Burns

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BY
DR. JOHN HONG

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BURNS

Skin burns occur in different ways: fire, hot oil, boiling water, electricity, etc. Twenty-five million persons are treated for burns annually in the US; 50,000 are hospitalized each year for this. Luckily, 75% of hospitalized burn patients have less than 10 percent of their body-surface area involved. Death due to these types of burns is pretty low nowadays. The elderly and those with smoke inhalation have the highest chance of mortality.

Burns involving more than 15-20% of the body will usually cause shock - meaning the blood pressure drops and usually leads to death. Therefore, fast treatment is needed to save the person's life. During the first 6-8 hours after the burn occurs, a lot of swelling and inflammation occurs. [N Engl J Med, Volume 335(21).November 21, 1996.1581-1586]

What is a first-degree burn?
A first-degree burn, the least serious type, is one in which the top layer of skin has been burned slightly. These burns produce pain and redness of the skin.

What causes first-degree burns?
First-degree burns are usually caused by:
overexposure to the sun
brief contact with a hot object, such as an iron or skillet
minor scalding by hot water or steam
brief contact with harsh chemicals.

What are the symptoms?
First-degree burns cause redness, mild swelling (with few or no blisters), and pain. Some first-degree burns, such as extensive sunburns, cause restlessness, headaches, and fever.

What is the treatment?
Remove jewelry or tight clothing from the burned area before it begins to swell.
Flush the burn with cool running water or apply cold-water compresses (a wet towel or handkerchief) until the pain lessens. Do not use ice or ice water, which can cause more damage to the tissues.
Cover the burn with a clean (sterile, if possible), dry, nonfluffy bandage such as a gauze pad. Do not put tape on the burn.
Take aspirin or an aspirin substitute such as acetaminophen or ibuprofen to relieve the pain and inflammation.
Apply an antiseptic solution to help prevent infection or an aloe cream to soothe the skin. Do not use old-time folk remedies, especially food or oil, to help heal the burn.
They can keep the burn from healing and may cause infection.
Get medical treatment for widespread first-degree burns. For chemical burns, follow these steps:
Flush liquid chemicals from the skin thoroughly with running water for 15 to 30 minutes.
If the chemical spills on clothing or jewelry, remove it.
Brush dry chemicals off the skin if large amounts of water are not available. Small amounts of water will activate some chemicals like lime. Be careful not to get any of the chemicals in your eyes.
Cover the burn with a dry, loose bandage.

How long will it take a first-degree burn to heal?
Usually, first-degree burns heal quickly. The damaged skin may peel within a day or two. You will not have any scarring unless an infection occurs.

When should I see a doctor?
See your doctor immediately if you develop any of the following:
fever
puslike drainage from the burned area
excessive swelling of the burned area
increased redness of the skin.

What are second-degree burns?

Second-degree burns are more serious than first-degree burns because a deeper layer of skin is burned. They can more easily become infected. Also, if the burn affects more than 10% of your skin, you may go into shock because large quantities of fluid are lost from the burned area.
All second-degree burns greater than 2 to 3 inches in diameter should be treated by a medical professional. Smaller burns can usually be treated at home.

What causes second-degree burns?
deep sunburn
exposure to flames
contact with hot liquids
burning gasoline or kerosene
contact with chemicals.

What are the symptoms of second-degree burns?
The skin is bright red and blotchy and has blisters. It usually looks wet because of the loss of fluid through the damaged skin. Second-degree burns are often very painful.

What is the treatment?
The goals of treatment for second-degree burns are easing the pain and preventing infection.
For second-degree heat burns without open blisters, follow these steps:
Remove jewelry or tight clothing from the burned area before it begins to swell.
Flush the burn with cool running water or apply cold-water compresses (a wet towel or handkerchief) until the pain lessens. Do not use ice or ice water, which can cause more damage to the burned area.
Try not to break the blisters. If the blisters break, the exposed skin can become infected.
Cover the burn with a clean (sterile, if possible), dry, nonfluffy bandage such as a gauze pad. Do not put tape on the burn.
Do not put ointments, grease, petroleum jelly, butter, or home remedies on the burn. These substances can hold the heat in, making the burn worse.
Keep burned arms or legs raised to reduce swelling.
Get medical help for second-degree burns greater than 2 to 3 inches in diameter or for burns on the hands, face, penis, buttocks, or vaginal area.

For second-degree heat burns with open blisters, follow these steps:
Do not remove clothing if it is stuck to the burn.
Do not run water over the burn or use water on the bandage because it increases the risk of shock.
Cover the burn with a clean (sterile, if possible), dry, nonfluffy bandage, such as a gauze pad. Do not put tape on the burn.

For extensive second-degree burns that are more than 2 to 3 inches in diameter, see your doctor.
You will need extra fluids to replace the large quantities of fluids your body loses through the burned area. Your doctor may give you fluids intravenously (through a tube into your vein).
Your doctor will prescribe antibiotics because the burned skin can no longer protect your body from infection by airborne bacteria.
Your doctor will either lightly bandage the burned area with an antibacterial dressing or leave it unbandaged.
Your doctor will prescribe medicine to kill the pain.
Your doctor may recommend a skin graft to lessen scarring.
Your doctor may give you a tetanus booster.

