Burns Nearly everyone has had a burn at one time or another. We all know how painful a burn can be. Fortunately, most burns are minor and heal without serious scars or deformity but not all. Burns can be some of the most deforming and disabling injuries one can suffer. Chapter contents A) Description of burns B) Cause of burns C) Treatment D) Indications for professional burn care E) Burn management when professional help is not available A) Description 1 / 9
1. First-degree burns Burns may be very superficial, burning only the uppermost layers of skin. These are sometimes referred to as first-degree burns. First-degree burns turn the skin red. They may be very painful and usually do not form blisters, but may peel after a few days. They usually do not cause scarring. Sunburn is an example of a first-degree burn. 2. Partial thickness burns (second-degree burns) Partial thickness burns injure deeper layers of the skin, but do not burn all the way through the skin. They too are very painful, are red in color, and often form blisters. These burns heal much more slowly than first degree burns the deeper, the longer they take to heal. They often become infected and may cause infection in the bloodstream (sepsis). Small partial thickness burns usually heal without skin grafts, but large burns often require skin grafts to hasten healing and reduce scaring. If infection is uncontrolled, partial thickness burns may rapidly become full thickness, just by the infection. 3. Full thickness (third-degree) Full thickness burns are deep burns that extend all the way through the skin and into the deeper structures. They appear pale, gray, or charred in appearance. They are not painful since the burn destroys the nerves responsible for pain. (Partial thickness areas in and around these burns may still be painful.) All but the very smallest of full thickness burns will require skin grafts to heal. 4. Inhalation burns 2 / 9
Burns may also involve the air passages, the nose, throat, and windpipe when superheated air, smoke, steam, or chemical fumes are inhaled. Death may occur as a result of swelling and obstruction of the airways. B) Cause of burns Burns may be caused by the ultraviolet rays of the sun, by spilling or being immersed in hot water, steam or other liquids, by flames of fire, or by direct contact with hot objects. Immersion into the hot liquid usually causes a deeper burn than spilling. Flame burns are usually deeper than hot water or steam burns. Burns may also be caused by chemicals. Chemicals continue to burn until removed. Alkalis typically burn deeper and cause more destruction to tissue than acids and organic compounds. Chemical burns may also occur from inhalation of fumes or while swallowing the liquid. Electrical currents, including lightening, can cause burns. Sometimes electricity may cause the heart to stop beating or cause other internal injuries without much evidence of injury to the skin. When skin is burned by electricity, it is often burned full thickness (third-degree). C) Treatment of burns PUT OUT THE FIRE! Place victim on the ground and roll him/her over; cover with a blanket or douse with water to smother flames. Remove hot clothing and all jewelry at once. DO NOT stand or run except to escape the fire (running fans the flames). All partial or full thickness burns need tetanus protection! 3 / 9
The treatment of burns will depend upon how large they are, how deep they are, the cause of the burn, the age of the person (children and the elderly have thinner skin, and elderly persons often have other complicating health problems), and the availability of health care. Size of the burn: Small burns may be safely managed at home. Large, deep burns will cause extensive disability or death if not cared for in a burn care center. The size of a burn may be estimated as follows: The palm of the hand represents about 1% of the body surface. The front of the chest is about 9%. Using these two measures it is simple to estimate the total amount of burn. Depth of burn may be estimated by color, presence of pain or tenderness, and location. (The skin on the face is thinner than on the back, and more likely to be burned full thickness.) 1. Treatment of burns caused by heat (thermal burns) a. Superficial (first-degree) burns Reduce pain by applying cold water or other cold drink. Apply aloe vera early and frequently (provides rapid pain relief and speeds healing). Use other moisturizing lotion if aloe vera not available. Drink plenty of water to replace fluid going into swollen tissues. Treat symptoms of nausea (Section III, chapter 1, E). 4 / 9
