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Burns
Burn injuries can be classified as
thermal (heat), chemical, or
electrical.
. Thermal (heat)
burns. Not all thermal burns
are caused by flames. Contact with hot
objects, flammable vapor that ignites
and causes a flash or an explosion,
and steam or hot liquid are other
common causes of burns.
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. Chemical burns.
A wide range of chemical agents can
cause tissue damage and death if they
come in contact with the skin. As with
thermal burns, the amount of tissue
damage depends on the duration of
contact, the skin thickness in the
area of exposure, and the strength of
the chemical agent. Chemicals will
continue to cause tissue destruction
until the chemical agent is removed.
Three types of chemicals-acids,
alkalis, and organic compounds-are
responsible for most chemical burns.
. Electrical
burns. The severity of an
injury from contact with electrical
current depends on the type of current
(direct or alternating), the voltage,
the area of the body exposed, and the
duration of contact.
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Historically, burns have been
described as first-degree, second-degree,
and third-degree injuries. The terms
superficial, partial thickness, and
full thickness are often used by
burn-care professionals because they
are more descriptive of the tissue
damage.
. First-degree
(superficial) burns affect the
skin's outer layer (epidermis) .
Characteristics include redness, mild
swelling, tenderness, and pain.
Healing occurs without scarring,
usually within a week. The outer edges
of deeper burns often are first
-degree burns.
. Second-degree
(partial-thickness) burns
extend through the entire outer layer
and into the inner skin layer ( _
Figure 2 ). Blisters, swelling,
weeping of fluids, and severe pain
characterize these burns, because the
capillary blood vessels in the dermis
are damaged and give up fluid into
surrounding tissues. Intact blisters
provide a sterile, waterproof
covering.
First-degree
Second-degree burn blisters
Once a blister breaks, a weeping
wound results and the risk of
infection increases.
. Third-degree
(full-thickness) burns are
severe burns that penetrate all the
skin layers, into the underlying fat
and muscle (_Figure 3). The skin looks
leathery, waxy, or pearly gray and
sometimes charred. There is a dry
appearance, because capillary blood
vessels have been destroyed and no
more fluid is brought to the area. The
skin does not blanch after being
pressed because the area is dead. The
victim feels no pain from a
third-degree burn because the nerve
endings have been damaged or
destroyed. Any pain that is felt is
from surrounding burns of lesser
degrees. Medical care for a
third-degree burn involves removing
the dead tissue and often a skin graft
to heal properly.
Respiratory damage may result from
breathing heat or the products of
combustion;
Rule of Nines
is used
to calculate the extent
of a burn
Do NOT
remove clothing stuck to the
skin.Pulling will further damage the
skin.
Do NOT forget to remove jewelry as
soon as possible-swelling could make
jewelry difficult remove later.
children and infants, the head
accounts for 18% and each leg is 14%.
For small or scattered burns, use the
rule of the palm. The victim's hand,
excluding the fingers and the thumb,
represents about 1 % of his or her
total
body surface. Estimate the unburned
area in number of hands.
Determine what parts of the body are
burned. Burns on the face, hands,
feet, and genitals are more severe
than on other body parts. A
circumferential burn (one that goes
around a finger, toe, arm, leg, neck,
or chest) is considered more severe
than a non circumferential one because
it can have constriction and
tourniquet effects on circulation and,
in some cases, breathing. All these
burns require immediate medical care.
Determine if other injuries or
preexisting medical problems exist or
if the victim is elderly (over 55)
or very young (under five). A medical
problem or belonging to one of those
age groups increases a burn's
severity.
