Burn Emergencies
General Information about Burns
One of the most painful injuries
that one can ever experience is a burn injury. When a burn occurs to the
skin, nerve endings are damaged causing intense feelings of pain. Every
year, millions of people in the United States are burned in one way or
another. Of those, thousands die as a result of their burns. Many require
long-term hospitalization. Burns are a leading cause of unintentional
death in the United States, exceeded in numbers only by automobile crashes
and falls.
Serious burns are complex injuries.
In addition to the burn injury itself, a number of other functions may be
affected. Burn injuries can affect muscles, bones, nerves, and blood
vessels. The respiratory system can be damaged, with possible airway
obstruction, respiratory failure and respiratory arrest. Since burns
injure the skin, they impair the body's normal fluid/electrolyte balance,
body temperature, body thermal regulation, joint function, manual
dexterity, and physical appearance. In addition to the physical damage
caused by burns, patients also may suffer emotional and psychological
problems that begin at the emergency scene and could last a long
time.
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Classifying Burns
Burns are classified in two ways:
Method and Degree of burn.
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Methods of Burns
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Thermal - including flame,
radiation, or excessive heat from fire, steam, and hot liquids and hot
objects.
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Chemical - including various
acids, bases, and caustics.
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Electrical - including electrical
current and lightning.
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Light - burns caused by intense
light sources or ultraviolet light, which includes sunlight.
-
Radiation - such
as from nuclear sources. Ultraviolet light is also a source of radiation
burns.
Never assume the source of a
burn. Gather information and be sure.
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Degrees of Burns
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First degree burns are
superficial injuries that involve only the epidermis or outer layer of
skin. They are the most common and the most minor of all burns. The skin
is reddened and extremely painful. The burn will heal on its own without
scarring within two to five days. There may be peeling of the skin and
some temporary discoloration.
-
Second degree burns occur
when the first layer of skin is burned through and the second layer, the
dermal layer, is damaged but the burn does not pass through to
underlying tissues. The skin appears moist and there will be deep
intense pain, reddening, blisters and a mottled appearance to the skin.
Second degree burns are considered minor if they involve less than 15
percent of the body surface in adults and less than 10 percent in
children. When treated with reasonable care, second degree burns will
heal themselves and produce very little scarring. Healing is usually
complete within three weeks.
-
Third degree burns involve
all the layers of the skin. They are referred to as full thickness burns
and are the most serious of all burns. These are usually charred black
and include areas that are dry and white. While a third-degree burn may
be very painful, some patients feel little or no pain because the nerve
endings have been destroyed. This type of burn may require skin
grafting. As third degree burns heal, dense scars
form.
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Determining the Severity of Burns
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Source of the burn - a minor burn
caused by nuclear radiation is more severe than a burn caused by thermal
sources. Chemical burns are dangerous because the chemical may still be
on the skin.
-
Body regions burned - burns to the
face are more severe because they could affect airway management or the
eyes. Burns to hands and feet are also of special concern because they
could impede movement of fingers and toes.
-
Degree of the burn - the degree of
the burn is important because it could cause infection of exposed
tissues and permit invasion of the circulatory system.
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Extent of burned surface areas -
It is important to know the percentage of the amount of the skin surface
involved in the burn. The adult body is divided into regions, each of
which represents nine percent of the total body surface. These regions
are the head and neck, each upper limb, the chest, the abdomen, the
upper back, the lower back and buttocks, the front of each lower limb,
and the back of each lower limb. This makes up 99 percent of the human
body. The remaining one percent is the genital area. With an infant or
small child, more emphasis is placed on the head and trunk.
-
Age of the patient - This is
important because small children and senior citizens usually have more
severe reactions to burns and different healing processes.
-
Pre-existing physical or mental
conditions - Patients with respiratory illnesses, heart disorders,
diabetes or kidney disease are in greater jeopardy than normally healthy
people.
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Treatment of Burns
Cool a burn with water. Do what you
must to get cool water on the burn as soon as you can. Go to the nearest
water faucet and turn on the cold spigot and get cool water on the burn.
Put cool, water-soaked cloths on the burn. If possible, avoid icy cold
water and ice cubes. Such measures could cause further damage to burned
skin.
Never apply
ointment, grease or butter to the burned area. Applying such products,
actually confine the heat of the burn to the skin and do not allow the
damaged area to cool. In essence, the skin continues to "simmer." After
the initial trauma of the burn and after it has had sufficient time to
cool, it would then be appropriate to put an ointment on the burn.
Ointments help prevent infection.
The one exception to the "Cool a
Burn" method is when the burn is caused by lime powder. In that case,
carefully brush the lime off the skin completely and then flush the area
with water. In the event of any serious burns, call 9-1-1.
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Emergencies
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