First aid brushup: Burn Injuries (Part 1 of 2)

This is part one of another first aid review post.  This part deals with treatment of common burns.  The second deals with burn injuries for which particular measures are needed.  As usual, I have drawn heavily on Kym Eden's Fun with First Aid.

Types of Burns

As is well known, burns fall into three categories.

First degree (or Superficial) Burns

These burns damage only the top layer of skin.  The skin will appear dry, red and possibly swollen.  The casualty may complain that their skin stings or is tender.  Common causes of superficial burns are sunburn or flash burns, friction or direct contact with hot objects.

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Second degree (or partial thickness) Burns

These burns consist of damage to the two upper layers of skin.  The skin will appear red, blistered and swollen.  It may appear blotchy or blistered and leak clear fluid.  The casualty will complain of pain.  Commonly these burns are caused by fire, hot water, steam or chemicals

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Third degree (or full thickness) Burns

These are the worst .  The upper layers of skin are severely damages or altogether destroyed, as are the underlying flesh or bone. The damaged flesh itself may be white or charred.  The surface itself may well be pain free because the nerves have been obliterated (although the casualty may have difficulty distinguishing this from the pain from the surrounding second degree burns).  Third degree burns tend to be caused by contact with hot metal, scalding with hot steam or fluids, flames, chemicals and electricity.




Third degree burns are potentially lethal.  A burn which encircles a limb will affect circulation to the extremities.  Burns to the neck can cause swelling which may impair breathing.

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Treatment

First degree (or Superficial) Burns

The key is to cool the affected area.  Move the patient to shade and cool the affected area with water or a similar product (e.g Hydrogel) for about ten minutes.  Sponging with moist compresses is also recommended.  After the skin has been cooled an after-sun lotion should be applied.

Second degree (or partial thickness) Burns

Apply cool running water to the burn for about 20 minutes.  If no water can be had, remove any clothing which is not adhering to the burn (the clothing will retain heat).  Cover the burned area with a dry non-adherent dressing.  The patient should be kept lightly covered,  Medical assistance is recommended.

Third degree (or full thickness) Burns

Send for an ambulance.  Cool the burned area with continuous cool running water (or a gel) for at least 20 minutes or until skin temperature returns to normal.  Keep the burn cool with water or wet compresses.  If possible, remove clothing which may retain heat, but do not pull clothing which has become attached to the burned area (cut around it instead).  Also remove any jewelery in the burned area as it may restrict circulation when swelling occurs.




The burned area should be covered with a dry, sterile, non-adherent dressing.  At a pinch, a dressing can be improvised from a clean sheet, cling film or a clean plastic bag.  Fasten the dressing in place with a bandage or tape.  A burned limb should be elevated if possible: this will reduce swelling and shock.