Ethan Rhodes
Burns are injuries caused by heat, radiation, electricity, friction, or chemicals, resulting in skin damage. Treatment for burns depends on the severity and cause of the burn. Immediate first aid for all burns involves stopping the burning process and running cool water over the affected area for at least 20 minutes. In the case of electrical burns, it is crucial to shut off the power supply or separate the victim from the electrical source using a non-conductive material. Chemical burns necessitate removing contaminated clothing and washing the affected skin with water for up to an hour. If the burn is severe, a specialist may need to perform a skin graft, which involves replacing the burnt skin with a graft from another body part. Deep burns can take months or years to heal and often leave scars, requiring protection from direct sunlight during the healing process.
| Characteristics | Values |
|---|---|
| First aid | Remove the person from the area, douse flames with water, or smother flames with a blanket. |
| First aid | Remove any clothing or jewellery near the burnt area of skin. |
| First aid | Cool the burn with cool or lukewarm running water for 20 minutes as soon as possible after the injury. |
| First aid | Keep the person warm using blankets or layers of clothing, but avoid covering the injured area. |
| First aid | Use cling film on the burn to reduce pain and protect the wound. |
| First aid | Treat the pain with paracetamol or ibuprofen. |
| First aid | Do not use ice, iced water, or any creams or greasy substances like butter on the wound. |
| First aid | Do not try to remove anything that is stuck to the burnt skin. |
| Hospital treatment | Skin grafts for severe burns. |
| Hospital treatment | Electrical burns: switch off the power supply or remove the person from the electrical source using a non-conductive material. |
| Hospital treatment | Acid and chemical burns: find out what chemical caused the burn and inform healthcare professionals. |
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What You'll Learn
Assessing burn severity
When assessing burn severity, it is important to consider the type of burn, possible inhalation injury, and possible associated injuries. Electrical burns, for instance, may not look serious but can cause extensive internal organ injury. Acid and chemical burns can also be very damaging and require immediate medical attention.
The severity of a burn is determined by the amount of body surface area (BSA) affected, the depth of the burn, and the degree of damage to the skin. The Rule of Nines and the Lund and Browder Chart are methods used to estimate the percentage of total BSA burned. Burn depth is classified into three types based on how deeply the injury extends into the epidermis or dermis. The burn's extent and depth are major factors in evaluating burn severity.
Burns are classified from first to fourth degree. First-degree burns are the most minor, while fourth-degree burns are the most severe, extending beyond the skin into tendons and bones. Second- and third-degree burns carry the most risk for complications such as infections, blood loss, and shock, which can lead to death. Third-degree burns may not be painful due to nerve damage, but they cause severe scarring and contracture without surgery.
The worse the burn blisters are, the longer the healing process will take. Skin grafting may be required to repair the damage in severe cases. Severe burns also carry the risk of hypothermia and hypovolemia due to excessive loss of body heat and blood volume, respectively. Therefore, it is crucial to seek immediate medical attention for severe burns to prevent complications and ensure proper treatment.
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Removing items stuck to the burn
When treating burns, it is important to act quickly to limit the damage to the skin. The first step is to stop the burning process by removing the person from the area, dousing flames with water, or smothering them with a blanket. Remove any clothing or jewellery near the burnt area, but do not attempt to remove anything stuck to the burn, as this could cause further damage. Instead, seek medical attention, especially if the burn is larger than 3 cm in diameter, or if it is on the face, hands, or groin area.
In a hospital setting, the treatment for burns depends on the cause and severity of the injury. For electrical burns, it is crucial to first switch off the power supply or remove the person from the electrical source using a non-conductive material, such as wood. Acid and chemical burns also require immediate medical attention, and healthcare professionals will need to know the specific chemical involved.
When it comes to removing items stuck to the burn, the approach may vary depending on the nature of the item and the condition of the skin. In some cases, healthcare professionals may opt to leave the item in place to prevent further damage or infection. In other cases, they may carefully remove the item, ensuring that the wound is thoroughly cleaned and dressed to promote healing and prevent infection.
One common method for removing items stuck to burns is the use of water and baking soda (sodium bicarbonate). This involves creating a paste with baking soda and water, which can then be applied to the affected area. The alkaline nature of baking soda can help neutralise acids in the burn and promote the release of stuck items. This method is often used for removing burnt-on food from pans and can be effective for similar types of debris stuck to burns.
Another approach is the use of vinegar, which has acidic properties that can help break down and loosen stuck-on substances. This can be combined with baking soda to create a fizzing reaction that may help dislodge items. However, it is important to note that vinegar's acidity may not be suitable for sensitive skin or open wounds, so it should be used with caution and under medical supervision.
