Burns
What are burns?
Burns are wounds that damage and kill skin cells. Burns can be caused from
- hot liquids and materials
- Chemicals (e.g. household chemicals)
- Fire
- Radiation (e.g. sun)
- Other sources.
Types of Burns:
There are four types of burns:
- Thermal burns caused by fire, hot objects, hot liquids, and gases; or by nuclear
blast or fireball.
- Electrical burns caused by electrical wires, current, or lightning.
- Chemical burns caused by contact with wet or dry chemicals or white phosphorus
- Laser burns (eye injury).
When someone has been burned there are three important factors that must be looked at:
 depth (first, second, or third degree)
 Location (where the burn is on the body). The most important factor is location. If
a burn occurs on the neck or near the nose and mouth, the persons breathing
passages may be affected.
 Area (total body space covered): the total body area is also important, the skin is a
barrier to protect the body, and when it’s damaged, the victim is subject to fluid
loss and infections. If more then 15% of the body surface is damaged the victim
can go into shock, and may require hospitalization for IV fluid resuscitation and
skin care.
Burn Prevention
Burns of all kinds can be prevented easily. Keep household chemicals out of reach of
children. Make sure hazardous chemicals are well marked and caps are screwed on tight.
Keep hot object safely out of reach and make sure to turn off heaters and stovetops when
finished. Also keep socket caps over all unused electrical sockets to protect against
electrical shock, and keep all electrical wires away from water.
Degrees (classifications) of Burns
To distinguish a minor burn from a serious burn, the first step is to determine the degree
and the extent of damage to body tissues. The three classifications of burn will help you
determine emergency care (see table 1):
First-degree burn
The least serious burns are those in which only the outer layer of skin is burned. The skin
is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't
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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.
Second-degree burn
when the first layer of skin has been burned through and the second layer of skin (dermis)
also is burned, the injury is called a second-degree burn. Blisters develop and the skin
takes on an intensely reddened, splotchy appearance. Second-degree burns produce
severe pain and swelling. If the second-degree burn is no larger than 3 inches (7.5
centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn
is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn
and get medical help immediately.
Third-degree burn
The most serious burns are painless, involve all layers of the skin and cause permanent
tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black
or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or
other toxic effects may occur if smoke inhalation accompanies the burn.
Sun Burns
A sunburn is the result of being exposed to too much of the suns ultraviolet radiation.
Amount of sunlight depends on the geographic features, clothing, lifestyle and
occupation. Indoors, sunburn-producing rays are filtered out by ordinary window glass.
Outdoors however the suns rays are able to pass through light clouds, 25 cm of clear
water, and fog.
Table 1: Degree of burns and their characteristics
Nomenclature
Layer
Involved
Appearance Texture Sensation
Time to
Healing
Complications
First degree
Epidermis
Redness
Painful
1wk or
less
None
Second degree
(superficial
partial
thickness)
Extends
into
superficial
(papillary)
Dermis
Red with
clear
Blisters.
Moist
Blanches
with pressure
Painful
2-3wks
Local
infection/cellulitis
Second degree
(deep partial
thickness)
Extends
into deep
(reticular)
dermis
Red-andwhite with
bloody
Moist
blisters. Less
blanching.
Painful
Weeks may
progress
to third
degree
Scarring,
contractures (may
require excision
and skin grafting)
Extends
Third degree
through
(full thickness) entire
dermis
Stiff and
white/brown
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Dry
Dry,
Painless
leathery
Scarring,
Requires
contractures,
excision
amputation
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Percentage of body burned
 Rule of Nines: A method of estimating how much body surface
was burned by mentally dividing the body into regions, each
representing 9% (or a multiple of 9%) of the body surface
First aid management of burn:
For minor burns, including first-degree burns and second-degree
burns limited to an area no larger than 3 inches (7.5 centimeters) in
diameter, take the following action:
-
Cool the burn. Hold the burned area under cold running water for at least five
minutes, or until the pain subsides. If this is impractical, immerse the burn in cold
water or cool it with cold compresses. Cooling the burn reduces swelling by
conducting heat away from the skin. Don't put ice on the burn.
