Types of Burns and Their Treatment

Burns, they’re excruciatingly painful but they happen every day to regular people like you and I. Here’s a quick guide to the initial treatment of burns.

Chemical Burns

In view of this it’s vital to keep chemicals in their original containers, the label will have advice on what to do should the chemical get onto the skin. Some chemicals should not be mixed with water (see list below) some should be rinsed off etc so knowing what you are dealing with is vital and can prevent permanent injury or in some cases death.

If a chemical, such as bleach, or acids not listed below , burn your skin, you should follow this advice:

• Wearing protective gloves, remove any chemicals from the skin by running the affected area under cool tap water for 20 minutes, or more.
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• If the chemical involved is in powder form, such as lime, VERY LIGHTLY brush it off the skin with a soft brush or a light flicking motion with a tissue. Be careful not to cause abrasions to the skin. Make sure neither you or the casualty inhale any powder, or get it into your eyes. When you have removed as much as you can rinse under running water.
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• Remove any jewellery, or clothing, that may have been exposed to the chemical.
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• Apply a cool wet towel to help relieve pain.
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• Cover the burnt skin with a dry, sterile dressing, or clean cloth.
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• If you experience an increased sensation of burning, re-wash the skin for several more minutes.

The following should NOT be rinsed off with plain water:

• Carbolic acid or phenol does not mix with water, so use alcohol first to flush the chemical off the skin and then flush with water. If alcohol is not available, flush with a large amount of water. Do not flush the eye with alcohol.
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• Sulfuric acid is flushed with a mild, soapy solution if the burns are not severe. Sulfuric acid feels hot when water is added to the acid, but it is better to flush the area and not leave the acid on the skin.
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• Hydrofluoric acid is flushed with a bicarbonate of soda (baking soda) solution. (Use a small amount of water to make the solution.) Then flush with a large amount of water. Burns from this acid may not show at first, so flush the area even if a burn is not seen. Do not flush the eye with a baking soda solution.
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• Metal compounds should be covered with mineral oil.

Electrical Burns

Electrical burns can come from those people stuck by lightning or from exposure to mains electricity and in either of those cases there is little you can do. Less severe but still damaging electrical burns can come from any device that stores energy, batteries for example. These burns are to be taken seriously even if they look pretty minor. The discharge of electricity if strong enough to burn the skin is strong enough to cause deeper tissue damage.

Fishermen have been known to hook a power line as they cast. If you come across a collapsed fisherman always look up before approaching, the circuit may still be intact.

Ditto kite flyers. Look up and check the area before getting too close.

• DO NOT TOUCH THE CASUALTY if mains electricity is involved.
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• Turn off the supply if you can
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• If you can’t get to the mains pull or knock the person away from whatever they’re holding with for example a broom or other non-metallic inert object.
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• Call emergency services
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• Check vital signs and start CPR/.Basic life support as appropriate

A word of caution about microwaves. DO NOT be tempted to scavenge bits from the circuits etc. Even when switched off and unplugged they retain enough electrical energy not only to burn but to kill outright. Taking the back off is quite literally dicing with death unless you really know what you’re doing and even most electricians would not take the risk.

Lightening strikes are considered to be electrical burns. Often there will be little to see but massive internal damage often results. If the person survives the strike there will be no way of knowing the internal damage that has been sustained. There can sometimes be a slow breakdown of one or more internal organs after the event. Other people have impairment to a given limb, or memory loss after a lightning strike. Personality change is not uncommon. The burns should be kept clean and covered with a dry dressing as should any type of electrical burn.

Radiation Burns

If you’ve ever been sunburnt you have had a non-ionizing radiation burn. Radiation burns are painful in the extreme. How severe the burn is depends on the exposure.

• Wrap in cool wet cloths that are changed frequently.
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• Natural yogurt takes the heat out of sunburn very effectively, as does a liberal coating of yellow mustard.

Radiation burns are also possible if you have been exposed to fallout from a thermonuclear device. These however are ionising radiation burns.

Having a radiation burn means the body has been exposed to ionizing radiation but unless the exposure time and dose is known it’s impossible to say if the internal organs have been affected and if death will follow.

Not all exposure to nuclear radiation kills, and a short burst reddening the skin is much less dangerous than a long drawn out low-level exposure such as that experienced after Chernobyl or the ongoing situation with Fukushima.

Contact Burns

Contact burns as the name suggests results in coming into contact with something hot. This could be any number of things, a spark from the fire, a pan handle or contact with a hundred and one other things. Scalds from boiling liquids can also be considered contact burns, as can steam burns.

• Immediately get the person away from the heat source to stop the burning.
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• Cool the burn with cool or lukewarm water for 10-30 minutes minimum, longer if the pain returns within a minute or so of removing it from the water.
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• Do not use ice, iced water or any creams or greasy substances, such as butter.
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• Remove any clothing or jewellery that is near the burnt area of skin, but do not move anything that is stuck to the skin
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• Make sure the person keeps warm – for example by using a blanket – but take care not to rub it against the burnt area.
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• Cover the burn by placing a layer of cling film over it. Plastic bags are idea for burns on the hands or feet.
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• Give pain relief such as paracetamol (acetaminophen) or ibuprofen. Children under 16 should never be given aspirin though it’s fine for adults.
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• Do not interfere with the burn or break any blisters even if the burn is very painful or appears to be getting worse.

First, second and third degree burns

1. First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.
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3. Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering.
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5. Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.

Symptoms of burns

•Blisters
•Pain (the degree of pain is not related to the severity of the burn — the most serious burns can be painless)
•Peeling skin
•Red skin
•Shock (watch for pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness)
•Swelling
•White or charred skin

Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns.

The main danger from severe burns is dehydration due to loss of fluids, and colonization with Pseudomonas, an aggressive form of bacteria that flourish in the moist open environment provided by burnt skin. It’s important to cover burns with a non-stick dressing as soon as possible if blisters are present. Cling film is great and plastic bags are ideal for burns on the hands and feet

Be aware that severe burns smell, even before any infection sets in severe burns smell and it’s the kind of smell you will never forget. In any kind of very severe burn you will only be able to offer palliative care and this should be concentrated on making the patient as comfortable as possible.

Care should also be taken to make sure that full barrier nursing is employed, gloves and some kind of gown or apron at a minimum. Pseudomonal infection is opportunist and is as happy infecting any cuts or grazes you have as it would be infecting a burns victim.It may not be causing trouble in your minor graze but it will kill a severe burns victim.

Airway Burns

The airways can be burnt due to the inhalation of smoke or other hot gases.

Signs of an airways burn:

• Charred mouth; burned lips
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• Burns on the head, face, or neck
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• Wheezing
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• Change in voice
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• Difficulty breathing; coughing
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• Singed nose hairs or eyebrows
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• Dark, carbon-stained mucus

Airway burns are survivable but the chances of survival depend entirely on the amount of lung damage which in turn depends on the temperature of the smoke that was inhaled. Severe impairment of gas exchange due to damaged airways will usually result in death either immediately or very shortly after the fire.

Give cool drinks if they are able to swallow, the only hope is that the swelling of the airways can be prevented.

Should the victim survive there is no way of predicting how much damage there has been and what the medium to long-term effects will be

Take Care

Liz