Burn is defined as tissue damage caused by dry heat of open flame, hot object, molten metal or electricity.
Burn : Classified according to the area and depth of the injury.
Degree of burns : This classification indicates degree of damage to the tissues.
First degree : Reddened skin.
Second degree : Blisters on the skin.
Third degree : Destruction of deeper tissues and charring.
Scald: Wet heat such as steam, hot water, hot oil etc. produces scalds. The scald is superficial but often extensive. Blisters and red areas are in the surface.
Assessment of burn
The danger from burns depends on the area of the burns rather than the degree. Superficial burns over a large area are more dangerous than the complete charring of a part.
Any burn more than 30% should be hospitalised. Calculation for the percentage of the burn is to be done in the following manner as shown in the figure.
The skin area involved in a burn case is more important than the depth. Even a superficial burn involving more than 5% of the body surface is serious. If more than 15% the patient may suffer from shock. By following the “Rule-of-Nine”, the percentage of skin area is to be calculated.
Rule of nine
Head and neck : 9%
Chest : 9%
Abdomen : 9%
Genital area : 1%
Front of each leg : 9%
Back of each leg : 9%
Each hand : 9%
Back : 18%
General action
1. Remove the source of burning or scalding.
2. Cool the affected area at once.
3. Treat shock if present.
4. Get medical help if the person is severely ill.
Do not
1. Put cotton wool or any other fluffy dressings on to the burn (as they stick and are very difficult to remove).
2. Put grease, oily creams or butter on the wound. Leave blisters alone (if you burst them, you are encouraging infection).
What to do
1. Place the part under running cold water for several minutes, or until the pain is relieved.
2. Gently remove rings, bracelets and other constricting things if possible from the affected are before swelling makes this difficult or impossible.
3. If you cannot put the burn area under water, drench it with water from a container and apply soaking towels.
4. Do not use iced water — this can be painful in itself.
5. Do not spray with a shower either. This can be extremely painful and may further damage the tissues.
6. Do not pull off any clothing around the burnt area unless the burn has affected only a small, confined area. Never pull away adherent charred clothes from flesh — this is an expert job.
7. Once the area has been cooled, you can gently remove clothing from the affected area around the scald. This goes for chemical burns too. Be careful not to burn yourself with chemical-soaked clothes.
8. Decide whether the person needs medical attention.
Is medical attention needed ?
No, if the scald or burn is small (less than 2.5 cm (1 in) across), shallow, easily covered by a dressing and the person is well.
Yes, if
1. the victim is a child;
2. the burn is large and especially if it involves areas of the body that move (around joints for example); affects the face; affects the palm or fingers or cannot easily be covered by a dressing.
3. the person is in shock or if you are at all worried;
4. caused by a chemical, electricity or molten metal (e.g. solder).
Be prepared to treat shock and to call an ambulance or doctor if the victim has 10 per cent or more of his body burned or scalded.
For burns that you can treat
1. Dry the area carefully.
2. Apply a dry dressing (not of cotton wool), preferably a non-adhesive burns dressing from your first-aid box.
3. Bandage the area lightly to hold the dressing in place.
4. Keep the burnt part elevated to reduce swelling.
5. Give the person a painkilling drug in the full recommended dose if the pain is bad.
6. If the burn gets infected (red, pussy, weeping or increasingly painful), get medical help. Infection will produce scarring later.
For burns you cannot treat
1. Lie the victim down and make him comfortable.
2. Give only tiny sips of water — any more may cause vomiting.
3. Keep calm and reassure him.
Some useful hints
1. Remove clothes drenched in boiling fat, water or steam as soon as possible.
2. Remove clothes drenched in chemicals. If necessary cut them to get them off quickly. Wash the area with plenty of running water.
3. Take any electrical burn to a doctor.
4. Treat severe friction burns as other burns.
5. Scalds in the month can be helped by sucking ice.
6. If chemicals enter the eye, wash it out with water at once. Get the person to hold his face under water and blink or put the eye under gently running water. Protect the uninjured eye. Go to hospital quickly.
7. Sunburn victims need cool, shade, fluids to drink (small sips) and soothing cream (or calamine lotion). Get medical help for severe cases.