-
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.
-
Give pain reliever. These include aspirin, ibuprofen (Advil), or paracetamol.
-
Never give aspirin to children (may cause Reye's syndrome)
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Minor burns usually heal without further treatment. They may heal with pigment changes,
meaning the healed area may be a different color from the surrounding skin. Watch for
signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection
develops, seek medical help. Avoid re-injuring burns are less than a year old this may
cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.
Caution
 Don't use ice. Putting ice directly cause frostbite, further damaging your skin.
 Don't apply butter or ointments to the burn. This could prevent proper healing.
 Don't break blisters. Broken blisters are vulnerable to infection.
For major burns
-
If the victim still on fire:

Quickly remove the victim from danger and cover the thermal burn with any large
material (a jacket)
If the victim clothing still on fire, roll the victim on the ground to put out the flames.
Dial 911 or call for emergency medical assistance. Until an emergency unit arrives,
follow these steps:


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1. Check for signs of circulation, airway and breathing alteration. begin
cardiopulmonary resuscitation (CPR) if needed.
2. Don't remove burnt clothing. However, do make sure the victim is no longer in
contact with smoldering materials or exposed to smoke or heat.
3. Don't immerse large severe burns in cold water. Doing so could cause shock.
4. Elevate the burned body part or parts above heart level, when possible.
5. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth;
or moist towels. If fingers or toes are involved in the burned area, place small
nonstick gauze pads between the involved fingers and toes before bandaging. This
will prevent the burned fingers and toes from sticking together.
6. Do not use oils or butter on a burn.
7. Remove and constricting jewelry
Chemical burns: First aid
If a chemical burns the skin, follow these:
Dial 911 or call for emergency medical assistance. Until an emergency unit arrives,
follow additional steps:
1. Check for signs of circulation, airway and breathing alteration. begin
cardiopulmonary resuscitation (CPR) if needed.
2. Remove the cause of the burn by flushing the chemicals off the skin surface with
cool, running water for 30 minutes or more.
3. If the burning chemical is a powder-like substance, brush it off with a gloved hand or
piece of cloth the skin before flushing.
4. Remove contaminated clothing or jewelry and make sure not to contaminate yourself
in the process
5. Apply a cool, wet cloth or towel to relieve pain.
6. Wrap the area loosely with a dry, sterile dressing or a clean cloth.
7. Rewash the burned area for several more minutes if the person experiences increased
burning after the initial washing.
8.
In case of an acid or alkali exposure to the skin or eye, immediately irrigate the
affected area with plentiful amounts of water
9.
If you seek emergency assistance, bring the chemical container.
Electrical burns: First aid
An electrical burn may appear minor or not show on the skin at all, but the damage can
extend deep into the tissues beneath the skin. If a strong electrical current passes through
the body, internal damage, such as a heart rhythm disturbance or cardiac arrest, can
occur. Sometimes the shake associated with the electrical burn can cause the victim to be
thrown or to fall, resulting in fractures or other associated injuries. Respiratory arrest may
result from electrical injury to the respiratory center in the brain or from tetanic
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contractions or paralysis of respiratory muscles. High voltage electrical burns may cause
temporary unconsciousness.
 Do not place yourself in danger by touching an electrocuted victim while the power is
on. Turn off the power at its source; at home the switch is usually near the fuse box.
While helping someone with an electrical burn and waiting for medical help, follow these
steps:
1. Look first. Don't touch. The person may still be in contact with the electrical
source. Touching the person may pass the current through you.
2. Turn off the source of electricity. If not possible, move the source away from both
you and the injured person using a dry non-conducting object made of cardboard,
plastic or wood.
3. Dial 911 or call for emergency medical assistance.
4. Check for signs of circulation, airway and breathing alteration. begin
cardiopulmonary resuscitation (CPR) if needed.
5. Prevent shock. Lay the person down with the head slightly lower than the trunk
and the legs elevated.
6. Cover the affected areas. If the person is breathing, cover any burned areas with a
sterile gauze bandage, if available, or a clean cloth. Don't use a blanket or towel.
Loose fibers can stick to the burns.
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