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accidents, such as scalding hot water or steam. More than 300 000 persons die each year worldwide because of fire-related burn injuries. Many more are seriously injured, disabled, or disfigured because of all types of burns. Risk factors for burns include cooking with an open flame, open cooking facilities on the ground floor of a building or residence, wearing loose clothing while cooking, smoking, alcohol use, water heaters that are set too hot, poor electrical safety, and unsupervised children. Occupational injuries involving burns can also occur, especially at job sites with open flames, chemicals, or superheated materials.
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Burns cause varying degrees of pain, blisters, swelling, and skin loss. Deep, extensive burns can cause serious complications, such as shock and severe infections. Small, shallow burns may need only to be kept clean and to have an antibiotic cream applied. People with deep or extensive burns may require intravenous fluids, surgery, and rehabilitation, often at a burn center.
Burn is an injury involving the skin, including muscles, bones, nerves and blood vessels. This results from heat, chemicals, electricity or solar or other forms of radiation. Burns destroy skin, which controls the amount of heat our bodies retain or release, holds in fluids, and protects us from infection. While minor burns on fingers and hands are usually not dangerous, burns injuring even relatively small areas of skin can develop serious complications. Burning causes blisters that will form at the place that is burned especially if it is caused by fluids. Blisters contain lymph that should not be burst as it causes a wound immediately after bursting it. You should treat the blisters carefully and make sure that you are using the right kind of medicine and if it bursts, bandage it. The skin has an important role to play in the fluid and temperature regulation of the body. If enough skin area is injured, the ability to maintain that control can be lost. The skin also acts as a protective barrier against the bacteria and viruses that inhabit the world outside the body. There are three layers: 1.Epidermis, the outer layer of the skin 2.Dermis, made up of collagen and elastic fibers and where nerves, blood vessels, sweat glands, and hair follicles reside. 3.Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are located. This is the layer of tissue that is most important in temperature regulation.
TYPES OF BURNS Burns are classified based on how much of the skin’s thickness is involved. First-degree (or superficial) burns involve only the top layer of the skin and are the least serious burn injuries. Second-degree (or partial-thickness) burns injure deeper into the skin and cause blistering. Third-degree (or full-thickness) burns involve all the layers of the skin, including the nerves that supply the skin, and are extremely serious injuries. Fourth-degree burns extend into the muscle below the skin.
Three degrees of burns FIRST-DEGREE BURNS are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns involve only the epidermis. Most sunburns can be included as first-degree burns. Signs:
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Red Painful to touch Skin will show mild swelling
Apply cool, wet compresses, or immerse in cool, fresh water. Continue until pain subsides. Cover the burn with a sterile, non-adhesive bandage or clean cloth. Do not apply ointments or butter to burn; these may cause infection. Over-the-counter pain medications may be used to help relieve pain and reduce inflammation.
Do not place the victim in the shock position if a head. seek emergency medical attention. Third-degree burns result in scarring and victims will also exhibit the loss of hair shafts and keratin. SECOND-DEGREE BURNS manifest as erythema with superficial blistering of the skin. elevate the feet about 12 inches. Take steps to prevent shock: lay the victim flat. Further medical treatment is required. Dry with clean cloth and cover with sterile gauze. however. and cover the victim with a coat or blanket. Signs: • • • • • Deep reddening of the skin Pain Blisters Glossy appearance from leaking fluid Possible loss of some skin Treatment: • • • • • • • Immerse in fresh. neck. Do not attempt to treat serious burns unless you are a trained health professional. as all the nerves have been damaged by the burn and are not sending pain signals. and sometimes hard eschar will be present. THIRD-DEGREE BURNS occur when the epidermis is lost with damage to the subcutaneous tissue. Do not apply ointments or butter to burns. However. cool water. (Pain may be caused by patches of first. these may cause infection Elevate burned arms or legs. Skin is dry and leathery Skin may appear charred or have patches which appear white. all third-degree burns are surrounded by first and second-degree burns. Burns that require more than three weeks to heal are often excised and skin grafted for best result. or the victim is an infant or elderly. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer. and can involve more or less pain depending on the level of nerve involvement. back. Continue for 10 to 15 minutes. These burns are not painful. Deep dermal burns usually take more than three weeks to heal and should be seen by a surgeon familiar with burn care. if a first-degree burn covers a large area of the body. These burns may require grafting. brown or black . or apply cool compresses. or if it makes the victim uncomfortable. as in some cases severe hypertrophic scarring can result. Signs: • • • • Loss of skin layers Often painless. Burn victims will exhibit charring and extreme damage of the epidermis. Do not break blisters. or leg injury is suspected.and second-degree burns which often surround third-degree burns). First degree burns usually heal without further treatment.
