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Burn Management

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Burn Management

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A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin. Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured.
 
There is a physical, mental and emotional experience associated with being burned. The human body responds remarkably to any potential threat of danger with a "fight or flight" response. When this reaction is triggered, our brain sends messages to the adrenal glands, which release chemicals into the bloodstream that cause our bodies to change. These changes include increased respirations, increased blood flow to muscles and limbs, intensified awareness, enhanced impulses, and diminished pain.

Many crash victims/survivors report recognizing the need to get out or away from the fire and after doing so remember little else about the event. Some only remember vague details such as smells and images.

Despite removal from or extinction of the fire, the burn victim/survivor remains in immediate danger. Depending upon the size and degree of the burn injury there is now the risk of breathing failure and shock. Shock is a physiological response to trauma and a life-threatening condition that should not be confused with the "fight or flight" response. Shock reduces blood flow to vital organs and affects a person's blood pressure, heart rate, respirations, as well as state of consciousness. Shock may also account for a victim / survivor's inability to recall details of a crash.
 


Burns and their types

A burn is an injury to the skin that damages or destroys skin cells and tissue. Burns are generally caused when skin makes contact with flames, chemicals, electricity, or radiation. Thermal burns are burns caused by intense external sources of heat, such as flames, scalding liquids, or steam. Burns resulting from a driving crash are most likely thermal burns.

 
Your skin is the largest organ of your body. It prevents infection from entering your body and it limits the loss of important fluids. Your skin "holds everything together." Once a victim/survivor with burn injuries is identified and stabilized, the burn team begins to assess and classify the burn injuries. Burns are assessed by their size in relation to the entire body and by their depth. They are rated according to how many layers of skin are damaged.

You skin resembles a very fluffy "Sofa". The top most layer is called the Epidermis, while the filling is called the Dermis and the lowermost basement layer is called Subcutaneous fat.

A first degree burn

A first degree burn involves the top layer of skin called the epidermis. First degree burns are labelled superficial and the body can heal itself quickly by creating new, healthy cells. First degree burns are often caused by sunburn or scalds, appear pink to red, can be painful with swelling, and typically leave no scarring.

Second degree burns

Involve the epidermis and the second layer of skin called the dermis. Second degree burns can range from superficial to partial thickness depending upon the extent of the damage.

While the body can heal from second degree burns, scarring and thickening frequently occur and healing can take up to six months. Contraction happens when the burn is deeper and the skin cannot heal properly.. The body closes the wound by drawing on the surrounding skin, or contracting. Because of these factors, doctors often recommend skin grafts for second degree burns.

Third degree burns

Third degree burns involve all layers of the skin and are referred to as full thickness burns. Full thickness burns destroy all of the epidermis and dermis, as well as nerves, hair, glands and vessels. Because of the damage caused by third degree burn, the body cannot repair itself and skin grafts must be performed to prevent infection to the body.

Fourth degree burns

Fourth degree burns involve the damage of bone and muscle and are rare.

Burns and their severity

The severity of a burn injury is not only determined by burn classifications, but also by the victim/survivor's age, the victim/survivor's previous health status, the size of the injuries, how much of the injuries can be attributed to third degree burns, and other medical complications related to the fire. It is often difficult to accurately assess a burn at first glance as the injury may change over the first several days following exposure.

Burns and their management

Managing burn injuries properly is important because they are common, painful and can result in disfiguring and disabling scarring, amputation of affected parts, or death in severe cases. Complications such as shock, infection, multiple organ failure, electrolyte imbalance and breathing distress may occur. The treatment of burns may include the removal of dead tissue (debridement), applying dressings to the wound, fluid replenishment, administering antibiotics, and skin grafting.

While large burns can be fatal, modern treatments developed in the last 60 years have significantly improved the fate of such burns, especially in children and young adults.

To distinguish a minor burn from a serious burn, the first step is to determine the extent of damage to body tissues. The three burn classifications of first-degree burn, second-degree burn and third-degree burn will help you determine emergency care:

In first degree burns, the skin is usually red, with swelling, and pain sometimes is present. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint, which requires emergency medical attention.

While in second degree burns, blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling. If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn and get medical help immediately.

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.6 centimeters) in diameter, take the following action:
 
  • Cool the burn. Hold the burned area under cool (not cold) running water for 10 or 15 minutes or until the pain subsides. If this is impractical, immerse the burn in cool water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.
  • Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other material that may get lint in the wound. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burn, reduces pain and protects blistered skin.
  • Take an over-the-counter pain reliever. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Minor burns usually heal without further treatment. They may heal with color changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.

Caution

 
  • Don't use ice. Putting ice directly on a burn can cause a burn victim's body to become too cold and cause further damage to the wound.
  • Don't apply butter or ointments to the burn. This could cause infection.
  • Don't break blisters. Broken blisters are more vulnerable to infection.

Third-degree burn

The most serious burns involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn. For major burns, call for an ambulance or emergency medical help immediately. Until an emergency unit arrives, follow these steps:
  • Don't remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
  • Don't immerse large severe burns in cold water. Doing so could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).
  • Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin CPR.
  • Elevate the burned body part or parts. Raise above heart level, when possible.
  • Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.

Get a tetanus shot. Burns are susceptible to tetanus. Doctors recommend you get a tetanus shot every 10 years. If your last shot was more than five years ago, your doctor may recommend a tetanus shot booster.
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