First degree burn

First degree burns are usually painful, red and swollen. They also turn white upon the application of pressure and will often peel and flake after a couple of days. Treat these by first soaking in cold water and using a topical ointment like Aloe Vera. One can also take over-the-counter pain killers to ease the discomfort. If the area is larger than 3 inches wide or is in the feet, face, or genitals, seek medical attention. Such injuries usually heal in a matter of days.

Second degree

These burns cause swelling, severe pain and splotchy skin with large blisters. Treat these kinds of burns by soaking in cool water for about 15 minutes. If the area is not big, place a wet, cool towel to lower the temperature. Use an antibiotic ointment/cream that the doctor prescribes.

The burn should then be covered using a nonstick dry gauze during the burns first aid. This should be changed everyday after washing the area gently. If any symptoms of infection appear, see a doctor immediately. This injury could take several weeks to heal. However, one should seek medical attention for large second degree burns.

Third degree

Third degree burns usually damage all skin layers and have a charred/white appearance. Due to the extensive nerve damage to the skin, the burn may be painless. Such severe injuries require immediate medical attention. Don’t soak or try to remove garments stuck to the skin. You can apply a clean bandage to the area till you arrive at the hospital.

Management of other types of burns

Burns could also be due to electricity or exposure to chemicals. For the former, damage may be present in other areas of the body besides the skin surface. Due to this, one should seek medical help immediately. Wash chemical burns using lots of water. Remove any clothing that has the chemical on it. Don’t apply topical medication because it could react with the chemical agent that caused the burn. If you’re unsure of whether to seek medical help, contact your local poison center.

For steam burns, first analyze the severity. Burns First aid treatment won’t be of any help if the injury is so intense that emergency treatment is needed. If the burn has open skin, is blistered or is larger than 3 inches in diameter, seek medical help. While severe burns are usually evident, there may be inconspicuous injuries such as respiratory damage due to inhalation.

Other common burns are due to cigarettes. For such, you can follow the burns first aid procedures used to treat first degree burns. This is because they are usually not severe. Provide oral painkillers 3 to 4 times a day to alleviate the pain. Burns first aid procedures should be carried out immediately they occur in order to reduce the chance of a scar developing and to prevent infection as well.

FACT CHECK

https://www.mayoclinic.org/first-aid/first-aid-burns/basics/art-20056649

https://www.webmd.com/first-aid/thermal-heat-or-fire-burns-treatment#1

https://www.nhsinform.scot/illnesses-and-conditions/injuries/skin-injuries/burns-and-scalds

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Burns cause death in several ways,

• Directly destroying tissues
• Causing  inner tissues exposed to air leading to oozing of body fluids leading to shock
• Inhalation of hot fumes/steam and facial burns will cause swelling of air ways leading to airway obstruction
• Burning objects (e.g. Plastics) releases an array of toxic gases together with hot gases will destroy lung tissues leading to Adult Respiratory Distress Syndrome (ARDS)
• Reduction of oxygen content in environment (e.g. in a burning house) will cause asphyxia as well as carbon monoxide poisoning

These have to be kept in mind in attending to burn victim.

Outcome of the burn is determined by the type of the burn, surface area of the burn, depth of the burn, distribution of burn (e.g. burns in face, chest, genital areas are considered critical), patients age, underlying diseases (e.g. Diabetes), other injuries and the duration of contact with cause of burn.

Burns can be categorized according to the depth of burns

	1st degree	2nd degree	3rd degree	4th degree
Depth	Epithelium (Outermost layer of the skin)	Dermal(2a)-superficial 2nd degree burn   (2b)-deep 2nd degree burn	Sub dermal with destruction of all the dermal appendages and necrosis of epidermis and dermis.	Extending to subcutaneous tissue and beyond to muscles etc.
Appearance	Reddening of skin without blistering	(2a)- blisters   (2b)-beyond blister stage. Moist red lesions, may find blisters	Dry, white, leathery lesions. Sometimes brown or black.no blisters.	Charring
Pain	Present	Present	Absent	Absent
Capillary return	Present	Present	Absent	Absent
Scarring	Absent	Absent	Present	Present
Eschar	Absent	Absent	Present	Present
Muscle burns	Absent	Absent	Absent	Present

Burn Surface area is determined by the “Wallace’s rule of nines”

Fig 1: Burn percentage in adults: Surface area of palm considered as 1%

Any burn involving ≥30% surface area of the body in adults is considered ‘Major’ or a serious burn and requires urgent medical attention. Also a burn involving any of vital areas (e.g. Face, Chest, Genitals) considered serious regardless of its size or depth. In children or elderly any burn ≥20% surface area is considered ‘Major’.

First aid management

1. Ensure safety first, victims as well as yours. Remove him/her from the vicinity to open air. Be careful in touching him with bare hands as you’ll get burned also.
2. If the victims is on flames help him to drop on to ground and roll around to smother flames. Do not allow to run in panic.
3. Remove burning or burnt clothing, if adherent to skin cut or tear around. Remove tight jewelry, belts as burns can swell quickly.
4. Cooling:

Cooling can be practiced for all flame, chemical or explosion burns. It will reduce retained heat as well as flush out chemicals. So reduces depth of penetration and severity of the damage.

• Use cool (not cold) running water. Tap water is ideal.
• Continue around 20 to 30 minutes.
• Do not use ice, butter or other ointments.

5.  Avoid hypothermia:

Surface burning hence loss of skin, removal of cloths and cooling are the factors that can leads to hypothermia in a patient with a burn.

So in order to avoid this keep the victim covered, keep warm and dry.

When transporting be sure that the victim is covered with warm clothing.

6.  In the same time try to identify the type and category of burn. If it looks ‘Major’ as described above, or if victim is having difficulty in breathing or unconscious have someone to call 911 urgently while monitoring the his vitals and attending to basic life support as necessary.

7.  In Minor/1^st degree burns(without affecting vital areas);

• Can be managed at home without hospitalization.
• Other than above mention steps cover the affected are with clean blanket or a sheet but do not use gauze as it can adhere to the wound causing shearing and damage to skin and pain on removal.
• Relieve the pain with over-the-counter painkiller such as acetaminophen, ibuprofen, or naproxen.
• Apply antibiotic cram such as Silver Sulphardiazine (do not use in face).
• Give a shot of tetanus toxoid booster if required.
• Seek medical help if there is continued pain, signs of infection, fever, or oozing.

8.  Major burns (2^nd, 3^rd, 4^th degree)/ ≥30% surface area/ vital area burn

• Need urgent hospitalization.
• Do not give any food or water as these interferes with general anesthesia if operative procedure is required.
• Other than above general measures check whether the victim is conscious and breathing. If not secure the airway and go through the steps of Basic Life Support as well.

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