Do not place a pillow under the victim’s head if the person is lying down and there is an airway burn. Elevate burned area higher than the victim’s head when possible. Dermis. Keep person warm and comfortable. A description of the traditional and current classifications of burns.Treatment: • • • • • • • Cover burn lightly with sterile gauze or clean cloth. insensate requires skin grafts How long does it take for burns to heal? . "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis. dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome. and complete destruction to Charred or leathery. Have person sit up if face is burned. these may cause infection Take steps to prevent shock: lay the victim flat. Do not attempt to treat serious burns unless you are a trained health professional. and watch for signs of shock. This can close the airway. Immediate medical attention is required. elevate the feet about 12 inches. Do not apply ointments or butter to burns. significant pain. OTHER CLASSIFICATIONS • A newer classification of "Superficial Thickness". and pain Whiter appearance or fixed red staining (no blanching). subcutaneous fat. Watch closely for possible breathing problems. clear fluid. reduced sensation Partial thickness third degree – deep Deep (reticular) dermis Full thickness fourth degree* Epidermis. (Do not use material that can leave lint on the burn). Nomenclature Superficial thickness Traditional nomenclature first degree Depth Clinical findings Erythema. eschar thrombosed blood formation and minimal pain. lack of blisters Example Epidermis involvement Partial thickness second degree – superficial Superficial (papillary) dermis Blisters. vessels.
as well as in the medical and automotive industries. which can be more serious than the burn itself. Forty-three percent of burn center admissions are fire/flame related.• • • First-degree burns usually heal in 3 to 6 days. 23 percent are related to scalding. hot liquids. Most chemicals that cause severe chemical burns are strong acids or bases. steam. One civilian fire injury occurs every 30 minutes. Second-degree burns usually heal in 2 to 3 weeks. Hydrofluoric acid can cause damage down to the bone and its burns are sometimes not immediately evident. alkaloids and other caustic chemicals come into contact with the skin.) Other potential causes of burn injuries from fire include: • • • • • • • • Car accidents Industrial products Defective machinery Water heater fires Explosions Faulty electrical wiring Home & other structural fires Flammable clothing and liquids Chemical burn Chemical burns represent approximately 3 percent of all burn center admissions. TYPES OF BURN INJURIES Thermal Burn Thermal burns — the most common type of burn injury — are the result of contact with heat sources such as fire. and 8 percent are linked to contact with a hot object. Many recalls have been issued for defective consumer products that pose fire hazards (for example. certain brands of candles and fire extinguishers. Chemical burns occur when certain acids. Chemical burns can be caused by caustic chemical compounds such as sodium hydroxide or silver nitrate. While a brief exposure (flash) tends to produce superficial or superficial partial thickness burns. prolonged exposure to flames can produce deep partial thickness to full thickness burns. Third-degree burns usually take a very long time to heal. Many patients burned in fires also suffer smoke inhalation injuries. Fire/Flame Injury. and acids such as sulfuric acid. Caustic chemicals are used in agriculture and construction. Possible causes of chemical burns at home or in the workplace include: . hot metals and hot objects.
causing both external and internal injuries. Seizures/coma and permanent neurological deficits Electrical burns can be caused by faulty electrical appliances or machinery. Electrical burn complications can be very serious and may include: • • • • Heart rhythm disturbances such as sudden cardiac arrest Fractures and other blunt trauma either from the force of the jolt or from resulting falls (caused by the jolt and/or involuntary muscle contractures) Severe skin burns from electrical arcs. Most of the damage from electric current occurs beneath the surface of the skin. flashes and clothes catching on fire. and by lightening. Tanning booths also emit these wavelengths and may cause similar damage to the skin such as irritation. When a low-voltage electric current (less than 500 volts) passes through the body. unintentional contact with batteries or household wiring. tanning booths. Electrical burns occur when electric current passes through the body. tar. the amount of moisture on the patient and the area of the body that the current passes through. the latter being more dangerous. Radiation burn Radiation burns are caused by protracted exposure to UV light (as from the sun). Low Voltage. radiation therapy (as patients who are undergoing cancer therapy). sunlamps. duration of exposure. and UVB. However. radioactive fallout. By far the most common burn associated with radiation is sun exposure. Power sources and power lines are often involved in high-voltage electrical burns. which are typically seen in young children who suck or bite on electrical cords High Voltage. including cardiac arrest. contact with low voltage can still have serious consequences: • • • Cardiac problems. or sodium hypochlorite (disinfectants and bleaches) Cosmetic products such as nail polish remover and hair dye Explosions and spills Electrical burn Electrical burns represent 4 percent of burn center admissions. . it generally does not cause severe burns. gasoline and wet pavement Household cleaners that contain lye (paint cleaners). sulfuric acid (toilet bowl cleaners). can occur if low-voltage electricity comes into contact with wet skin Muscle spasms. specifically two wavelengths of light UVA. which can prevent the patient from "letting go" or can suffocate the patient if the lungs spasm Oral burns. Factors affecting the extent of injury include the intensity and type of current. High voltage burns occur when an electric current of more than 1000 volts passes through the body.• • • • Industrial products. phenol (deodorizers). and X-rays.