For chemical burns, follow these steps:
Flush liquid chemicals from your skin thoroughly with running water for 15 to 30 minutes.
Remove any clothing and jewelry on which the chemical has spilled.
Brush dry chemicals off the skin if large amounts of water are not available. Small amounts of water will activate some chemicals. Be sure to keep the chemicals away from your eyes.
Cover the burn with a dry, loose bandage.

How do I take care of a burn?
After you have cleaned and bandaged the burn, leave it alone for at least 24 hours to allow the healing process to begin.
Preventing infection in the exposed skin is an important part of the treatment for second-degree burns. If you have been told to change your bandages, follow these procedures to help prevent infection:

Wash your hands carefully with soap and water.
Place the fresh bandage on a clean towel.
Take off the old bandage gently. Soak it off if it sticks to the burn.
Wash the burned area gently.
Check for any changes or worsening of the burned area, such as pus, swelling, or increased redness.
Apply a thin layer of antibiotic cream to the burn.
Cover with the clean bandage.

How long will it take a second-degree burn to heal?
Usually, second-degree burns heal in 10 days to 2 weeks. There may be few or no scars if the burn was not too extensive and if infection is prevented.

When should I call a doctor?
See your doctor immediately if you have any of the following:
fever
puslike drainage from the burned area
excessive swelling of the burned area
increased redness of the skin
numbness or coolness of the skin beyond the burned area on arms and legs
a blister filled with greenish or brownish fluid or one that becomes hot again or turns red
a burn that doesn't heal in 10 days to 2 weeks.

What are third-degree burns?

Third-degree burns, the most serious, involve all layers of skin.
Third-degree burns are so deep that only the edges will heal. Scars will eventually cover the rest of the burned area if skin grafting is not done.

What causes third-degree burns?
Third-degree burns are usually caused by:
clothing on fire
immersion in hot water
contact with flames, hot objects, or electricity
corrosive chemicals.

What are the symptoms of third-degree burns?
The skin may be white, or it may be black and leathery. There may be little pain in the burned area, but the areas surrounding the burn may be quite painful.

What is the treatment?
All third-degree burns require medical treatment. Call 911 for emergency rescue if available or transport the person to an emergency room. Assist a burned person as follows:

If the person's clothes are burning, do not let him run. Running can fan the flames so that they rise to the person's face. Smother the flames with a blanket, rug, or jacket while rolling him on the ground.
Remove jewelry and tight clothing from the burned area.
DO NOT remove clothing that is stuck to the burn.
DO NOT apply ice water, lotions, ointments, sprays, or home remedies.
Immerse the burned area in cold water or apply cold compresses BRIEFLY to bring body temperature back to normal. Leaving the burned area in cold water too long can lead to cooling down the body too much.
In extensive burns, check for these signs of shock:
decreased level of consciousness
rapid, shallow breathing
faint, rapid pulse
nausea, sometimes followed by vomiting.

If the person is in shock, be sure you have called for medical help. Do not move the person unless you have to. He should be lying down. Unless he has breathing difficulties or pain, raise his feet. Cover him with a blanket to conserve body heat.
Keep him as calm as possible.
Wrap the person loosely in a clean sheet if the burned area is extensive. Otherwise, apply dry, nonfluffy loose bandages, such as a pillowcase or disposable diaper.
Raise a burned arm or leg higher than the person's heart. However, keep the head and shoulders raised slightly if the person is burned on the neck or face or is having trouble breathing.
If the person is conscious and not vomiting and if medical help is more than 2 hours away, give him small sips of water or clear juice. If he is in shock, however, and asks for water, moisten his lips but do not allow him to drink.
DO NOT give the person alcohol.

For chemical burns:
Flush liquid chemicals from the skin thoroughly with running water for 15 to 30 minutes.
Remove any clothing and jewelry on which the chemical has spilled.
Brush dry chemicals off the skin if large amounts of water are not available. Small amounts of water will activate some chemicals. Be sure to keep the chemicals away from your eyes.
Cover the burn with a dry, loose bandage.

For electrical burns:
All electrical burns must be examined by a doctor. An electrical burn may appear to cause minor damage, but it can extend deep to the tissues beneath the skin.
Cover the area of the burn with a dry, nonfluffy, loose bandage. Do not apply any ointments or other substances to the burned area.

How long will it take a third-degree burn to heal?
Third-degree burns may require hospitalization for a few days or for many weeks. Scars may require several operations by a plastic surgeon, depending on the severity of the burns. Extensive burns are usually treated at a burn center.

Examples:
Skin Layer - First Degree Burn
Skin Layer - Second Degree Burn
First and Second Degree Burn
Skin Layer - Third Degree Burn
Third Degree Burn

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