First Aid - Burns

What are the categories of burns?
The treatment of burns depends on the depth, area and location of the burn. Burn depth is generally categorized as first, second or third degree. A first degree burn is superficial and has similar characteristics to a typical sun burn. The skin is red in color and sensation is intact. In fact, it is usually somewhat painful. Second degree burns look similar to the first degree burns; however, the damage is now severe enough to cause blistering of the skin and the pain is usually somewhat more intense. In third degree burns, the damage has progressed to the point of skin death. The skin is white and without sensation.

Regardless of the type of burn, the result is fluid accumulation and inflammation in and around the wound. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. Damage to the skin can predispose the burn victim to both infection at the site of the wound as well as internally.

What is the significance of the total body area affected?
In addition to the intensity, the total area of the burn is significant. This is usually measured in terms of percent of total body burnt. The skin acts as a barrier from the environment, and without it, patients are subject to infection and fluid loss. Burns that cover more than 15% of the total body surface can lead to shock and require hospitalization for intravenous fluid resuscitation and skin care.

How important is the location of a burn?
Burn location is even more important than the above factors. Burns of the neck or signs of burns to the nose or mouth require emergent guarding of the patient's airway, as swelling may results in life threatening obstruction. Burned tissue shrinks and can cause damage to underlying structures. Burns that extend circumferentially around body structures require surgical release of the tissue, often referred to as escharotomy. Finally, all eye burns require special attention as soon as possible. Burns to the eye may lead to clouded or lost vision.

BURN FIRST AID TREATMENT

• First remove any constricting jewelry, such as rings.
• Do NOT use butter or oils on a burn.
• The effected area should be dowsed with cool water as soon as possible. It can be cleansed gently with chlorhexidine solution. Do NOT apply ice or cool to near-freezing temperatures (this can cause additional tissue injury).
• A tetanus booster should be obtained if not administered within the previous 5 years.

First degree thermal burns can be treated with local skin care such as aloe vera. Many topical antibiotics and antiseptics are available in the drug store for minor burns.

All second and third degree thermal burns and the complicated locations listed above need immediate physician evaluation. Special topical antiseptic creams are used for more serious burns, including silver sulfdiazine, silver nitrate, and mafenide acetate creams.

Burns can be caused by heat (thermal), as well as by electricity, and chemicals.

What about electrical burns?
Any significant burn resulting from electricity, requires immediate physician evaluation. These burns often result in serious muscle breakdown, electrolyte abnormalities, and occasionally kidney failure. The actual site of damage can be internal and may not be visible on the skin surface.

What about chemical burns?
The treatment for chemical burns is similar to thermal burns except copious amounts of water should be used to irrigate the effected region. Contaminated clothing should be removed. Do NOT attempt to neutralize the burn with a reciprocal chemical. This may cause a chemical reaction that could result in a thermal burn too! Many chemicals have, in addition, specific treatments that can further reduce the resulting skin damage. If in doubt, call your local poison control center or make a quick trip to your local Emergency Room.