Inhalation injuries – Inhalation injuries result from: direct inhalation of a hot air or flame source. FIRST DEGREE BURN SECOND DEGREE BURN THIRD DEGREE BURN FOURTH DEGREE BURN . or injury from smoke inhalation. which can cause brain damage or even death. which will damage the upper airways. such as carbon monoxide. Fourth degree burns involve the thickness of the skin. hair follicles.redness. swelling. second. Second-degree burns (also called partial-thickness burns) extend into the middle layer of skin (dermis). Second-degree burns are sometimes further described as superficial (involving the more superficial part of the dermis) or deep (involving both the superficial and the deep parts of the dermis). and inflammation. FACTORS TO DETERMINE THE SERIOUSNESS OF BURNS Burn Depth: The depth of injury from a burn is described as first. dermis. and fat layer). They affect only the top layer of skin (epidermis). Usually. Microwave burns are caused by the thermal effects of microwave radiation. or third degree: • • • • First-degree burns are the most shallow (superficial). the sweat glands. bone or even the tendons. and nerve endings are destroyed as well. It may look blackened or charred and sometimes may look white in color. and sometimes the muscles. More severe cases of sun burn result in what is known as sun poisoning. inhalation of toxic chemicals. People suffering from inhalation injuries as a result of chemical or industrial accidents often frequently suffer from serious chemical burns. Third-degree burns (also called full-thickness) involve all three layers of skin (epidermis. The person may not feel any pain due to nerve endings being severely damaged.
seconddegree burns involving more than 10% of the body surface area. The severity determines how they are predicted to heal and whether complications are likely. Burn Severity: Burns are classified as minor. Adjustment is needed because different areas of the body grow at different rates. doctors use charts that adjust these percentages according to the child's age (Lund-Browder charts). the arm constitutes about 9% of the body. or genitals.Estimating the Extent of a Burn To determine the severity of a burn. feet. doctors estimate what percentage of the body's surface has second. SIGNIFICANCE OF THE AMOUNT OF BODY AREA BURNED . • • Minor burns: All first-degree burns as well as second-degree burns that involve less than 10% of the body surface usually are classified as minor. For example. For children. These classifications may not correspond to a person's understanding of those terms. Separate charts are used for children because their body proportions are different. This method divides almost all of the body into sections of 9% or of 2 times 9% (18%). and all third-degree burns involving more than 1% of the body are classified as moderate or. or severe. in an adult.or thirddegree burns. doctors use the rule of nines. Doctors determine the severity of the burn by its depth and by the percentage of the body surface that has second. For adults. moderate.or third-degree burns. face. more often. doctors may classify a burn as minor even though it can cause the person significant pain and interfere with normal activities. For example. as severe. Moderate and severe burns: Burns involving the hands. Special charts are used to show what percentage of the body surface various body parts comprise.
back = 9%) As an example. though this measurement is adjusted for infants and children. this would involve 55% of the body. If more than15%-20% of the body is involved in a burn. the skin integrity is intact and it is able to do its job with fluid and temperature maintenance. While first degree burns are painful. if both legs (18% x 2 = 36%). significant fluid may be lost. the groin (1%) and the front chest and abdomen were burned. . Burns are measured as a percentage of total body area affected. This calculation is based upon the fact that the surface area of the following parts of an adult body each correspond to approximately 9% of total (and the total body area of 100% is achieved): •Head = 9% •Chest (front) = 9% •Abdomen (front) = 9% •Upper/mid/low back and buttocks = 18% •Each arm = 9% •Each palm = 1% •Groin = 1% •Each leg = 18% total (front = 9%. The "rule of nines" is often used. The Parkland formula (named for the trauma hospital in Dallas) estimates the amount of fluid required in the first few hours of care following a burn: As an example.In addition to the depth of the burn. if both legs (18% x 2 = 36%). this would involve 55% of the body. the total area of the burn is significant. Only second and third degree burn areas are added together to measure total body burn area. Shock may occur if inadequate fluid is not provided intravenously. the groin (1%) and the front chest and abdomen were burned.
