MedicoPlexus

First Aid Project

Elective Course: First Aid at Home and Work

TOPIC: Burns. First aid for Burns.

Author: Raghib Siddiqui

Group 19E.   

First Year. 

Varna 2019

Introduction-

Burns are a widespread and burdensome critical care problem. With rapid urbanization and developments in the common era, contact with extreme heat substances in various forms has also increased. Whether it be in the kitchen, or working in proximity with machines and chemicals, or simple accidents, appropriate knowledge of burns and proper first aid is essential to prepare ourselves in the event of a mishap.

Study and exploration on burns and burn related injuries has generated continued interest over the past few years, and several important advancements have resulted in more effective patient stabilization and decreased mortality. In addition, burn wounds are intricate and complex, and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient recovery and care, research in burn wound care has yielded progressions that will continue to improve functional recovery.

Burn:

Defined as the damage to the skin or other body parts caused by extreme heat, flame, contact with heated objects, or chemicals. Burn depth is generally categorized as first, second, or third degree. The treatment of burns depends on the depth, area, and location of the burn, as well as additional factors, such as material that may be burned onto or into the skin. Treatment options range from simply applying a cold pack to emergency treatment to skin grafts.^[1]

Thermal burns from dry sources (fire or flame) and wet sources (scalds) account for approximately 80 % of all reported burns and can be classified based on the depth of burn. In addition to local injury at the site of burn, severe thermal injury over a large area of the skin, roughly 20 % total body surface area or greater, results in acute systemic responses collectively known as burn shock.

Burn shock occurs in a major burn injury (covering >20% total body surface area [TBSA]) with disruption of normal organism homeostasis. It is a is a unique combination of distributive and hypovolemic shock, recognized by intravascular volume depletion, low pulmonary artery occlusion pressure (PAOP), increased systemic vascular resistance and depressed cardiac output. ^[2]

Types of Burns:

Classification based on the depth of the burn and the area damaged due to the contact of the skin (outermost layer of tissue of the body which comes in contact with the external environment first and foremost) with extreme heat substances;^[9]

• SUPERFICIAL BURN (FIRST-DEGREE BURN)

  Superficial burns involve only the epidermis. Like a sunburn, the skin is warm, painful, blanching, and dry without blisters. The epithelium remains intact but will begin to slough within 7 to 14 days. They are self-limited and have no potential for scar.^[3]                           

• PARTIAL-THICKNESS BURN (SECOND-DEGREE BURN)

Partial thickness burns involve the epidermis and penetrate to the dermis, but do not completely penetrate through the dermis or down to the subcutaneous tissue. These burns appear wet, weeping, and erythematous, and are exquisitely painful, with blisters or sloughing epidermal remnant. They are further divided into 2 categories:

• Superficial partial thickness burn: blanching, more painful, hyperemic and erythematous, typically heal in approximately 2 weeks with appropriate wound care, low risk of scar and pigment change. Involves epidermis and papillary dermis. These can be managed conservatively with dressing changes or xenograft.
• Deep partial-thickness burn: non-blanching, less painful, pink or pale, require more than 3 weeks to heal, high risk of hypertrophic scar and pigment change, outcomes may be improved by excision and grafting. Involves epidermis, papillary dermis, and reticular dermis. These typically require debridement and grafting.^[3]

• FULL-THICKNESS BURN (THIRD-DEGREE BURN)

Full-thickness burns penetrate to the subcutaneous tissue and beyond, affecting all dermal layers. These burns are dry, leathery, waxy, non-blanching, insensate, and eschar is frequently shading of brown, white, gray, or black. 

The transition from adjacent partial-thickness burn is clear by the lack of tissue edema. They will not heal without surgical excision with skin grafting or tissue transposition. Sequela, such as contractures and hypertrophic scars, are common. Of note, “fourth-degree burn” has been used to refer to burn injuries that penetrate to and/or expose deep structures (e.g., bone, muscle, tendon). Skin grafting alone is not adequate treatment for burns of this severity, and limb loss may occur. ^[3]

Burns; (Classification by Cause):

Burn injuries can be caused by various encounters with substances possessing extreme heat.

• FLAME BURN

Thermal injuries, caused by fire or flames, are the most common burn etiology reported over the past decade. Thermal injuries are associated with the highest risk of death and complications compared to all other burn etiologies. Flame burns most commonly occur at home (64%), while work fires and recreational fire burns account for 12% and 6% of flame burns, respectively. 