7. Determine the burn's severity (
"'Table 1 ). This forms the basis for
how to treat the burned victim. Most
burns are minor, occur at home, and
can be managed outside a medical
setting. Seek medical attention for
all moderate and severe burns, as
classified by the ABA, or if any of
the following conditions applies:
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Minor Burns
First-degree burn
covering less than
50%
BSA*
in adults (face, hands,
feet, or genitals not burned)
Second-degree burn
covering less than 15% BSA in adults
Second-degree burn
covering less than 10% BSA in
children/elderly persons
Third-degree burn
covering less than 2% BSA in adults
(face, hands, feet, or genitals not
burned)
Moderate Burns
First-degree burn
covering more than 50% BSA in adults
Second-degree burn covering 15% to 30%
BSA in adults Second-degree burn
covering 10% to 20% BSA in
children/elderly persons
Third-degree burn
covering 2% to 10% BSA in adults
(face, hands, or feet not burned)
Critical Burns
First-degree burn
covering more than 70% BSA
Second-degree burn covering more than
30% BSA in adults Second-degree burn
covering more than 20% BSA in
children/elderly persons
Third-degree burn
covering more than 10% BSA in adults
Third-degree burn covering more than
2% BSA in children/elderly persons or
any part of the face, hands, feet or
genitals
Also most inhalation
injuries, electrical injuries, and
burns accompanied by major trauma or
significant preexisting conditions
*BSA
= body surface area
Source:
Adapted from the
American Burn Association
categorization
Critical
injury exists when hands, feet, or
genitals are burned. Surface area of a
second-degree burn is less than 15% of
the body surface area. More then 15%
is third-degree
Put
the burned area in cold water or
apply a dump cloth to reduce pain
. Cold also stops the burn from
progressing into deeper tissue. If
cold water is unavailse any cold
drinkable liquid to reduce the rature
of the burned skin.
Ubiprofen to relieve
pain and inflammation. children
acetaminophen.
Apply an aloe vera gel
or a skin moisturizer lotion to
keep the skin moister and to reduce
itching and peeling. Aloe vera has
licrobial properties and is an
effective analgesic for relieve.
Burned arm or leg elevated.
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Cool burn with cold
water until pain is relieved.
DO NOT
apply cold to
more than 20% of
An adult's body surface
(10% for children); widespread cooling
can cause hypothermia. Burn victims
lose large amounts of heat and water.
DO
NOT
apply salve, ointment, grease, butter,
cream, spray, home remedy, or any
other coating on a burn until after it
cools. Such coatings are unsterile and
can lead to infection. They also can
seal in heat, causing further damage.
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Care of
Small Second-Degree Burns «200/0 BSA)
1. Follow steps 1 and 2 of
First-Degree Burn care.
2. After the burn cools, apply a thin
layer of bacitracin ointment. Topical
antibiotic therapy like bacitracin
does not sterilize a wound, but it
does decrease the number of bacteria
to a level that can be controlled by
the body's defense mechanisms and
prevents the entrance of bacteria.
3. Cover the bum with a dry,
nonsticking, sterile dressing or a
clean cloth. Covering the burn reduces
the amount of pain by keeping air from
the exposed nerve endings. The main
purpose of a dressing over a burn is
to keep the burn clean, prevent
moisture
loss through evaporation, and reduce
pain. If toes or fingers have been
burned, place dry dressings between
them.
4. Have the victim drink as much water
as possible without becoming nauseous.
DO NOT cool more
than 20% of an adult's body surface
area (10% for a child) except to
extinguish flames.
DO NOT break any
blisters. Intact blisters serve as
excellent burn dressings. Cover a
ruptured blister with bacitracin
ointment and a dry, sterile dressing.
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Large
Second-Degree Burns 20% BSA
Do not apply cold because it may cause
hypothermia.
Follows steps 2 through 4 of Small
Second- Degree Burn care «20% BSA).
Seek medical attention.
Care of
Third-Degree Burns
Cover the burn with a dry, nonsticking,
sterile dressing or a clean cloth.
Treat the victim for shock by
elevating the legs and keeping the
victim warm with a clean sheet or
blanket.
Seek medical attention.
Chemical Burns
Chemical burn is the result of a
caustic or corrosive materials
touching the skin. Because chemicals
continue to "burn" as long as they are
in contact with the body, they should
be removed from the victim as rapidly
as possible. The aid is the same for
all chemical burns, except a few ones
for which a chemical neutralizer has
to be Alkalis such as drain cleaners
cause more serious, than acids such as
battery acid because they penetrate
deeper and remain active longer.
Organic compounds as petroleum
products are also capable of burning.
Chemical burn from
sulfuric acid
DO NOT
apply
water under high pressure-it will
drive the chemical deeper into the
tissue.