The areas that need most attention are the face. Burns on the face and the neck may cause oedema in the upper respiratory passages. since the skin is burned and can no longer protect the area from contamination from airborne bacteria. and the perineum. are more dangerous in children under 2 yr old and in the elderly. Age : Burns. and the weakened organism of the elderly is also unable to handle the burn effectively. Burns in the limbs may leave scars causing mobility problems.Location of the burns: The seriousness of a burn depends to a large degree on the localization of the burn. as also to functioning of the eyes. In children. irrespective of their degree and extent. i. etc. nose. the precise area injured. Problems may also arise with regard to the patient’s appearance. ears.The risk of infection is high when the perineum is involved. the neck. . the immune system is not mature enough to withstand such a complex situation.e. the limbs.
This infection can easily turn into septicaemia. The most frequent form of poisoning involves carbon monoxide. electric devices. which is a product of incomplete combustion. Complications involving all systems of the body may develop. Injuries caused by inhalation of smoke are dangerous owing to the pernicious impact that combustion products have on the mucous membrane as also to the absorption of poisonous substances inhaled together with smoke by the mucous membrane. the burned area is more liable to contamination from airborne bacteria. 2. heart disease. 3. it becomes more serious and even life-threatening. B. Possible infection Since the continuity of the skin in the burned area has been destroyed. Loss of fluids It has already been said that a severe problem facing the patient is the loss of fluids from the burned area. The acute pain due to the burn is one of the causes of shock. Changes in the patient’s appearance . chemical substances.Burns are very common in children and the elderly . COMPLICATIONS AND SEQUELAE The complications and sequelae of burns depend on their gravity. Co-existing illnesses : Diabetes mellitus. Shock The immediate danger after a burn injury is shock as a result of the loss of body fluids (oligaemic shock) or of septicaemia (septic shock). The most serious complications are the following: Complications that threaten the life of the patient directly: 1. while the elderly may not be able to react effectively to an accident involving fire. pneumonia. immunosuppression. When the burn is associated with other injuries occurring at the time of the accident or before the patient is taken to hospital. the larger the quantity of fluids lost. Co-existing injuries : A burn creates a very serious problem for the human organism. and various other illnesses make the human organism less resistant to burns. as the organism is already affected by a serious burn injury and is incapable of effective resistance. cancer. Presence of inhalation burns : An injury to the respiratory system may be life-threatening. Complications that do not threaten the life of the patient directly 1. The more extensive the burn. lighters) in their ignorance of the possibly dangerous consequences.children are often attracted by dangerous objects (matches.
wound closure. and the phase continues until wound closure is achieved . pain management.begins when the client is hemodynamically stable.includes prehospital care and emergency room care Resuscitative phase .begins w/ the initiation of fluids and ends when capillary integrity returns to near normal levels and the large fluid shifts have decreased .emphasis during this phase is placed on restorative therapy. and physical therapy Rehabilitative phase .most fluid replacement formulas are calculated from the time of injury and not from the time of arrival at the hospital .usually begins 48 . 2.overlaps the acute care phase and goes well beyond hospitalization .72 hours after the time of injury . capillary permeability is restored.the amount of fluid administered is based on the client’s weight and extent of injury .The wrinkles and scars that form as the burn heals generate various aesthetic problems. usually at 48-72 hours after the injury . never smoke in bed.the focus is on infection control. • Never throw a lighted cigarette or a match anywhere. If you do smoke.the goal is to prevent shock by maintaining adequate circulating blood volume and maintaining vital organ perfusion Acute phase . and diuresis has begun .the 1˚ goal is to prevent hypovolemic shock and preserve vital organ functioning . Avoid smoking while consuming alcoholic beverages. wound care. Dispose of those hazards in proper ashtrays. PHASES OF THE MANAGEMENT OF BURN INJURY Emergent phase . Permanent disabilities When the wrinkles and scars affect mobility and/or limit the patient’s movements. the burn is responsible for functional problems or disabilities.begins at the time of injury and ends with the restoration of capillary permeability. .final phase of burn care .goals of this phase are designed so that the client can gainindependence and achieve maximal function BURN PREVENTION: • Do not smoke. nutritional support.
