You take a walk down your favorite lane on a particular evening. You wonder afar cognitively as the evening breeze bellows wildly, evident by the sound of the caressing leaves. Alas, a perfect evening you thought. Suddenly, you hear a cry. It is a group of young boys playing around with fire which has unfortunately lite up one of them. What will you do in this situation to assist the helpless boy?
Introduction
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The dermis consists of nerves, blood vessels, sweat glands, hair follicles (hair roots), sebaceous glands, muscles etc. The nerves mentioned here are responsible for recording sensations from the body surface. From extreme sensations to the slightest ones (You probably wonder how these nerves are able to receive such mild sensations with a layer of dead cell lining the top of the skin), be it heat, cold or pain. There is however a layer of fat which lie beneath the dermis called the subcutaneous fat.
Any physical damage to the skin, mucous membrane or conjunctiva caused by heat, cold, electricity, radiation or caustic chemicals can be referred to as burns.
The most common cause of burns is heat. This could be dry burn (caused by flames, contact with hot objects or friction) or scald (caused by hot liquids such as hot water, steam). Other forms such as cold (freezing metal etc.), chemical (industrial and domestic chemicals e.g. bleach), radiation (sunburn, radioactivity etc.), and electrical (lightning strikes, high voltage) may be less rampant but also causes a significant amount of injury to lots of people.
Classification of Burns
Burns is classified according to the depth of skin damage. There are 3 classifications, superficial, partial thickness, and full thickness.
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Superficial burns (First Degree Burns); This involves only the epidermis. It heals well if first aid is given promptly and if blisters do not form. It is characterized by redness, swelling and tenderness.
Partial thickness burns (Second Degree Burns); It involves the epidermis and part of the dermis, and are very painful, the skin becomes red and blisters formed over the skin due to fluid released from the damaged tissues.
Full thickness burns (Third Degree Burns); This affects all layers of the skin, usually causing loss of pain sensations as it may cause damage to some nerves, fat tissues, muscles and blood vessels.
Estimating the area of skin burnt
In determining the severity of burn, it is best to calculate by the size of area burnt than the depth of tissue destroyed. The size of the area is determined by the Wallace’s rule of nine.
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- Whole of each upper limb = 9%. Therefore both limb equals 18%
- Whole of head and neck = 9%
- Whole of each lower limb = 18%. Therefore both limb equals 36%
- Front of trunk = 18%
- Back of trunk = 18%
- Perineum = 1%
If 15% of the body of an adult or 10% of the body of a child is burned, the condition should be considered serious and require immediate hospital treatment.
General First Aid Management of Burns
As a first aider, always assess the situation and make a plan.
The aim of management in a case of burns is not to provide complete treatment but to manage the situation until professional help arrives or the casualty is transferred to a hospital.
Aim;
- to stop the burning.
- to relieve pain.
- to maintain an open airway (in cases of burning of the throat).
- to manage associate injuries.
- to minimize the risk of infections.
- to arrange for transport.
What to do?
- Quickly remove the casualty from the source of the burns, whether fire or liquid. Take your own safety into consideration when doing this, a dead first aider cannot really offer much help. Can they?
- In trying to stop the burning, roll the casualty on the ground to stop the fire if clothing is till on fire.
- Burns can be extremely painful, position the casualty to ensure comfort. If the casualty feel more comfortable in a certain position that doesn’t worsen their condition, allow them to do so.
- Watch for signs of smoke inhalation such as dyspnea.
- Remove any constriction but do not remove any clothing that
is stack to them as you may end up pealing off some skin off of their body.
- Carefully remove any clothing or jewelry from the area before it starts to swell.
- Cover the burn and the surrounding area with a sterile or clean dressing.
- Monitor and manage for shock.
- Transport to hospital.
First Aid Management of Specific Burns
Burning Clothing
In an instance where the cloth of a casualty is still on fire, the flame must be extinguished immediately. The most tried and tested procedure is the “Stop, Drop and Roll”. Stop - do not run around in a circle screaming. Drop - let yourself fall to the ground. Roll - roll around, as this will smother the flames. Bystanders can help by covering the person with a coat, wet towel, blanket, or whatever is at hand. The purpose of this covering is to smother the flames (starve them of oxygen), so once the flames are gone, remove these additional coverings.
After the flames are extinguished, lay the patient down either in bed or on a crouch and remove the rug or bed cover and examine the burn area. Do not attempt to remove any clothing which may be sticking to the burnt area. Cover the burn area with a clean material, keep the burn dry and do not attempt to apply any lotion or ointment.
Assess the situation and extent of the burn area. It is best to send the Doctor with a written report/ message informing him of the damage done. If the burn is severe, arrangements should be made immediately for the transportation of the patient to the hospital. Besides, the casualty might have to visit the hospital for subsequent dressing anyway. Hence, won’t it be the best to ask them to visit the hospital even in mild and moderate burns to prevent infection?
Assess and treat for shock, the presence of shock may not be immediately apparent, but it is to be remembered that it is likely to occur, especially in the very young and very old people.
Reassure the patient.
Burns to the Mouth and throat
Hot fluid or chemical, when taken by mouth, causes severe burning of the mouth and throat. Apart from the pain involved, there is great danger of swelling of the throat and larynx. And if you remember the ABCD of primary assessment during first aid, the very first letter, “A” stands for Airway which means a swelling of the throat and larynx is life threatening and must be prevented at all cost.
If the chemical ingested is not known (i.e. the causative agent for the burns), a demulcent should be given to the casualty (a demulcent is a substance which soothes irritated mucous membrane). Milk is probably the most palatable, and the patient should be made to drink as much as possible.
Warm or cold compress may be applied to the neck to relieve swelling. If the throat does begin to swell it may obstruct breathing, so send for medical aid or transport the casualty to the hospital.
Burns from steam or hot water
- Remove the clothing from area as quickly as possible because when it gets dry, it could get stuck to the skin but if it does, do not attempt to forcefully remove it.
- Keep the area dry by applying a clean material lightly to the affected part (dressing or bandage if possible).
- If blisters appear do not try to burst them, protect the blisters using a loose dressing and keep the part dry.
- Assess and treat for shock.
- Arrange for transport and send casualty to hospital if necessary.
- Reassure the casualty.
Complications of shock
- Shock
- Infection
- GIT problems e.g. curling's ulcer
- Respiratory problems
- Deformities and contractures
- Keloid and hypertrophic scars
- Death
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