Burns
are injuries to the skin and, sometimes, the underlying tissues.
They are most commonly caused by excess heat but can also be
caused by sunlight (see Sunburn), chemicals, electricity and
nuclear radiation. The commonest burn is the first degree burn
usually caused by scalding with hot water or steam, or by momentary
contact with a hot surface. First degree burns involve just
the outer layer of the skin and usually there is pain, tenderness,
some local inflammation and blistering. Second degree burns
involve both the outer layer of the skin and the underlying
layer, the dermis. Third degree burns involve the whole thickness
of the skin and, usually, the tissues underneath. These severe
burns are often painless because of the destruction of the sensory
nerves. Second and third degree burns are most often caused
by flames and electricity. First degree burns usually heal with
little or no scarring. Second and third degree burns may result
in disfigurement, scarring and disability, particularly if on
the face, hands and over the joints. If more than 15% of the
body surface is burnt (less in children) shock may result necessitating
the patient be given intravenous fluids. Anything but the simplest
burn can get infected with bacteria.
The management of a simple burn with unbroken skin is to put it under running cold water as soon as possible. This will cool the tissues down and restrict damage. Blisters should be left intact, if possible, as they provide a sterile dressing to the burn and should just be covered with a soft, clean dry external dressing such as gauze. If there is wide spread burning of clothes the patient may be rolled in a blanket and cold water can be used but no attempt must be made to remove clothing. Running cold water can also be used in chemical burns unless there is a particular reason to think not. Most burns, except for the least serious, should be seen by a doctor as they are, sometimes, much more severe than they appear. Most severe burns will be referred to the hospital for specialist treatment, and skin grafting may be necessary. Local preparations for use on burns have varied enormously down the years. Doctors and nurses often use silver sulphadiazine preparations. Antibiotic locally, and by mouth, may be used if there is any sign of infection. Generally speaking, the rule with small, simple burns is to use a clean dressing and apply no ointments etc. |