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DO NOT
try to neutralize a chemical even if
you know which chemical is
involved-heat may be produced,
resulting in more damage. Some product
labels for neutralizing may be wrong.
Save the container or the label for
the chemical's name
What to Do
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1. Immediately remove the chemical by
flushing the area with water . If
available, use a hose or a shower.
Brush dry powder chemicals from the
skin before flushing, unless large
amounts of water are immediately
available. Water may activate a dry
chemical and cause more damage to the
skin. Take precautions to protect
yourself from exposure to the
chemical.
2. Remove the victim's contaminated
clothing and jewelry while flushing
with water. Clothing can hold
chemicals, allowing them to continue
to burn as long as they are in contact
with the skin.
3. Flush for 20 minutes all chemical
burns (skin, eyes). Washing with large
amounts of water dilutes the chemical
concentration and washes it away.
4. Cover the burned area with a dry,
sterile dressing or,
for large areas, a clean pillowcase.
5. Seek medical attention immediately
for all chemical burns.
critical Burns
A mild electrical shock
can cause serious internal injuries. A
current of 1,000 volts or more is
considered high voltage, but even the
110 volts found in ordinary house
could cause an electrical shock.
High Electrical current can be deadly.
There are three types of electrical
injuries: thermal In (flame), arc burn
(flash), and true electrical
injury(tact).
A thermal burn
(flame) results when clothing
objects get in direct contact with the
skin are ignited by an electrical
current. These injuries are caused by
the flames produced by the electrical
current and not by the passage an
electrical current or arc.
arc burn (flash)
occurs when electricity jumps, or
arcs, one spot to another. The
electrical current does not go through
the body. Although the duration of the
flash brief, it usually causes
extensive superficial injuries.
true electrical
injury (contact) happens when
an electrical current truly passes
through the body. This type of injury
characterized by an entrance wound and
an exit
d. The important factor in this type
of injury is that surface injury may
be just the tip of the iceberg. High
electrical currents passing through
the body may stop the normal heart
rhythm and cause cardiac arrest, and
other injuries.
Getting an electric shock, electricity
enters the body at point of contact
and travels along the path of least
Electrical burn on toe
resistance (nerves and blood vessels).
The major damage occurs inside the
body-the outside burn may appear
small. Usually, the electricity exits
where the body touches a surface or
comes in contact with a ground (eg, a
metal object). Sometimes, a victim has
more than one exit site
What to Do
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1. Make sure the area is safe. Unplug,
disconnect, or turn off the power. If
that is impossible, call the power
company or EMS for help.
2. Check ABCs.
3. If the victim fell, check for a
spinal injury.
4. Treat the victim for shock by
elevating the legs 8 to 12 inches if
no spinal injury is suspected; prevent
heat loss by covering the victim with
a coat or blanket.
5. Seek medical attention immediately.
Electrical injuries usually require
burn center care.
Contact with a
Power Line (Outdoors)
If the electric shock is from contact
with a downed power line, the power
must be turned off before a rescuer
approaches anyone who may be in
contact with the wire.
If you feel a tingling sensation in
your legs and lower body as you
approach a victim, stop. The sensation
signals that you are on energized
ground and that an electrical current
is entering through one foot, passing
through your lower body, and leaving
through the other foot. Raise one foot
off the ground, turn around, and hop
to a safe place.
If you can safely reach the victim, do
not attempt to move any wires, even
with wooden poles, tools with wood
handles, or tree branches. Do not use
objects with a high moisture content
and certainly not metal objects. You
should not use wood -handled rakes,
brooms, or shovels because if the
voltage is high enough (you seldom
will know how much voltage is
involved), those objects can conduct
electricity and you will be
electrocuted. Do not attempt to move
downed wires at all unless you are
trained and are equipped with tools
that can handle the high voltage.
Wait until trained personnel with the
proper equipment can cut the wires or
disconnect them. Prevent bystanders
from entering the danger area.
Contact Inside
Buildings
Most electrical burns that occur
indoors are caused by
faulty electrical equipment or
careless use of electrical appliances.
Turn off the electricity at the
circuit breaker, fuse box, or outside
switch box or unplug the appliance if
the plug is undamaged. Do not touch
the appliance or the victim until the
current is off.
Once there is no danger to rescuers,
first aid can begin.
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