If you hear an alarm. Let them know if anyone is trapped inside. Change batteries in smoke alarms at least once a year. Tell them your address and do not hang up until you are told to do so. pets. pets. Never put electrical appliances or cords in or near water. Draw a floor plan and find two exits from each room. property. IF YOU ARE TRAPPED IN A BURNING BUILDING • • Smoke rises. (Never borrow smoke alarm batteries for other purposes). etc. . Call the fire department after escaping. Respond to every alarm as if it were a real fire. Never go back into a burning building to look for missing people. Never go back into a burning building to look for missing people. should have working smoke alarm systems. Establish an outside meeting place where everyone can meet after they have escaped. so crawl low to the ground where the air will be cleanest. Learn the location of all building exits. Ensure that fire exits are unlocked and clear of debris. Wait for firefighters. • Follow electrical safety rules. whether homes. • Supervise children carefully. Tell them your address and do not hang up until you are told to do so. One alarm must be outside a bedroom where you sleep. Windows can serve as emergency exits. Designate a meeting place at a safe distance outside the home. Cover your nose and mouth with a cloth (moist if possible). Keep emergency phone numbers and other pertinent information posted close to your telephone. property. You may have to find your way out in the dark.• Be very cautious around any type of open flames. Let them know if anyone is trapped inside. Respond to every alarm as if it were a real fire. Practice getting out of the house through the various exits. Get out quickly if it is safe to leave. Make sure you know what the alarm sounds like. Wait for firefighters. • Do not touch downed power lines SAFEGUARD YOUR HOME • • • • • • • • • Install smoke alarms on each floor of your home. HOTEL AND WORKPLACE FIRE SAFETY • • • • • • • • Become familiar with exits and posted evacuation plans each time you enter a building. Call the fire department after escaping. All buildings. workplaces or hotels. leave immediately and close doors behind you as you go. etc.
evaluate how extensively burned the person is and try to determine the depth of the most serious part of the burn. Seal all doors and vents between you and the fire with rags. feet. intensive care (often in a specialized burn treatment intensive care unit). Use the stairs. Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns. Then treat the entire burn accordingly. If in doubt. CONSIDERATIONS • Before giving first aid. and genitals can be particularly serious. open it slowly. Prompt medical attention to serious burns can help prevent scarring. Wave or hang a sheet or other large object to attract attention. Burns on the face. If you cannot get to a phone. you can help lessen the severity of the burn. Anyone with symptoms of headache. Call the fire department for assistance if you are trapped. hands. By giving immediate first aid before professional medical help arrives. and the amount of body tissue involved. Persons who have large surface areas of their body burned have a poorer prognosis (chance of surviving and doing well after an injury). If it is cool. and deformity. physical therapy is often used in addition to other treatments to aid recovery and prevent complications such as contracture (where the burned skin and body tissue become very difficult to move). treat it as a severe burn. Close as many doors as possible between yourself and the fire. try another escape route. pain management. • • • IMMEDIATE TREATMENT FOR BURN VICTIMS . For persons who have serious burn injuries. and skin grafting. weakness.• • • • Test doorknobs and spaces around doors with the back of your hand. surgical debridement (removal of dead tissue) for third-degree or fourth-degree burns. or chest pain should be tested. towels. numbness. If the door is warm. yell for help out the window. Open windows slightly at the top and bottom. BURN TREATMENT Treating burns depends on the severity of the burn. In case of a fire. but close them if smoke comes in. disability. or sheets. Check to make sure your escape path is clear of fire and smoke. Never use an elevator during a fire. you and the others there are at risk for carbon monoxide poisoning. What you do to treat a burn in the first few minutes after it occurs can make a huge difference in the severity of the injury. the type of burn. Burn treatments include fluids (given intravenously for serious burns).
call 911 immediately. Do NOT breathe. medications. 4. While the burn is healing. if there is a severe burn. If that happens. . ice." then call 911 immediately. This is very important. belts. cut or tear around burned area. and Roll” to smother flames. blow. or any household remedy to a severe burn. Burns destroy skin and the loss of skin can lead to infection. Do NOT disturb blistered or dead skin. If swollen or tight hands and feet become numb and tingly. Make sure that burn victims get emergency medical help if experiencing any of the following: dizziness or confusion weakness fever or chills shivering cold sweats DO NOT • • • • • • • Do NOT apply ointment. Do NOT place a pillow under the person's head if there is an airways burn. from over the burned areas and from around the victim’s neck. Remove all burned clothing. Harsher fabrics will irritate the skin even more. blue. Do NOT immerse a severe burn in cold water. tight clothing. or cough on the burn.. butter. etc. Burns that completely circle the hands or feet may cause such severe swelling that blood flow is restricted. 3. 2. If clothing adheres to the skin. cream. Burns of the face and neck can sometimes swell enough to cause difficulty breathing (see illustration). TIPS: 1. burned areas swell immediately. Burns cause swelling. Do NOT remove clothing that is stuck to the skin.1. “Stop. Remove all jewelry. This can cause shock. This can close the airways. cold. or "fall asleep. dehydration and hypothermia (loss of body heat). oil spray. 2. 3. Do NOT give the person anything by mouth. wear loose natural clothing like silks or light cottons. Drop.
