A Family Doctor's Tale - BURNS AND SCALDS

DOC I HAVE A BURN ON MY SKIN

A burn is skin which is damaged most commonly by
1.fire or heat.
2.chemicals,
3.electricity
4.light including sunlight
5.radiation. 

A scald is a burn caused by hot liquids or steam.


All burns and scalds are dangerous whether first degree or small because of danger of infection especially in the young, elderly, people with chronic illness.

However most of the burns or scalds seen in a family clinic are relatively minor and can be treated easily.


The following are considered when determining the severity of the burn:


1.Degree of burn
2.Extent of the burn   
3.Age of patient
4.Body region burned
5.Other illnesses and injuries


There are 3 degrees of a burn:


First degree Burn:
superficial injury only affecting the epidermis
The skin is red, hot and painful.
Damage is superficial and temporary.
There is no blisters.


Second degree burn:
first layer of skin is burned through, second layer is damaged
The underlying tissues are not damaged..
The skin is red, hot, swollen and  intensely painful and there is blister formation.


Third degree Burn:
The full thickness of the skin is damaged including sometimes the underlying tissues.
The skin may appear pale and leathery or charred.
Because the nerves are damaged, there may not be pain.



The rule of nines give a rough estimate of the extent of the burn:
Each of the following represents 9% of body surface:
head and neck
each upper limb
the front of each lower limb
the back of each lower limb
the chest
the abdomen
the upper back
the lower back and buttocks


These constitute 99% of the body surface.
The remainder 1% is assigned to the genitals. 


The infant and young child have a surface which are  greater in proportion to the whole body compared with a older child or adult. There is therefore more body fluid loss and more danger.
An older adult above 55 years has less ability for his tissues to heal from any burns as compared to an younger adult. 


Face and head -  burn to the face is serious because it may involve the airway or injury to the eyes.
Hands and feet - burns are also of special concern because scarring may loss of movement of the fingers and toes.
Groins,buttocks- burns here are particularly prone to bacterial infection
Circumferential burns- encircle the body or body part and can block circulation to the tissues distal to the burn.


Illnesses such as those below can aggravate the severity of the burns and affect the healing:
Respiratory diseases
Diabetes
Heart disease
Injuries like fractures


The source of the Burn is also important.


A minor burn caused by nuclear radiation is more dangerous than one caused by heat.

Chemical burns are particularly more serious because the chemicals may remain on the skin and burn for hours and may enter the bloodstream causing toxic reactions.


Treatment for burns and scalds can be done at the clinic or at home:

Superficial(first degree) burns and scalds and partial-thickness(2nd degree) ones which does not involve an area smaller than that of the victim's palm can be treated at home: 

1.Remove all jewelry and clothing at the burn area


2.Put the injured part under cold running water for a few minutes to ease the pain.
Dry by patting with a clean cloth.


3.apply a soothing cream or lotion for scalds and burns.


4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.


5.Painkillers may be necessary for pain.


More severe cases should be sent to a hospital for treatment:


1.the burn or scald is full-thickness (3rd degree).
2.the mouth or throat, eyes, ears, entire face or genital area is involved .  
3.chemical or any corrosive substance burns.
4.electric current or lightning burns .
5.thick smoke or hot air inhalation with breathing difficulty
6.the burn or scald gets infected(fever, pus formation and increasing pain, redness and swelling).
7.partial-thickness burn affects an area larger than the victim's palm.
8.medical illnesses such as diabetes, heart attack and stroke are present