Burn Emergencies

Burn Injuries


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.

Complexity of Burns


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.

Classifying Burns


Burns are classified in two ways, method and degree of burn.

Methods


  • Thermal - including flame, radiation, or excessive heat from fire, steam, and hot liquids and hot objects.
  • Chemical - including various acids, bases and caustics.
  • Electrical - including electrical current and lightening.
  • Light - burns caused by intense light source 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.

Degrees


  • 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 both 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.

Determining the Severity of Burns


  • 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.

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. 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 911.

Do Not Apply Products


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.