oil. 7. or constricting clothing from the affected area before it begins to swell. We place it under a tap or in a bucket of water. i. or we apply cold-water compresses (but not ice) to the burned area. bracelets. We immerse the burned area immediately in cold running water. In electrical burns. 3. ointments. In chemical burns. We remove any watches. . 1. we look for the entrance and exit points of the electric current. and to transfer the burn patient to hospital only if the burn is extensive. the burn is regarded as an inhalation burn that requires assessment by a physician. belts.19. where the accident took place. On the contrary. We do not press the burned area.9.18 There are two ways of treating a burn patient. If the patient has suffered burns in the face or has inhaled smoke or hot air in a burning building. or creams to the wound. dry cloth.e. We do not remove clothing adhering to the wound. 6. Blistering or sloughing (skin coming off) means the top layer of skin is completely damaged and complications are likely. Charring indicates even deeper damage to all three layers of skin. we do not use other materials to neutralize the chemicals without detailed medical instructions. The second way is to move the patient to a specialist burns centre immediately in order to treat the burn injury systemically and topically. 5. 9. rings. The first way is to provide first-aid treatment on the spot. 4.21. o we douse the victim with cold water and keep washing off the burned area with running water for at least 5 minutes.22 This treatment is not administered in extensive or third-degree burns. However: o we remove contaminated clothing and the patient’s shoes and socks. a burn can seriously threaten not only the patient’s life but also his or her rehabilitation in society and at work because of malformations and disabilities. We continue to cool the burned area with cold water for about 5 minutes or until the pain diminishes. We do not apply butter. or charred (blackened) skin. We use analgesic drugs. as cold water may aggravate the state of shock. or sprays only in first-degree burns or according to medical instructions. We do not prick blisters or otherwise interfere with the burned area. o we relieve pain with cold-water compresses. We then dry the area gently with a clean towel and dress it with a sterile or clean. 8.TREATMENT A burn is an injury that in most cases leaves no disability. given the availability of the necessary equipment and specialist knowledge. 2. Look for blistering. sloughing. if treated inadequately or not following standard rules and principles.20 FIRST-AID TREATMENT IN BURNS The treatment of burns caused by heat or electricity starts with the application of cold water in order to cool destroyed tissues and to minimize damage to them. provided it is properly treated.
the victim is wrapped in a clean sheet and transferred to hospital. such as increased pain. we require evaluation by a physician even when the burn is not extensive. o o For minor burns. If infection develops. seek medical help. people should be laid on the ground. Putting ice directly on a burn can cause frostbite. Don't put ice on the burn. we require evaluation by a physician. We should then remove any clothing still burning and anything that could retain heat. Don't break blisters. further damaging your skin. fever. We should also ensure that any clothing adhering to the wound is not removed. redness. Bandaging keeps air off the burned skin. 12. people should not stand upright as this facilitates inhalation of smoke and their hair may catch fire. Caution Don't use ice. including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7. FOR MAJOR BURNS . Motrin. second-degree burns in the limbs or perineum.we cover wounds with a damp bandage. which may irritate the skin. Never give aspirin to children or teenagers. Wrap the gauze loosely to avoid putting pressure on burned skin. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. This could prevent proper healing. moisturizing lotion also can help. take the following action: Cool the burn. Take an over-the-counter pain reliever. ibuprofen (Advil. extensive first-degree burns. or until the pain subsides. Once the skin has cooled. In extensive burns. they should not start running as this will only cause the fire to expand. If this is impractical. Don't apply butter or ointments to the burn. Hold the burned area under cold running water for at least five minutes. others). 11. Cover the burn with a sterile gauze bandage. In face burns. swelling or oozing. Also. reduces pain and protects blistered skin. Use sunscreen on the area for at least a year. Minor burns usually heal without further treatment. They may heal with pigment changes. burns in more than 10-15% TBSA. Don't use fluffy cotton. meaning the healed area may be a different color from the surrounding skin. Broken blisters are vulnerable to infection. immerse the burn in cold water or cool it with cold compresses. 10. Cooling the burn reduces swelling by conducting heat away from the skin. These include aspirin. douse them with cold water. and all third-degree burns. When people’s clothing is on fire. or roll them over in order to extinguish the fire. Watch for signs of infection. In such moments.5 centimeters) in diameter. others). Make sure the person is up to date on tetanus immunization. where it is easier to wrap them in a blanket. naproxen (Aleve) or acetaminophen (Tylenol.
