Burns - First Aid

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First aid

First aid

Skin problems

Superficial wounds and grazes Burns Sunburn
  • Superficial wounds and grazes
  • Burns
    • How a burn forms
    • Evolution of a burn
    • What to do now
    • What not to do
    • What to do when the burn has healed
  • Sunburn

Burns

The burn is an injury to the skin and sometimes to the underlying structures that can be caused by heat (so-called thermal burn: caused by a flame, boiling liquids or contact with overheated solids), by a chemical, by electricity or radiation. Thermal burns are by far the most frequent.

In Italy over 100, 000 people report burns every year; among these, almost 10, 000 have extensive or deep burns that force hospitalization. Deaths from severe burns amount to almost 500 every year and inhalation damage, resulting from flame burns, is the main cause, both early and late.

Accidents occur in 70% of cases in the domestic and recreational environment.

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How a burn forms

The thermal damage is consequent to the heating of the tissues above a critical level and the extent of this damage is a function of the thermal energy of the burning agent, the duration of exposure and the ability of the organic structures involved to transmit the heat. With the same location and thermal trauma, the skin of the child and the elderly usually have deeper burns than that of an adult. Heat coagulates proteins, activates cellular enzymes and causes the death (necrosis) of the tissues involved. A congested area is formed between the necrotic zone and the surrounding tissue which can either progress towards the death of the tissue or evolve favorably towards the reabsorption of the swelling and healing without visible permanent effects. The process takes place within 48-72 hours, the time usually necessary to be able to fully assess the extent of the burn damage.

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Evolution of a burn

The severity of a burn is related to its extent, depth and location.

Burns have always been traditionally distinct, according to their thickness, in four degrees (the fourth degree is the most serious) but today we tend, more simply, to divide them into superficial and deep burns, also according to their different evolutionary behavior .

  • Superficial burns, which include 1st and 2nd degree superficial burns, heal spontaneously and generally with full functional recovery within a few weeks.
  • The deep burns, which include those of II degree deep and those of III degree or full thickness, go through a much slower repair process (over 4 weeks) with serious scarring results. Surgical treatment, possibly early, with removal of necrotic tissues and repair with skin grafts is necessary. Deep degree II burns differ from superficial burns by the extent of epidermal damage, the involvement of the middle dermis and that of the superficial nerve structures, which often makes pain and burning less intense. Full-thickness III degree burns are characterized by the presence of crusts (in medical terms escare) of a color ranging from grayish-white to brown. The damage involves both the epidermis and the dermis in all its thickness and, sometimes, it can also affect the underlying hypodermic structures. The complete destruction of the vascular and nervous structures makes the III degree burn outbreaks cold and insensitive and for them surgical repair is indicated.
  • IV degree burns are characterized by the involvement of osteotendinous structures with carbonization; these burns often require amputation.

The extent of a burn is usually quantified as a percentage value on the total body surface; only II degree areas should be taken into account in the calculation. The area corresponding to the patient's palmar surface, including the fingers, represents approximately 1% of the total body surface and allows a rapid estimate of the percentage extension of small burns. In other cases, Wallace's Rule of 9 (head 9%, upper limb 9%, lower limb 18%, trunk 36%, genitals 1%) easily allows an approximate calculation of the extension.

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What to do now

Treat autonomously only superficial and not extensive burns. The first thing to do is to stop the burn process: wash the affected area for a long time with fresh running water and, if the affected area is covered with clothes, these must be removed. This removes heat, stops the progression of thermal damage and reduces pain.

Currently the most used local dressing is the so-called semi-exclusive, which not only prevents and cures infections but helps to reduce pain and promote healing.

The burned areas must be cleaned with mild antiseptic solutions; useful are fatty gauze, which are well tolerated, keep the burned surface moist (preventing dangerous crusts) and are also used in case of any skin grafts, for which they still represent the dressing of choice.

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What not to do

  • Burns, even superficial, if they are extensive, let alone deep ones, must not be treated independently.
  • In case of burns in which the presence of clothes or other materials melted with the patient's skin is observed, their immediate removal is not appropriate.
  • Do not administer antibiotics independently: these are prescribed by the doctor only if signs of suppuration and deepening of the "dead skin" area appear, with the appearance of high fever of septic type (that is, which presents the characteristics of an infection).

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What to do when the burn has healed

The very large burned areas and especially those located in aesthetically important areas, even if they do not have scars, must be protected from sunlight for a period of time ranging from 1 to 2 years because they can remain annoying and unsightly changes in the color of the skin.

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