When considering thermal injuries, it is important to consider smoke inhalation as it significantly impacts the morbidity and mortality of patients recovering from flame burns. The majority of inhalation injuries occur while the patient was indoors or in an enclosed space, and very few occur in patients who were burned while outside. Inhalation injury is present in 17% of patients with flame burns. The presence of smoke inhalation in burn patients is associated with an overall mortality rate of 24%, compared to the mortality rate of 4% in those patients without smoke inhalation damage.^[4]

• SCALD BURN

Scalds are the second leading cause of burn injuries and are the most common mechanism of burns in the pediatric population. More than 50% of scalds are associated with food preparation or consumption, with a smaller proportion associated with bathing. Common mechanisms, including pulling a tablecloth, reaching up and tipping a container near the edge of a counter, pulling electric cords attached to kitchen appliances, and carrying containers with hot liquids. Contact burns from touching a hot object are extremely common in the pediatric population as well. Overall, contact burns make up 9% of burns reported, but they are the third leading cause of burns in children. Scald burns tend to cause a greater inflammatory response than flame burns.^[4]

• ELECTRICAL BURN

Although only 4% of burns admitted to burn centers are caused by electricity, they pose the greatest diagnostic, therapeutic, and prognostic challenge among burn mechanisms. 

To pass through dry human skin, a current must either surmount a huge amount of resistance, gain access to internal tissues through skin deficits such as cuts or burns, or induce skin breakdown (common above 500 volts V). Electrocution injuries are traditionally classified as low voltage (<1000 V) or high voltage (>1000 V), but ultimately it is the current (amperage) of the electricity and its direction of travel that ultimately determine ensuing tissue damage and lethality.

 During electric shock by alternating current, both flexor and extensor muscles are stimulated, but the strength of flexors is greater than that of extensors, causing the “no let-go” phenomenon, and increasing contact time and tissue destruction.^[4]

Due to increased communication with technology and more technological advancements, human interaction with electrical appliances has increased which results in the exponential increase of electrical burn related injuries.

• CHEMICAL BURN

Slightly more than 3% of burn center admissions are chemical burns, and with equal proportions occurring at work and at home. According to the Centers for Disease Control and Prevention, carbon monoxide, ammonia, chlorine, hydrochloric acid, and sulfuric acid are the chemicals with the highest frequency of associated injury. Important clinical categories of chemical burns include alkali, acid, hydrofluoric acid, phenol, and white phosphorous.

 Acids induce burn damage through binding of hydrogen ions to proteins, inducing coagulation. Alkali burns are typically deeper and more serious than acid burns, as hydroxide ion saponification of fats induces liquefactive necrosis and permits further depth of chemical penetration. Mortality from chemical injury is low, and treatment cost is small relative to other injury mechanisms.^[4] 

First- Aid for Burns

Large burns are managed in 3 general phases: 

1. Initial evaluation and resuscitation.
2. Wound debridement and biologic closure.
3. Rehabilitation and reconstruction.

-Long-term outcome quality tends to be very good in patients surviving large burns.^[5]

Evaluation;

-Is it a major or minor burn?

Call Emergency authorities or seek immediate care for major burns, which:

• Are deep
• Cause the skin to be dry and leathery
• May appear charred or have patches of white, brown or black
• Are larger than 3 inches (about 8 centimeters) in diameter or cover the hands, feet, face, groin, buttocks or a major joint

A minor burn that doesn’t require emergency care may involve:

• Superficial redness similar to a sunburn
• Pain
• Blisters
• An area no larger than 3 inches (about 8 centimeters) in diameter ^[5]

• Treating major burns

• Protect the burned person from further harm. Make sure the person you’re helping is not in contact with the source of the burn. For electrical burns, make sure the power source is off before you approach the burned person.
• Make certain that the person burned is breathing. If needed, begin rescue breathing. 
• Remove jewelry, belts and other restrictive items, especially from around burned areas and the neck. Burned areas swell rapidly.
• Cover the area of the burn. Use a cool, moist bandage or a clean cloth.
• Don’t immerse large severe burns in water. Doing so could cause a serious loss of body heat (hypothermia).
• Elevate the burned area. Raise the wound above heart level, if possible.
• Watch for signs of shock. Signs and symptoms include fainting, pale complexion or breathing in a notably shallow fashion.^[6]

