BURNS

About Your Diagnosis
Thermal burns are injuries to the skin (and possibly deeper structures) caused by the application of excessive heat or certain types of light. Burns may occur from intense heat for a short time, such as hot grease, or from low levels of heat or light over long times, such as a heating pad or sunburn. The severity of a burn is determined by the depth of tissue injury. The four degrees of thermal burns and the signs and symptoms of each degree are shown in Table 1. Chemicals such as acids and alkali may cause burns from interaction with the body’s liquids and molecules. Chemical burns are more complex and difficult to classify.

Table 1. The Classification of Burns

Degree Depth Appearance Painful
1st Superficial Red. No Yes
skin blisters
2nd Deeper skin Blisters, Extremely
layers light charring
3rd Full skin Pale, charred, No
depth leathery
4th Skin with Deep charring No
fat, muscle

Living With Your Diagnosis
The diagnosis of a thermal burn is usually obvious to the patient. Pain is the usual initial symptom. First-degree burns may not require attention, nor do some small areas of second-degree burns. Any second-degree burn larger than the size of the patient’s palm requires medical attention. Any sized second-degree burn of the hands, feet, face, or genitals, as well as any second-degree burn anywhere on an infant, requires medical attention. All thirddegree burns require immediate medical evaluation. Fourth-degree burns are immediately life threatening. Chemical burns should always be evaluated by a physician.

Treatment
Most first- and second-degree burns respond well to local treatment. The injured area requires protection in the form of dressings and antibiotic ointments. Dead layers of skin are gently removed periodically as the burn begins to heal (a process called debridement). The burn is watched closely for signs of infection. Dressings and ointment are changed frequently. All burns deeper than first degree leave scars. Sometimes healing is hastened by the surgical process of skin grafting from uninjured areas to the burn. Some types of burns and large areas of burns require treatment at specialized burn centers.

The DOs
• Change your dressing and apply fresh antibiotic ointment at the prescribed times.
• Elevate the burned area above the heart when possible.
• Use pain medicines as directed. Avoid alcohol.
• Drink a lot of extra fluid. Even small burns cause excessive water loss.
• Eat a healthy balanced diet. Burn healing requires proper nutrition.
• Keep your scheduled follow-up appointments.

The DON’Ts
• Don’t ignore second-degree burns. Seek care promptly.
• Don’t apply butter or nonprescription creams or ointments to burns.
• Don’t allow bandages to become soiled or wet.
• Don’t exercise or return to work until instructed by your doctor.
• Don’t expose healing burns to sunlight. This will increase scarring.
• Don’t try to peal dead skin layers. This leads to infection.

When to Call Your Doctor:
• If you have a fever or chills.
• If you have pus, odor, or red streaking from your wound.
• If you are not urinating regularly, or urine is dark.
• If you are having increasing pain.
• If you have a reaction to your medication.

Websites:
First Aid Book
http://www.medaccess.com/first_aid/FA_TOC.htm
First Aid Online
http://www.prairienet.org/%7Eautumn/firstaid/