Burn care basics

April 12, 2010
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Burns are one of the most painful physical injuries because they affect nerves, blood vessels, muscles and bones. A burn occurs when skin comes in contact with heat, electricity, chemicals or radiation for enough time to cause damage. Internal organs, such as the lungs (from inhalation burns) or the heart (from electrical burns) can also be burned.

Gloves and other personal protective equipment (PPE) can help prevent burns. PPE is constructed from materials that offer flame resistance, thermo insulation, electrical insulation and chemical protection, or various combinations. A comprehensive safety equipment supplier can offer PPE suggestions based upon the specific application.

Even with PPE options available, National Fire Protection Association statistics show U.S. emergency rooms treat an average of 224,000 burn injuries each year. With this number of serious injuries occurring, it’s important to know more about burns and their treatment.

Types of burns
There are three types or “degrees” of burns: first, second and third degree. The type of burn is determined by the severity and depth of the burn into the affected area.

First Degree: Involving the upper or first layer of skin called the epidermis, this is the least serious type of burn. It produces a pinkish-red color on the burned skin and does not form blisters or open wounds. There may be mild swelling and pain associated with this burn; however, this type of burn usually heals on its own in a few days.

Second Degree: This burn involves both the epidermis and the second layer of skin called the dermis. The skin usually appears bright red in color, and blisters are produced. Swelling occurs, and pain may be severe because the dermis layer contains the nerves. This type of burn can take one to three weeks to heal and may produce scarring.

Third Degree: This burn is the most serious because it can lead to an infection, loss of body heat and shock due to fluid loss. A third-degree burn involves the third layer of skin called the subcutaneous layer (also known as the fat layer). Both the dermis and epidermis are damaged, and the burn may also affect muscles, bones and other organs. A third-degree burn may appear black and charred or have patches of white, shiny and leather-textured skin. These burns may also weep or leak fluids because they have reached into the blood vessels. This type of burn may have no pain in the center of the burned area because the burn has damaged the nerve endings. Nonetheless, there may still be severe pain around the edges where the skin has first- or second-degree burns. These burns produce deep scars and may take months to heal, often needing cosmetic surgery and skin grafts.

Get medical help
Medical attention is needed depending on the degree of the burn and the percentage of the body covered by the burn. Burns that require immediate medical attention are:
  • First-degree burns covering 50% or more of the body
  • Second-degree burns covering 10% or more of the body
  • Third-degree burns covering 5% or more of the body
To put the percentage of the body into context, 5% is about the size of the victim’s hand.

Causes of burns
Four major causes of burns determine the severity or degree of a burn. The major causes are heat, electrical, chemical and radiation.

Heat. The most common type of burn, it is caused by a hot object, hot air, hot water or open flame that comes in contact with the skin. The heat source needs to be removed as soon as possible and the skin cooled down immediately to stop the depth of burn.

Electrical.
Similar to heat burns because they produce a contact burn from electricity, but these burns are more serious because there is usually an entrance burn and an exit burn where the electricity needed to ground itself. Electrical burns can cause internal burns and damage to internal organs or interrupt the electrical conduction system of the heart. Electricity must be shut off first before touching the victim. Then the victim can be removed from the electrical source by using a non-conductive material, such as a piece of wood. The victim can be checked for breathing or circulation and CPR started if needed. Otherwise, burns should be cooled and treated appropriately.

Chemical. This type of burn can start out looking minor but can lead to a more serious degree burn and cause poisoning. Some chemicals can penetrate the skin and get into the bloodstream, potentially causing the body chemistry to change and poison the victim. A chemical that gets on the skin should first be flushed off with lots of water (See Figure 1 above.) for at least 15 minutes. The burn can then be treated appropriately and may require a special antidote to counteract the chemical reaction.

Radiation. Radiation burns occur in certain jobs where people are working with Alpha, Beta, Gamma or X-ray radiation. This burn can affect the whole body internally as well as the external skin and may require certain antidotes to counteract the radiation. Degree of severity is determined by the type of radiation and the time exposed to it. Otherwise, these burns are treated by cooling the victim down with water and then wrapping the victim in bandages.

Treatment of burns
All burns are generally treated the same way, provided the source of heat, electricity, chemical or radiation has been removed.

1. Apply cool water to the burned area. Do not use cold water — the victim may go into hypothermia. If the burn is chemical, flush with water for 15 minutes to stop any reaction.

2. Carefully remove contaminated clothing or metal objects that may retain heat, such as rings, watches or belts — only if they are not embedded in the burn.

3. Examine the burn for severity of degree and percentage of body coverage to determine if an ambulance is needed. When unsure, always seek medical attention.

4. Do not break blisters, and do not apply butter, creams or ointments to blisters or open wounds resulting from a burn. This may cause infection.

5. Cover the burn loosely with clean, dry dressings or special burn dressings and elevate the burned body part.

6. Consider aspirin, ibuprofen or acetaminophen for pain relief if needed for pain and swelling.

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