b. Treatment of partial thickness burns (second-degree) Relieve pain of small burns by applying aloe vera, cold water, or other cold drink to the burned area (narcotics may be necessary by physician prescription). Leave unbroken blisters intact. Cut away loose tissue of broken blisters. Apply antiseptic to burned area bacitracin, silvadene (silver sulfadiazine) or other antiseptic as available (honey, aloe vera, povidone iodine ointment, etc., work well). Keep burns well covered with antiseptics at all times (Section VII, chapter 2 and VII, chapter 3, J). Cover with a sterile, dry, non-sticking dressing to reduce pain and to keep clean change several times daily. Drink copious amounts of fluids to replace the large amount of fluid lost from the burns. ( Note : If nausea not quickly relieved with simple measures (Section III, chapter 1, E). Do not push fluids by mouth, but consider administration by another route (Section VII, chapter 5, CC, 3). Use pain-control measures as needed (Section VII, chapter 9, Y, 1) (Section V, chapter 14, C). The use of the HEALTH SMART lifestyle will significantly improve wound healing (Section VI, chapter 1 and chapter 2A). 5 / 9
c. Treatment of full thickness burns (third-degree) Treat the same as partial thickness burns until medical care available. 2. Treatment of chemical burns Immediate irrigation with copious amounts of water to completely remove chemical is mandatory. Give subsequent care similar to above. 3. Treatment of electrical burns Turn off power source at once prior to trying to remove victim from source. If unable to turn power off, use a dry piece of wood to remove victim from power line. DO NOT use anything metal to do this. Administer life support if indicated (Section II, chapter 1). Treat associated injuries and medical problems as indicated. Treat burns as above. D) Indications for professional burn care 6 / 9
Critical Note: Professional burn care can save lives, prevent or reduce long term disability, and greatly shorten hospital care if begun during the first 12 24 hours after injury in a modern burn center. All second-degree (partial thickness) and third-degree (full thickness) burns. All but the smallest and most superficial burns in small children. Signs of infection increasing pain or tenderness; increasing redness or red streaks around burn; pus or fever after the first 2-3 days (Note: All large burns may cause fever for the first couple days). All partial or full thickness burns to the face, hands, feet, or genitals. All electrical burns. All patients with difficulty breathing or suspected of inhalation injury. All patients suspected of swallowing caustic chemicals; lye, etc. E) Additional treatment of burns when professional health care is not available Burn patients lose tremendous quantities of fluid from their burns. They must be kept hydrated. If water is not tolerated in adequate amounts by mouth, other means of administration must be sought (Section VII, chapter 4). 7 / 9
Silvadine 1% (silver sulfadiazine cream) is a time-tested ointment that works well for burns. It must be applied in thick layers over the whole burn and remain in contact with the burned areas at all times. Dry dressings are usually necessary to maintain this contact. Honey is also very effective in burn management (at least as good as Silvadine in some studies). Other antiseptic measures may also be very effective. Use them very generously as well (Section VII, chapter 2, 3). Some studies report very effective pain management and enhanced healing with the frequent and generous use of aloe vera, either from the fresh leaf or from commercially available supplies. Covering second- and third-degree burns with fresh human placenta membrane within the first 12 24 hours after injury may reduce pain and hasten healing of second-degree burns (Note: Membranes must be carefully washed with sterile saline before applying to the burn). Some very small burns may be excised and a skin graft applied immediately (Section VIII, chapter 12). All associated injuries and illnesses must be managed as well. See appropriate section. Dead and devitalized tissue must be cut away with sterile, sharp instruments on a daily basis to keep the wound clean (Note: it may take a week or two for deep partial or full thickness burned skin to separate enough from unburned tissues to be able to cut it away). Once dead tissues are gone and the burn wound is clean and free of pus, wet to dry dressings will help to keep it clean until healing is complete or until skin can be grafted on (Section VII, chapter 5, EE) (Section VIII, chapter 12). Cold water works well for initial pain control. Use other natural measures as available (Section V, chapter 14, C) or prescription meds as needed. Antibiotics are useful for the first 2-3 days to prevent life-threatening streptococcal infections. They may be necessary again later if signs of sepsis develop (fever, etc.) (Section VII, chapter 9, Y, 1, 5). 8 / 9
Note: Survival for large partial or full thickness burns is very poor outside of modern burn centers. Do not get your hopes up! Smaller burns may heal in time but will require much hard work as described above to keep them clean and healing. Do not ignore the principles of HEALTH SMART during this time (Section VI, chapter 1 and chapter 2A). Do not forget that God is our partner in healing. Ask Him, and trust Him to give you wisdom in caring for the patient and to bless your healing efforts. God is faithful to those who put their trust in Him. 9 / 9