Thursday, April 2, 2015

Burns and Their Treatment

Burns are some of the most common and potentially dangerous injuries that can affect you in daily life and more so in a crisis situation. Being of Northern European ancestry, with a good dose of Irish and Scandinavian blood, I burn easily. I got my first sunburn of the year before the end of March this year. (I don't tan, I just burn.)

Between that, and a friend who recently had a bad accident with some burning wax, I thought it would be a good time to go over burns and their treatment at different levels of care.

There are several different types of burns
  • Thermal: damage caused by extreme heat or cold. Electricity causes thermal burns by generating heat inside the tissue. 
  • Chemical: damage caused by contact with strong chemicals. 
  • Radiation: damage from exposure to high-energy radiation, typically gamma radiation, but possible from X-rays and other radiations. 

There are several degrees of burns
  • First degree: irritation and minor damage to the outermost layer of skin, commonly seen as a sunburn. Painful but heals within a few days by itself. 
  • Second degree: damage to the lower layers of skin, causing swelling, blistering and peeling of the outer layers. Second degree burns will be moist compared to first degree burns, which are normally dry. They are very painful and subject to infection due to the loss of the protective outer layers of skin. Scarring is possible as the skin heals. 
  • Third degree: involves destruction of all layers of the skin. Damage to nerve endings can mean lack of pain immediately after the burn, but severe pain will follow. Scarring is a given and will be determined by how deep and how wide-spread the burn is as well as the availability of advanced care. 
  • Fourth degree: As a third degree burn, but the destruction extends into underlying tissue such as muscles, tendons and ligaments. Will require skin grafts if the patient survives (which is rare). 
  • Fifth degree: As third, but destruction extends to the bone itself. Chance of survival is extremely low and amputation of affected areas practically guaranteed. 
  • Sixth degree: Unsurvivable; bones are charred and the victim is lying on an autopsy table. 
Treatment for fourth and fifth degree burns is identical to treatment of third, only more extensive and with decreasing odds of survival. For purposes of first aid, anything past third is a distinction without much meaning.

Determining Damage creative commons, share-alike license
There is a standard method of determining how bad a burn is based on how much of the body is covered by the burn. Commonly referred to as the “Rule of Nines”, which is best visualized by the chart to the left. . Basically divide the body into 11 areas with 9% of the skin each, and the remaining 1% is assigned to the genitalia.

The extent or coverage of the burn is used to compute what is known as a "Baux score" to predict the survivability of a burn injury. A Baux score is basically the percentage of the body burned + the patient's age, with a score of 140 being the limit for survivability. If the patient inhaled anything that causes burns to the lungs, add 17 to the Baux score to compensate for the difficulty in treating internal injures. Recent advances in treatment have slightly increased the survival rates, but absent a well-stocked burn unit or in the case of a mass-casualty event things could degrade to past levels of survival.

Treatment Methods
Treatment of burns is normally best left to medical professionals. If you have access to a doctor or hospital, by all means use them. What I am going to describe is treatment when access to such professional aid is delayed or non-existent. Since even FEMA suggests we should all be prepared for at least 72 hours after a disaster, knowing how to take care of minor medical emergencies is prudent.

General Care
The ABC's of emergency care take precedence over any other injury. Airway, Breathing, and Circulation are what will keep someone alive; the other injuries can be taken care of after these three are taken tended to. 
  1. The first step in treating any burn is to stop the cause of the burn. Put out the fire, get out of the sun, wash off the chemicals, whatever you need to do to stop further damage. 
  2. Next, check for other injuries that may require more immediate care than the burn. 
  3. Be aware that the very young and elderly are less able to recover from burns. 

First degree burns will normally heal by themselves if allowed to. 
  • Cooling the skin and preventing further damage is the best you can do for a first degree burn, and all that can really be done. 
Minor pain killers like aspirin or Tylenol should handle the pain associated with a first degree burn.

Second degree burns require more treatment, but are still fairly easy to handle on your own. If you are transporting a burn victim to a hospital, cover the burn with dry, clean cloth and keep the victim warm.

If you are forced to treat a second degree burn on your own, do not use ice or butter on the burn. Neither will do any good, and may actually cause more damage to the tissue underneath the burn.
  1. Wash the burned area with soap and water, keep it clean and covered as best you can.
  2. Do not open blisters, and when they pop on their own keep the area clean and covered. 
  3. Antimicrobial ointments (Silvadene, Neosporin, etc.) will help prevent or reduce infections and scarring. The depth and extent of the burn will dictate how fast it will heal.
Third degree burns should be left to the professionals. Since skin grafts and intravenous fluids will normally be required, only those with advanced training and facilities should even attempt it. Unless you have been trained in monitoring fluid input and output in a patient, and the dangers of over-hydrating (compartment syndrome), don't mess with it. 

In a true SHTF situation where help is not going to be coming from any outside source, treating for pain and preventing infection are about all most of us are going to be able to do. 
  1. Keep the burned area clean and make sure the patient is getting enough fluids to replace what they are going to lose through the wound seeping as well as evaporation. 
  2. Without the outer layer of skin, the body's tissues will lose water through evaporation.
  3. Permanent scarring and loss of function will have to be expected and death is a distinct possibility.

There are plenty of resources available for training for simple first aid, but burn care is one of the fields where specialized training and facilities are required for proper treatment of anything other than the minor burns. This is one of the situations where having a properly trained expert is the only way to survive. Making connections with others who have the training and skills that you lack and knowing what resources hospitals, burn centers, etc.) are available in your area may be the only way to go.

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