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Burns : First Aid

A major burn is a horrifying injury, necessitating painful treatment and a long period of rehabilitation. It's often fatal or permanently disfiguring and incapacitating (both emotionally and physically). In the United States, about 2 million persons annually suffer burns. Of these, 300,000 are burned seriously and over 6,000 are fatalities, making burns this nation's third leading cause of accidental death

Causes

Thermal burns the most common type,are frequently the result of residential fires, motor vehicle accidents, playing with matches, improperly stored gasoline, space heater or electrical malfunctions, or arson. Other causes include improper handling of firecrackers, scalding accidents, and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns in children are sometimes traced to parental abuse.

Chemical burns result from the contact, ingestion, inhalation, or injection of acids, alkalis, or vesicants. Electrical burns usually occur after contact with faulty electrical wiring or high voltage power lines or when electric cords are chewed (by young children). Friction or abrasion burns happen when the skin is rubbed harshly against a coarse surface. Sunburn, of course, follows excessive exposure to sunlight.

Depth of skin and tissue damage

A traditional method gauges burn depth by degrees, although most burns are a combination of different degrees and thicknesses.

• First-degree - Damage is limited to the epidermis, causing erythema and pain.
• Second-degree - The epidermis and part of the dermis are damaged, producing blisters and mild to moderate edema and pain.
• Third-degree - The epidermis and the dermis are damaged. No blisters appear, but white, brown, or black leathery tissue and thrombosed vessels are visible.
• Fourth-degree - Damage extends through deeply charred subcutaneous tissue to muscle and bone.

Burn size

The size is usually expressed as the percentage of body surface area (BSA) covered by the burn. The Rule of Nines chart most commonly provides this estimate, although the Lund-Browder chart is more accurate because it allows for BSA changes with age. A correlation of the burn's depth and size permits an estimate of its severity.

• Major - third-degree burns on more than 10% of BSA; second-degree burns on more than 25% of adult BSA (more than 20% in children); burns of hands, face, feet, or genitalia; burns complicated by fractures or respiratory damage; electrical burns; all burns in poorrisk patients
• Moderate - third-degree burns on 2% to 10% of BSA; second-degree burns on 15% to 25% of adult BSA (10% to 20% in children)
• Minor - third-degree burns on less than 2% of BSA; second-degree burns on less than 15% of adult BSA (10% in children).

Treatment - Burns: First aid

First-degree burn

The least serious burns are those in which only the outer layer of skin (epidermis) is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't been burned through. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint.

FOR MINOR BURNS

• If the skin is unbroken, run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area submerged for at least 5 minutes. A clean, cold, wet towel will also help reduce pain.
• Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin.
• Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.
• Protect the burn from pressure and friction.

Caution

• Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
• Don't break blisters. Broken blisters are vulnerable to infection.

FOR MAJOR BURNS

• If someone is on fire, tell the person to STOP, DROP, and ROLL. Wrap the person in thick material to smother the flames (a wool or cotton coat, rug, or blanket). Douse the person with water.
• Don't immerse severe large burns in cold water. Doing so could cause shock.
• Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.
• If fingers or toes have been burned, separate them with dry, sterile, non-adhesive dressings.
• Make sure that the person is no longer in contact with smoldering materials. However, DO NOT remove burnt clothing that is stuck to the skin.

Prevention

• Teach children about fire safety and the hazards of matches and fireworks.
• DO NOT give the person anything by mouth, if there is a severe burn.
• Know about and practice fire escape routes at home, work, and school.
• DO NOT breathe, blow, or cough on the burn.
• DO NOT place a pillow under the person's head if there is an airway burn. This can close the airway.