First Aid
Burns
 

Overview:

Burns are tissue damage that results from exposure to burning heat, chemicals and electricity, as well as overexposure to the sun, and the like causes of burns. Common as they are, most skin burns are minor and can be managed at home. However, it is important to know the signs of a more serious skin burn, which should be evaluated and treated by a health care provider. Moderate to severe burns can cause a number of serious complications and usually require urgent treatment.

Causes of burns:
  • Hot water, steam, and hot objects;
  • Flames;
  • Chemicals;
  • Electricity; or
  • Overexposure to the sun.

When to see a doctor:
  • If the burn involves the face, hands or fingers, genitals, or feet;
  • If the burn is on or near a joint (e.g., knee, shoulder, hip);
  • If the burn encircles a body part (e.g., arm, leg, foot, chest, finger);
  • If the burn is large (larger in diameter than 7 cm) or deep;
  • If the burn is sustained by a person who is under age 5 or over age 70; or
  • If there are signs of skin infection, such as increasing redness, pain, pus-like discharge, or temperature greater than 38ºC.

Burn types:  
Burns are classified based on the thickness of the skin burned. The classification of a burn can change over the first few days. This means that a burn may appear superficial initially, and then become deeper over time.
  • Superficial skin burns (first-degree burns): 
  • Superficial skin burns involve only the top layer of skin, are painful, dry, and red, and turn white when pressed. Superficial burns generally heal in three to six days without scarring. Such type of burns include: non-blistering sunburns.
  • Superficial partial-thickness skin burns (second-degree burns): 
  • Superficial partial-thickness skin burns involve the top two layers of skin. They are painful burns, especially when exposed to the air, cause the skin to become red (which turns white when pressed), and usually develop blisters. Superficial-partial thickness burns usually heal within seven to 21 days. The burned area may permanently become darker or lighter in color but a scar does not usually form. Sunburns that blister after several hours are good examples of superficial partial-thickness burns.
  • Deep partial-thickness skin burns (third-degree burns): 
  • Deep partial-thickness skin burns extend deeper into the skin, are painful with deep pressure, almost always form blisters, and do not turn white with pressure. Deep partial-thickness skin burns take more than 21 days to heal and usually develop a scar, which may be severe. Burns that blister immediately are deep partial-thickness burns. A blister that persists for several weeks is also considered a deep partial-thickness burn.
  • Full-thickness burns (fourth-degree burns): 
  • Full-thickness skin burns extend through all layers of the skin, completely destroying the skin. The burned area usually does not hurt, is a waxy white to leathery gray or charred black color. The skin is dry and does not blanch when touched. Full-thickness burns cannot heal without surgical treatment and scarring is usually severe.

Skin burn treatment:
Small superficial or superficial partial-thickness burns can often be treated at home. However, burns that are larger or deeper should be evaluated by a health care provider. Home treatment of skin burns should include cleaning the area, immediately cooling it, preventing infection, and managing pain—as detailed below:
1. Clean the area: 
- Remove any clothing from the burned area. If clothing is stuck to the skin, do not try to remove it and seek emergency medical care.
- Gently remove any accessories (e.g., rings, watches, belts, shoes, etc.), if any.
- Wash the burned skin gently with cool tap water and plain soap. It is not necessary to disinfect the skin with alcohol, iodine, or other cleansers.
2. Cool the area: 
- After cleaning the skin, you may apply a cold compress to the skin or soak the area in cool (not iced) water for a brief period of time to mitigate pain and reduce the extent of the burn.
- Avoid placing ice directly on the skin because this can damage the skin further.
3. Prevent infection: 
- To prevent infection in partial-thickness and severer burns, apply aloe vera or an antibiotic cream to the burned area.
- Avoid applying other substances (e.g., mustard, egg whites, lavender oil, butter, mayonnaise, toothpaste) to skin burns.
- Keep burns clean by washing the burned area daily with soap and water.
- Burns that form blisters should be covered with a clean bandage, preferably a bandage that does not stick to the skin (e.g., non-sticking bandage or a vaseline dressing). Minor burns may be covered with a clean bandage, as needed.
- Change the dressing once or twice a day, and do not try to break open skin blisters with a needle because this can increase the risk of skin infection.
4. Tetanus prevention:
If you have not had a tetanus shot in the past five years and your burn is superficial partial-thickness or deeper, you need a tetanus booster vaccine.
5. Treat pain:
- Elevating burns on the hand or foot above the level of the heart can help to prevent swelling and pain.
- You may take a painkiller (e.g., acetaminophen or ibuprofen) if needed.
- If the pain so severe that it cannot be controlled with the above-mentioned medications, consult your doctor.
- Topical anesthetic agents should not be used regularly on burn wounds, as irritation may occur.
6.       Avoid scratching the skin: 
The burned area naturally becomes itchy as the skin begins to heal. Try to avoid scratching the skin. Use a moisturizing lotion or an antihistamine if needed.

Skin burn follow-up: 
  • If the burn is not healing, or when redness spread greater than 2 cm from the edge of the burn, you should see a doctor.
  • Most skin burns that are small and superficial will heal within one week and will not usually scar.
  • After a superficial partial-thickness burn, the skin may become darker or lighter in color, but will not usually scar.

Preventing skin burns: 
  • To avoid sunburns, avoid exposure to the sun during daytime (10 a.m. to 4 p.m.). 
  • Keep lit candles, matches, and lighters out of the reach of children.
  • Keep hot foods and drinks, irons, and curling irons away from the edge of counters and tables.
  • Keep children away from hot stoves, fireplaces, and ovens.
  • It is advisable to cook on the rear burners when possible. Never carry a child in your arms while cooking.
  • Install a smoke detector on each floor of your home, and test its quality once per month.
  • Set the thermostat on your hot water heater no higher than 49°C.
  • Cover car seats, especially strollers, with some sort of protective cover against the sun in summer. And avoid parking the car in an open, unshaded place on a hot day.




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