One of the most painful injuries that one can ever experience is a burn injury. Every year, many of our community members are burned in one way or another. Of those, some may require long term hospitalization or actually die as a result of their burns.  

The skin is the largest organ in the body and performs many important functions. It protects against infection by keeping out bacteria. It prevents loss of body fluids and helps control body temperature.

Serious burns are complex injuries. In addition to the burn injury itself, a number of other functions may be affected. Burn injuries can affect muscles, bones, nerves, and blood vessels. The respiratory system can be damaged, with possible airway obstruction, respiratory failure and respiratory arrest. Since burns injure the skin, they impair the body's normal fluid/electrolyte balance, body temperature, body thermal regulation, joint function, manual dexterity, and physical appearance. In addition to the physical damage caused by burns, patients also may suffer emotional and psychological problems that begin at the emergency scene and could last a long time.

Determining the severity of burns

• Source of the burn - a minor burn caused by nuclear radiation is more severe than a burn caused by thermal sources. Chemical burns are dangerous because the chemical may still be on the skin.
• Body regions burned - burns to the face are more severe because they could affect airway management or the eyes. Burns to hands and feet are also of special concern because they could impede movement of fingers and toes.
• Degree of the burn - the degree of the burn is important because it could cause infection of exposed tissues and permit invasion of the circulatory system.
• Extent of burned surface areas - It is important to know the percentage of the amount of the skin surface involved in the burn. The adult body is divided into regions, each of which represents nine percent of the total body surface. These regions are the head and neck, each upper limb, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower limb, and the back of each lower limb. This makes up 99 percent of the human body. The remaining one percent is the genital area. With an infant or small child, more emphasis is placed on the head and trunk.
• Age of the patient - This is important because small children and senior citizens usually have more severe reactions to burns and different healing processes.
• Pre-existing physical conditions - Patients with respiratory illnesses, heart disorders, diabetes or kidney disease are in greater jeopardy than normally healthy people.

To distinguish a minor burn from a serious burn, the first step is to determine the degree and the extent of damage to body tissues.

The three classifications of first-degree burn, second-degree burn and third-degree burn will help you determine emergency care:

First-degree burn (superficial)
The least serious burns are those in which only the outer layer of skin is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't been burned through. 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.

Second-degree burn (partial-thickness)
When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

Third-degree burn (full-thickness)
The most serious burns are painless, 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.

 
Treatment of Burns

If your clothing catches fire: STOP - do not run, DROP - to the ground, ROLL - to put the fire out

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.5 centimeters) in diameter, take the following action:

• Cool the burn. Hold the burned area under cold running water for at least five minutes, or until the pain subsides. If this is impractical, immerse the burn in cold 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.
• Never apply ointment, grease or butter to the burned area. Applying such products, actually confines the heat of the burn to the skin and does not allow the damaged area to cool.  
• Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin. Don't break blisters. Broken blisters are vulnerable to infection.
• Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.
• Minor burns usually heal without further treatment. They may heal with pigment 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.

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 major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps:

• Don't remove burnt 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 shock.
• Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin cardiopulmonary resuscitation (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.

Burn Prevention Tips in the Home 

• Keep hot items in the centre of the table and hot liquids and drinks away from children.
• Keep young children away from the cooking area.
• Use place mats instead of tablecloths - young children use tablecloths to pull themselves up.
• Use pot holders, not towels.
• Turn pot handles, inward, toward the back of the stove; use back elements of stove for cooking.
• Store pot holders, paper towels and seasonings away from the stove top.
• Avoid full or puffy sleeves while cooking.
• Do not reach across hot stove elements.
• Use a large lid or baking soda to put out small grease fires in pans.
• Keep matches and lighters away from children.
• Run hot and cold water together.
• Set the hot water heater thermostat to low 120F / 50C.
• Never leave children alone in the bathroom. 

Did You Know?

• Children under 5 years old suffer the highest number of scald burns.
• Some fabrics burn faster and hotter. Cotton burns readily and produces great heat, while wool is difficult to ignite and burns with a smaller flame.
• Children aged 5 to 9 years suffer clothing burns most frequently. 
• The most common scald burns from microwaves occur when plastic wraps/lids are removed from heated items.
• Most reported infant burn injuries from a microwave involve mouth burns from heated bottles.
• Using a liniment and heating pad together increases the risk of burn.
• There is legislation concerning flame retardant sleepwear for sizes 1 to 12x - look for the protective label.