This means pulse. neck. follow these steps: • If someone is on fire. Areas may be charred black or appear dry and white. wet cloth or towel to relieve pain. drop. Difficulty inhaling and exhaling. such as lime. Protect the burn area from pressure and friction. Wet the person with water. and blood pressure. Wrap the person in thick material to smother the flames (a wool or cotton coat. or blanket). 5. . do NOT place the person in this shock position if a head. • • • • • • • CHEMICAL BURNS: FIRST AID If a chemical burns the skin. However. Do NOT apply any ointments.Wrap the burned area loosely with a dry. Cover the burn area with a dry sterile bandage (if available) or clean cloth. carbon monoxide poisoning. rug.The most serious burns are painless. If the burning chemical is a powder-like substance. or other toxic effects may occur if smoke inhalation accompanies the burn or major burns. sterile. do NOT remove burned clothing that is stuck to the skin. If breathing has stopped. involve all layers of the skin and cause permanent tissue damage. Fat. rate of breathing. elevate the feet about 12 inches. or leg injury is suspected or if it makes the person uncomfortable. dial 911 or call for emergency medical assistance. Take steps to prevent shock. Elevate the body part that is burned above the level of the heart. Avoid breaking burn blisters. However. brush it off the skin before flushing. non-adhesive dressings. Make sure the person is breathing. follow these steps: 1. separate them with dry. muscle and even bone may be affected. A sheet will do if the burned area is large. begin rescue breathing and CPR. or if the person's airways are blocked. 2.Remove clothing or jewelry that has been contaminated by the chemical. sterile dressing or a clean cloth. Until an emergency unit arrives. Lay the people flat. and roll. 4. 3. If necessary. Make sure that the person is no longer in contact with flaming materials. tell the person to stop. running water for 20 minutes or more.Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing. back. and cover the person with a coat or blanket. If fingers or toes have been burned. Continue to monitor the person's vital signs until medical help arrives.Remove the cause of the burn by flushing the chemicals off the skin surface with cool.Apply a cool. open the airways.
Checking of respiratory passages The respiratory passages must be checked to ensure that the patient is properly oxygenated. Motrin.25. arterial pressure. The drip inserted into the vein should not pass through the affected area. and if the patient takes drugs. or in the crural vein. including the conditions in which the accident took place. groin or buttocks. so that the patient can be properly treated.23. it is recommended that it should be placed in the neck (subclavicle). heart disease. in order to avoid thrombophlebitis. and the resulting second-degree burn covers an area more than 3 inches (7. such as fainting. The victim has pain that cannot be controlled with over-the-counter pain relievers such as acetaminophen (Tylenol. Close observation of the victim can prevent suffocation. or has suffered any other injury apart from the burn (e. in order of precedence. . allergy. The chemical burn occurred on the eye. hands.5 centimeters) in diameter. 4. 3. Record of vital signs Pulse.24 1. SEEK EMERGENCY MEDICAL ASSISTANCE IF: The victim has signs of shock. has ever suffered from allergies caused by a drug. The treatment of burns in the Emergency Department includes the following actions. The chemical burn penetrated through the first layer of skin.g. Placement of phlebocatheter A vein chosen for intravenous fluid replacement should be able to accept large quantities of fluids (15-20 l per 24 h in extensive burns). feet. pale complexion or breathing in a notably shallow manner. Record of the patient’s case-history (information from the patient directly or accompanying persons) The patient’s name and age are recorded. TREATMENT OF BURN PATIENTS IN THE EMERGENCY DEPARTMENT A.26 2.MINOR CHEMICAL BURNS USUALLY HEAL WITHOUT FURTHER TREATMENT. or over a major joint. others) or ibuprofen (Advil. It is of the utmost importance for the physician to know if the patient is suffering from any disease (nephropathy. in the arm. face. diabetes mellitus). temperature. a fracture). if first-aid treatment was given. as well as the causes of the burn. and respiration frequency (danger of dyspnoea) should be carefully recorded in order to evaluate the patient’s general state. others).