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Running cool water on the burn
When treating a burn, it is important to act quickly and appropriately to limit the damage to the skin. The first step is to stop the burning process by removing the person from the source of the burn, dousing flames with water, or smothering them with a blanket. It is important not to put yourself at risk of getting burned in the process. Once the burning process has been stopped, the next step is to cool the burn.
Running cool water over a burn is an effective way to treat it and is recommended by the NHS. The water should be cool or lukewarm and run gently over the burn for at least 20 minutes as soon as possible after the injury. This technique can be used by anyone, with or without formal medical training, and is especially useful in situations where access to a hospital is delayed, such as in military combat, rural areas, or during natural disasters.
Applying cool running water to a burn helps to mitigate the severity of the injury by dissipating thermal energy, stabilizing blood vessels, reducing the release of pro-inflammatory chemicals, and influencing cellular responses. It is a simple, low-cost method that can significantly improve patient outcomes, including reducing the depth of the burn, the need for skin grafting, hospital admissions, and the number of surgeries required.
It is important to note that ice, iced water, or any creams or greasy substances should not be applied to the burn, as these can further damage the skin. Additionally, while it is crucial to cool the burn, it is also essential to keep the person warm using blankets or layers of clothing, being careful not to cover the injured area.
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Preventing hypothermia
External Warming Methods
Nursing staff can employ external warming techniques to maintain a patient's temperature. This includes providing a warm environment, using warm air blankets, and administering warm fluids. These methods helped a 24-year-old male patient with severe burns respond to treatment and increase his body temperature.
Intravenous Temperature Management (IVTM)
The IVTM system, such as Thermogard XP®, can be used to regulate body temperature in severe burn patients. This system uses a balloon catheter inserted into the central venous system to circulate saline, with automatic temperature adjustments based on patient temperature monitoring. However, it is costly and may complicate the identification of underlying physiological changes.
Radiation Protection
Covering the patient as much as possible helps prevent heat loss to the environment. This includes ensuring that patients are not transported with wet dressings, as this can cause heat loss and lead to hypothermia.
Early Bleeding Control
Early bleeding control is essential, as bleeding can contribute to hypothermia.
Avoid Prolonged Use of Hydrogel Dressings
Prolonged use of hydrogel dressings can induce hypothermia.
Heated Ventilation
Mechanical ventilation, especially in the first 72 hours, can be a factor in body temperature regulation. Heated humidification of the ventilatory circuit can be included in the rewarming strategy.
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Skin grafts
Skin grafting is a surgical procedure used to treat severe burns. It involves taking healthy skin from one part of the body (the donor site) and transplanting it to cover the burned area (the graft site). Skin grafts are performed when the skin is unable to regenerate new cells on its own, helping to accelerate the healing process and minimise scarring.
There are several types of skin grafts, including allografts, xenografts, autografts, and synthetic skin substitutes. Allografts, or cadaver skin, involve using human cadaver skin donated for medical use as a temporary covering. Xenografts, or heterografts, use skin from animals, typically pigs, as a provisional solution until an autograft is available. Autografts are skin grafts using the patient's own healthy skin. Synthetic skin substitutes, such as those containing elastin, offer one-step procedures for skin grafting and improved incorporation.
The surgical procedure begins with the surgeon making incisions to remove healthy skin from the donor site. Techniques like meshing involve creating tiny holes or cuts in the healthy skin, allowing it to stretch over a larger area and promoting healing. The healthy skin is then attached to the excised (cleaned) area of burned skin.
After skin graft surgery, the grafted skin is kept motionless for about five days to initiate the healing process. This period includes three main phases: imbibition, inosculation, and revascularization. During imbibition, a thin protective film forms over the grafted tissue to maintain a moist environment. Inosculation involves the formation of new capillaries around the graft's edges, enabling nutrient transfer. Finally, revascularization, or vascular regrowth, occurs when new blood vessels grow in the grafted tissue, restoring regular blood flow.
The recovery time after skin graft surgery depends on various factors, including the patient's health, the size of the graft, and the surgical technique employed. Patients may need to remain in the hospital for up to two weeks following surgery, adhering to instructions such as wearing dressings over the wounds and avoiding physical activity that could damage the graft site during healing.
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Frequently asked questions
Remove the person from the area, then douse the flames with water or smother them with a blanket. If there is an electrical current, turn off the electricity before approaching the person.
Remove any clothing or jewellery near the burnt area of skin unless it is stuck to the burn. Then, cool the burn with cool or lukewarm running water for 20 minutes. Do not use ice, iced water, or any creams or greasy substances.
A specialist may need to look at the burn if it is severe. In some cases, a skin graft may be needed. Deep or severe burns can take months or even years to heal fully and usually leave some visible scarring.
