Burns (Thermal, Chemical, and Other)
One of the most common and most painful injuries is a burn injury. Burns are caused by extreme heat (both wet and dry), chemicals, electricity, radiation, and even extreme cold. They can affect the skin, eyes, lungs, and other internal organs. The severity of a burn is generally classified in one of three categories, based on the depth of the burn and damage.
First-degree burns (usually referred to as superficial burns) involve only the outermost layer of skin, called the epidermis. If treated quickly and blisters do not form, first-degree burns usually heal very well. Sunburns are a common form of first-degree burns.
Second-degree burns (usually referred to as partial-thickness burns) are more serious because a deeper layer of skin is affected and because they are easily infected. Second-degree burns are the most painful because more tissue is damaged, but the nerve endings are still preserved. These burns heal well and don't require medical attention unless they are larger than two to three inches in diameter or they occur on the hands, face, buttocks, penis, or vaginal area.
Third-degree burns (usually referred to as full-thickness burns) are the most serious burns, involving all of the layers of the skin. In third-degree burns, the skin may appear white, black, and or leathery-looking and there may be very little pain, although the areas surrounding the burn might be extremely painful. All third-degree burns require medical treatment. Call 911 for emergency rescue and transport or take the person to the nearest emergency room.
Never apply adhesive dressings or any lotions, ointments, or creams to a first or second degree burn that you are treating at home unless the skin is broken. For any broken blisters, wash carefully with antibacterial soap and tepid water, apply antibiotic ointment, and re-bandage.
When to Call for Help
For all burns, if you are unsure of the seriousness, call 911 or go to an emergency department. All burns on children, as well as any of the following, need to be seen by a doctor:
Second-degree burns larger than an area the size of the palm of your hand
First-degree burns larger than a five-palm-sized area
Burns that extend all the way around an arm or leg
Any “mixed” pattern of varying degrees of burns
Burns to the genital area, face, hands, or feet
First Aid for Severe Burns
Any burned person who is experiencing dizziness or confusion, weakness, fever or chills, or shivering needs immediate medical attention. For serious burns, always call 911 first, and then perform the following steps, remembering to stay safe, assess the situation, and use universal precautions if you are able to:
Extinguish the cause of the burn if you are able to with water or by wrapping the injured person in a heavy towel, coat, or blanket and rolling them on the ground. Make sure none of the smoldering materials are in contact with the injured person, but don't remove any burnt clothing.
Check for ABCs as outlined earlier, clear the airway if necessary, and begin CPR.
Cool the burned area with running water as outlined for treatment of minor burns, being careful not to overcool the injured person.
Wait for help to arrive, or if transporting the person yourself, cover the burned area with a dry, sterile bandage or a clean nonfibrous cloth such as a sheet, not a blanket or towel, as fibers may stick to injured tissues. Don't apply ointments, creams, or lotions, and don't break any blisters.
Second-degree burns that are two inches or larger in diameter and all third-degree burns require emergency medical assistance.
Treating Minor Burns
Minor burns, or first-degree burns, and small second-degree burns can be treated properly at home with the following steps:
For chemical burns, remove chemical source and all clothing or jewelry having contact with the chemical.
Cool the burn under running water, immerse the burn in cold water, or cover it with cold packs for about 15 to 20 minutes in order to stop the burn from damaging surrounding tissue and to reduce pain. Cover cold packs, and never apply ice directly to the skin.
After a first-degree burn has cooled completely, apply lotion or moisturizer to soothe and prevent dryness.
Cover the burn with a loosely wrapped sterile gauze bandage if necessary to keep pressure and air off the burn to reduce pain. If you can do so without causing irritation to the area, leave the burn uncovered because minor burns heal faster and more completely when they are not covered.
Use OTC pain relievers such as aspirin (adults only), ibuprofen, naproxen, and acetaminophen as needed for pain.
For any very tender, fluid-filled blisters, you may snip a tiny hole with small scissors that have been sterilized in alcohol. For these and any broken blisters, wash carefully with antibacterial soap and tepid water, apply antibiotic ointment, and rebandage.
As minor burns heal, keep the area moisturized with skin lotion and protect the area from exposure to sunlight with clothing or a UV-proof sunscreen for a period of about a year. Areas that scar may need permanent sun protection. Most minor burns will heal in as little as a week or up to a month, and if they are treated properly, most will not scar.
Never apply grease, oil, ointment, butter, or any other substance to any burn. Be sure to remove any clothing or jewelry from the burned area. If anything is stuck to the burn, leave it for medical professionals to remove. Immerse the burned area in cool (not ice) water to stop the heat damage to tissues near the burn.
Airway burns are always serious. Call 911 as soon as possible and advise the dispatcher that you suspect an airway burn. There is potential for an airway burn if the person has burns to the head, neck, face, or torso or has been on fire or in a confined-space fire (where gases and air can become superheated). In these cases, the airway can become swollen very quickly, obstructing the flow of oxygen into the body. Signs of airway burning are usually very evident, such as:
Soot around the nose and mouth
Swelling and actual burning of the mouth and tongue
Singed nose hairs
A very hoarse voice
If you see signs of airway damage in a conscious person, try offering small sips of cool water to reduce swelling, and loosen clothing around the neck to improve the person's breathing. Keep the person calm until help arrives.
Treating Chemical Burns
Chemical burns are always serious, and can be life threatening. Remember that personal safety in all first-aid situations is of utmost importance. After determining safety measures:
Remove the person from the scene if necessary, taking steps not to become exposed to toxic fumes or liquids that are present.
Seal any open chemical containers and ventilate the area.
Call 911 and the Poison Control Center immediately.
Chemical burns usually develop much more slowly than heat-related burns, but the first-aid treatment is similar. The first symptoms are typically intense stinging pain followed by blistering, peeling, swelling, and/or discoloration of the burn site.
Remove any articles of the person's clothing that might have become contaminated.
Brush away any dry chemicals left on the body, and immediately begin pouring cold water over the burn continually for at least twenty minutes or until help arrives.
If you have disposable rubber gloves, use them to prevent contaminating yourself and try not to let the contaminated water you're pouring pool up on or around the person or yourself.
Chemical Eye Burns
Chemical eye burns can severely or permanently damage or destroy the eye. As with other chemical burns, wear gloves and try to prevent splashing more chemical on the person or yourself. Don't attempt (or let the injured person attempt) to touch the eye or to remove a contact lens that seems stuck to the eye.
Steps to treat a chemical eye burn include:
Begin washing your eye and continue for at least ten minutes. In work settings, go to the emergency eyewash or shower station, use sterile isotonic saline solution, or if not available, use cold tap water. At home, get into the shower immediately with your clothes on in order to wash out your eye.
Attempt to keep your eyes as wide open as possible while using running water or eye solution to rinse them out.
For any alkali or hydrofluoric-acid burns, continue washing until help arrives or you are taken to an emergency department.
Most household chemical burns in children are a result of alkali in dishwasher products. Keep all household cleaning products, paints, solvents, and other hazardous products away from children.
Look on the product label or call your regional Poison Control Center to find out the type of chemical you were exposed to. The Poison Control Center can also advise you whether to seek immediate medical care. For any pain, tearing, redness, irritation, or vision loss, or if you are unsure, go immediately to an emergency department.