the rhinogastric tube is placed as soon as the patient is admitted to hospital in order to allow proper feeding. albumin.5. IMMEDIATE TREATMENT OF BURN INJURIES . erythema. irrespective of their depth. it was placed in order to divert gastric fluids. 10. Placement of a Levin rhinogastric tube In modern practice. and urine specific gravity. 8. Placement of a urocyst catheter. It is necessary to know the quantity and the specific gravity of the urine excreted by the patient. Relief of pain. liver function. Check of patient’s psychological state Steps should be taken to limit the patient’s psychological and emotional reactions (e. and blood group should be carefully recorded. During the first days after the accident. 9. pain. creatine. 13.28 The purpose of the clinical and laboratory check of the burn patient during the first two days after the accident is to evaluate the effectiveness of treatment and to diagnose complications as soon as possible. 11. formation of blisters. Urea. Qualitative evaluation includes sensibility of the burned area. electrolytes. In the past.g. 12. The depth of the burned area should therefore be re-assessed on the second or third day post-burn. Electrocardiogram Thorax radiography is necessary. Laboratory tests This entails haematocrit. Quantitative evaluation of the burned surface To evaluate the quantity of the burned surface. the tests should be repeated every 2-4 h. and the extent of oedema. Prevention of shock and anti-shock therapy 7. all burned areas are added together.27 6. anxiety). blood sugar. blood air. B. Qualitative evaluation of the burned surface The depth of the burn cannot always be evaluated precisely when the patient is admitted to hospital. and administration of painkillers or intravenous morphine1.
plus proper nursing care. . closed. an antibacterial drug or a combination of various drugs is applied to the burned area. The first purpose of systemic therapy is to prevent the patient’s death. iodide soap. the burned area should be scrupulously cleaned and. If haematosis is not considered to be satisfactory. and localization of the burn. Before selecting the antibacterial drug. contributes greatly to the maintenance of limb function after burn injury. and the drug’s reaction in the tissues. Daily physiotherapy. The lather produced by the antiseptic solution is cleansed with physiological saline. in order not to compress the burned area and to prevent it from adhering to the wound. its virulence and absorbency. starting immediately after the accident. All clothing that constricts the body is removed. We then check haematosis of the limbs. any watches. Any delay in treatment may complicate the patient’s recovery. antibiotic drugs are prescribed to protect the burned area from infection. Delay reduces the possibilities of making a sound prognosis and increases the risk of death. The burned area is treated in aseptic conditions. we consider the wound’s bacterial flora. bracelets. Once the method of treatment is selected (open. are removed from the burned area before it begins to swell. with large quantities of cold sterile water. In chemical burns. depth. or if there is extensive oedema. a section is recommended. as also of the perichondrium of the lobe and the nose are also checked. The vitality of the skin. water or any other suitable solution should be used. healing of the wounds will follow. Plastic surgery may be necessary to minimize scars and wrinkles.When a burn patient is admitted to hospital. inspecting the arteries or using a Doppler. or Betadin. and the blisters are emptied. The therapy applied to burn patients depends on the extent. THERAPY Therapy affects the recovery of burn injuries. The immediate application of appropriate therapy. the dead tissues are removed. antiseptic solution (NaCl). influences the final prognosis. and generally to improve the appearance of the patient’s skin and limb mobility. etc. or surgical). In all cases of burn injury. depending on the particular caustic chemical that caused the accident.
1 Burns in more than 15% TBSA require treatment in the plastic surgery department. or perineum. limbs. Complications may occur during the treatment of burn injuries. The quantity of urine excreted should be recorded. in factories). attract children. Burns constitute an injury to the skin. as they are unaware of the potential danger. heaters. and the utmost attention is necessary when nursing a burn patient. although they heal quickly. matches. Parents should go to great lengths to ensure that children do not touch such items and do not have access to them. Automatic fuses are necessary. After cleaning of the affected area and the administration of injections for tetanus. . neck. It is recommended that they should not occupy themselves in potentially dangerous household tasks. Treatment is given in the out-patients’ department. the fewer complications there will be and the greater the chances of recovery. We should never forget that burns are also caused by protracted exposure to the sun. radiators. pans with boiling water. Most burn accidents happen in the home and only occasionally at work (e. Stoves. Everyone should take care in the use of any energy source that can cause thermal injuries and avoid exposure to unnecessary danger. The sooner systematic treatment of the burned area begins.Burns affecting up to 15% TBSA in adults and 10% TBSA in children do not require hospital treatment. It should be borne in mind that a burn is an accident and is therefore to a large degree preventable. provided that the burn is not in the face. etc. The following points should be taken into account: • • • • Small children under 4 years old are exposed to various dangers when exploring their environment. it is recommended that the patient should be given analgesic drugs and fluids by mouth.g. Older people tend to forget electric appliances on or pans with boiling fat. electric current and cables. lighters.
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