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

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

Welder's Flash

A particular type of first degree burn can affect people exposed to ultraviolet light.  It is known as "welder's flash" or "arc eye" because it commonly affects welders.

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Identification

The casualty's eyes will be red and watering, and they will complain of pain and a sensation like sand in their eyes.  They may be very sensitive to light.

Treatment

Cool wet packs should be applied to the casualty's eyes.  It may be wise to have them remove any contact lenses.  Medical review is recommended.

Airway burns

Be alert to these if the injury occurred in a confined space or it is otherwise thought the casualty may have inhaled hot air or gases.  Where the airways have been badly affected, they can swell and restrict breathing.  Medical assistance is highly recommended.

Identification

The casualty's voice may be hoarse and it may be difficult for them to breathe or speak.  Their face or toungue may be swollen, There may also be singeing of the hair or nasal hair, and black carbon deposits in the nose and mouth.

Treatment

Send for an ambulance.  The casualty will find it easiest to breath if they sit up and lean forward.  They can be given cool water to sip, and the neck area should be cooled with compresses.  Tight restrictive clothing around the neck, chest and waist should be loosened.  If the patient becomes unconscious, move them into the recovery position and monitor their breathing.  If necessary commence resuscitation.

Electrical burns

Identification

These injuries may not be obvious as much of the damage will be internal.  There may be an entry and exit wound.  See whether the surroundings indicate an electrical incident has taken place.

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Treatment

Firstly, watch for danger.  If you consider that there is a credible risk of live electricity, stand back until you are confident the risk has been removed.  This may be as simple as turning off a switch or may require disconnection by the power company (a piece of advice I have received is to assume that a power line is live until you have seen an electrician pick it up with an ungloved hand!).


Remove any burned clothing which is not adhering to the casualty's wounds, and flood the entry and exit wounds with cool water.  Cover any burns with dry, sterile, non-adherent dressings.

Chemical and similar burns

If it appears the casualty has sustained a chemical burn, try to identify the substance involved so to advise medical staff.

Identification

The skin may be blistered, swollen and discoloured.  The casualty may also complain of severe stinging pain, and there may be chemical containers in the area.  Chemical burns can also cause poisoning, and so the casualty may be complaining of blurred vision, a headache and nausea.

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Treatment

Removing or reducing exposure is key.  To the extent possible, avoid contact with the chamical yourself.  Remove the patient from the area and if possible take off contaminated clothing.  Flood the burned tissue with cool running water for 20-30 minutes.  Burns should be covered with a dry, sterile, non-adherent dressing and an ambulance sent for.

Chemical injuries to eyes

If the burn is to one or both of the eyes, have the patient sit with the affected eye facing downwards.  Gently flood the eye with cool running water for 20-30 minutes, if necessary prizing the injured eye open.  If necessary the casualty should remove any contact lenses.  A sterile pad or non-adherent dressing should be applied to the injured eye.

Phosphorus burns

If the burn has been caused by phosphorus, keep the injured body part wet or submerged in water continuously (phosphorus will ignite when exposed to air).  Use forceps or a similar device to pick off phosphorus particles, and cover minor burns with a wet compress.  Medical assistance should be sought.

Molten substance burns

Burns caused by molten substances (for example, metal or bitumen) are generally treated as for third degree burns.  The injured area should be flooded with cool running water for 30 minutes (or until the substance has cooled), and after that cold compresses should also be applied. 


Clothing or jewellery should be removed if it may affect circulation when swelling sets in.  However, it is best not to remove the molten substance (save where it blocks an airway or encircles a limb such that circulation may be affected) because this may cause more skin damage.  The injury should be covered with a dry, sterile, non-adherent dressing and the injured limb elevated.  An ambulance should be called.

Cold burns

Identification

Where a casualty has suffered a cold burn, their skin will become hard and will be cold to the touch.  It will appear waxy and pale.  The casualty may complain of numbness, 'pins and needles' or other altered sensation.  When the burn begins to recover it will become red, hot, blistered and painful.

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Treatment

If physically possible, the casualty should be encouraged to warm the injury with their own body (for example, putting a hand under their arm).  If the face, nose or ears are affected, cover them with a towel or something similar to help them warm.  Consider using lukewarm water to return heat to the injury.  Elevate the limb to reduce pain and swelling, and gently apply a soft clean dressing.