BURNS

Thermal burns are injuries to the skin (and possibly deeper structures) caused by the application of excessive heat or certain types of light. Burns may occur from intense heat for a short time, such as hot grease, or from low levels of heat or light over long times, such as a heating pad or sunburn. The severity of a burn is determined by the depth of tissue injury. The four degrees of thermal burns and the signs and symptoms of each degree are shown in Table 1. Chemicals such as acids and alkali may cause burns from interaction with the body's liquids and molecules. Chemical burns are more complex and difficult to classify.

The diagnosis of a thermal burn is usually obvious to the patient. Pain is the usual initial symptom. First-degree burns may not require attention, nor do some small areas of second-degree burns. Any second-degree burn larger than the size of the patient's palm requires medical attention. Any sized second-degree burn of the hands, feet, face, or genitals, as well as any second-degree burn anywhere on an infant, requires medical attention. All third-degree burns require immediate medical evaluation. Fourth-degree burns are immediately life threatening. Chemical burns should always be evaluated by a physician.

Most first- and second-degree burns respond well to local treatment. The injured area requires protection in form of dressings antibiotic ointments. Dead layers skin are gently removed periodically as burn begins heal (a process called debridement). is watched closely for signs infection. ointment changed frequently. All deeper than first degree leave scars. Sometimes healing hastened by surgical grafting from uninjured areas burn. Some types large require treatment at specialized centers.

• Change your dressing and apply fresh antibiotic ointment at the prescribed times.
• Elevate the burned area above the heart when possible.
• Use pain medicines as directed. Avoid alcohol.
• Drink a lot of extra fluid. Even small burns cause excessive water loss.
• Eat a healthy balanced diet. Burn healing requires proper nutrition.
• Keep your scheduled follow-up appointments.

• Don't ignore second-degree burns. Seek care promptly.
• Don't apply butter or nonprescription creams or ointments to burns.
• Don't allow bandages to become soiled or wet.
• Don't exercise or return to work until instructed by your doctor.
• Don't expose healing burns to sunlight. This will increase scarring.
• Don't try to peal dead skin layers. This leads to infection.

• If you have a fever or chills.
• If you have pus, odor, or red streaking from your wound.
• If you are not urinating regularly, or urine is dark.
• If you are having increasing pain.
• If you have a reaction to your medication.

National Burn Victim Foundation
308 Main Street
Orange, NJ 07050
201-731-3112

National Institute for Burn Medicine
909 East Ann St.
Ann Arbor, MI 48104
313-769-9000

First Aid Book
http://www.medaccess.com/first_aid/FA_TOC.htm

First Aid Online
http://www.prairienet.org/%7Eautumn/firstaid/




Cross-section of skin indicating the degree of burn and structures involved. (From Lewis SM, Collier IC, Heitkemper MM: Medical-surgical nursing: assessment and management of clinical problem, ed 4, 1995, St Louis, Mosby. Used by permission.)

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