• Treating minor burns

• Cool the burn. Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases.
• Remove rings or other tight items from the burned area. Execute this protocol quickly and gently, before the area swells.
• Don’t break blisters. Fluid-filled blisters protect against infection. If a blister breaks, clean the area with water (mild soap is optional). Apply an antibiotic ointment. But if a rash appears, stop using the ointment.
• Apply lotion. Once a burn is completely cooled, apply a lotion, such as one that contains Aloe Vera or a moisturizer. This helps prevent drying and provides relief.
• Bandage the burn. Cover the burn with a sterile gauze bandage (not cotton). Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
• If needed, take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others). ^[6]

Abstain and Avoid –

• Contaminating the burn with potential germs by breathing or coughing on it.
• Applying any medical or home remedy, including ointment, butter, ice, spray, or cream.
• Giving the burned person anything to ingest.
• Placing a pillow under their head if it is speculated they have an airway burn.^[7]

Data and Statistics for Burn-related Injuries:

Burn Death Statistics ^[8]

The American Burn Association states that of the 3,400 U.S. burn injury deaths each year:

• 2,550 of these deaths are a result of residential fires.
• 300 of these deaths result from vehicle crash fires.
• The remaining 550 result from other causes, such as flames, smoke inhalation, scalding, and electricity.

Burn Cost Statistics

The Centers for Disease Control and Prevention provides the following statistics for costs related to burns:

• Males account for roughly $4.8 billion, or 64 percent, or total fire and burn-related costs each year, while females account for the remaining $2.7 billion, or 36 percent.
• Fatal burn and fire injuries cost roughly $3 billion, which accounts for two percent of the total cost of fatal injuries.
• Burn and fire hospitalization accounts for $1 billion, or one percent of hospitalized injury costs.
• Non-hospitalized burn and fire injuries account for two percent of non-hospitalized injury costs, or $3 billion.^[8]

Conclusion:

To conclude, the awareness of first aid and treatment of burns is crucial as well as essential in today’s day and time. In my personal opinion, our increased interaction with machines and technology proportionally increases our risk of extreme heat related accidents and this is why it is vital to be prepared for said situations. 

Burns account for hundreds of thousands of lives lost every year, as well as billions of dollars spent for burn related causes. This can be reduced and prevented with proper safety precautions and knowledge of how to handle such scenarios adequately.

According to me, the most important piece of information to keep in mind when faced with an emergency (related to burns, or first aid in general), is to keep calm and not panic. Panic reduces our decision-making capability and hinders clear thinking and fast action, which can be crucial when faced with the task of saving one’s life. Composure, following protocol and rapid action can be the difference between life and death, hence are crucial.

References

1. William C. Shiel Jr., MD, FACP, FACR. Medical Definition of Burn. MedicineNet. [Online] [Cited: 04 26, 2019.] https://www.medicinenet.com/script/main/art.asp?articlekey=31816.

2. Weavind, Liza. Critical Care Medicine Burn shock, Resuscitation of Burn Shock, Burn Shock Resuscitation. Cancer Therapy Advisor. [Online] [Cited: 4 26, 2019.] https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-care%20medicine/burn-shock-resuscitation-of-burn-shock-burn-shock-resuscitation/.

3. Levi, Benjamin and Wang, Stewart. Fitzpatrick’s Dermatology. [book auth.] Masayuki Amagai, Anna L. Bruckner, Alexander H. Enk, David J. Margolis, Amy J. McMichael, Jeffrey S. Orringer Sewon Kang. Fitzpatrick’s Dermatology. 

4. Judith E. Tintinalli, J. Stephan Stapczynski, O. John Ma, Donald M. Yealy, Garth D. Meckler, David M. Cline. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 

5. Ambulance, St. John. St. John Ambulance First Aid Reference Guide. St. John Ambulance First Aid Reference Guide. 

6. Staff, Mayo Clinic. First aid. Mayo Clinic. [Online] [Cited: 4 26, 2019.] https://www.mayoclinic.org/first-aid/first-aid-burns/basics/art-20056649.

7. Scott Frothingham, Gerhard Whitworth. Performing First Aid for Burns. Healthline. [Online] [Cited: 4 26, 2019.] https://www.healthline.com/health/first-aid-with-burns.

8. Burn Statistics. Burn Injury Guide. [Online] [Cited: 4 26, 2019.] https://burninjuryguide.com/burn-statistics/.

9. Benjamin Wedro, MD, FACEP, FAAEM. First Aid for Burns. Medicine Net. [Online] [Cited: 4 26, 2019.] https://www.medicinenet.com/burns/article.htm#introduction_to_burns.

10. Papini, Remo. Management of burn injuries of various depths. Ncbi.nlm. [Online] [Cited: 4 26, 2019.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC478230/.