while you wait for the parents?

• AWrap cling film tightly round the whole hand
• BLay a layer of cling film loosely over the burn✓
• CStick a large adhesive plaster over the burn
• DApply a thick layer of antiseptic cream

Answer: Cling film laid over a cooled burn keeps it clean without sticking to the damaged skin. Wrapping it tightly can cut off circulation as the burn swells, plasters and sticky dressings stick to the wound, and creams should not be applied to a burn.

Which of these burns needs 999 or A&E regardless of how small it looks?

• AA reddened patch on the forearm from a radiator
• BA sunburnt patch on the shoulder
• CA pink mark on the shin from a hot-water bottle
• DA burn caused by an electric current✓

Answer: Electrical and chemical burns always need hospital assessment, as do burns that are large or deep or on the face, genitals or bottom. A pink mark, a reddened patch from a radiator or mild sunburn can usually be managed with cooling and covering, with NHS 111 if you are unsure.

A blister has formed on a child's scald after cooling. What should you do with it?

• ASnip the top off with clean scissors
• BBurst it with a sterilised needle
• CLeave it intact and cover with cling film✓
• DPress it flat with a clean dressing

Answer: A blister is a natural barrier against infection, so it is left unbroken and covered. Bursting, pressing or cutting it opens the wound to infection and increases pain and scarring.

A three-year-old has a scald the size of a 50p coin on her forearm. You have cooled and covered it but are unsure whether it needs medical attention. Who should you contact for advice?

• APhone NHS 111 for advice✓
• BPhone the HSE incident line
• CPhone Ofsted to report it
• DPhone the local pharmacy

Answer: When you are unsure about a burn the NHS says to contact 111, and for a child under 5 you should phone rather than use the online service. Ofsted and the HSE are regulators, not sources of clinical advice, and a pharmacy is not the right place to assess a burn on a small child.

A child has chewed through a lamp flex and is lying still, with the bare wire still touching his hand. What should you do first?

• ASwitch off the power at the mains before touching him✓
• BStart chest compressions while he is still in contact
• CPull him away from the flex by his arm straight away
• DThrow a cup of water over the flex to break the current

Answer: The supply must be switched off at the mains or unplugged before anyone touches the child, otherwise the rescuer is electrocuted too; then follow DR ABC. Grabbing his arm or starting compressions while he is live puts you in the circuit, and water conducts electricity and makes things worse.

A child is in contact with a live electrical source and you cannot reach the mains switch or the plug. How can you separate her from it safely?

• APull her clear with your bare hands
• BPush her clear with a wooden broom handle✓
• CPush her clear with a metal mop pole
• DPour water over her to break the contact

Answer: A dry, non-conductive object such as a wooden broom handle lets you push the child away without the current passing through you. Bare hands and a metal pole conduct electricity to the rescuer, and water conducts too, so pouring it over the child endangers both of you.

A child who had an electric shock from a faulty socket has a small burn mark on his finger and otherwise seems fine. What should happen?

• ATake him to A&E because of possible internal injury✓
• BCool the burn and let him return to play
• CGive paracetamol and keep him in the quiet room
• DCover the burn with a plaster and tell the parents

Answer: Every electrical burn goes to A&E because the current can cause internal damage that is not visible from the small mark on the skin. Returning to play, a plaster or paracetamol all treat only what can be seen, and plasters should not be put on burns anyway.

A toddler has swallowed some cleaning product from a bottle found under the sink. Which action is correct?

• AMake her sick to bring the product up
• BGive her plenty of water to dilute the product
• CKeep the bottle to show the paramedics✓
• DGive her a glass of milk to line her stomach

Answer: The container tells hospital staff exactly what was swallowed, so it is found and kept to go with the child. Making a child vomit can cause a corrosive product to burn the throat again on the way up, and nothing is given to eat or drink, so milk and water are both wrong.

A child has swallowed some tablets from a handbag and is now drowsy and difficult to rouse. Who should you call?

• ACall the child's GP surgery
• BCall 999 for an ambulance✓
• CCall the parents to collect her
• DCall NHS 111 for advice

Answer: Drowsiness after swallowing something harmful is a 999 emergency, as is being unresponsive, not breathing, seizing or struggling to breathe. NHS 111 is for when you are unsure and the child is well, and a GP surgery or the parents cannot provide emergency treatment; while waiting, put her in the recovery position if she becomes unconscious but is breathing, and keep a sample of any vomit.

A two-year-old has swallowed a button battery from a toy remote and seems completely well. What should you do?

• AWatch her for 24 hours for signs of tummy pain
• BWait for it to pass naturally in her nappy
• CGive bread to push it through her gut
• DTake her to A&E or call 999 straight away✓

Answer: A swallowed button battery is treated as a 999 or A&E emergency whether or not the child has symptoms, alongside medicines, cleaning products, plants and berries as common nursery poisons. Watching and waiting or giving food to move it along delays treatment, and nothing should be given to eat or drink after a possible poisoning.