Burns may occur any time like during household works or in workplaces also, so people should have knowledge of first aid for burns. Here we are providing some important concepts related to burns.
Causes of Burns:
Burns are caused by dry heat like the flame, radiant heat, electricity, lightning, X-ray or highly heated substances. Scald is a type of injury resulting from moist heat, e.g. hot liquids at or near boiling points or by steam.
Classification of Burns:
(A) According to severity-
(1) The partial thickness of burnt area- Here only the superficial layers of skin is involved. This epithelial proliferates and gives a complete epithelial covering to the burnt surface. Hence, with partial thickness burn, spontaneous healing is expected.
Under the burnt area sufficient epithelial tissues are left in the hair follicles, sweat glands, and sebaceous glands, which remain uninjured. In this case.
(2) The full thickness of burnt area– The whole thickness of skin, including the depth of dermis, is injured. This type, therefore, requires treatment by skin grafting.
All epithelial elements, including those in the hair follicles, etc., are destroyed. Spontaneous epithelialization of the burnt surface is impossible
(B) According to surface area –
Wallace’s “Rule of Nine”. This helps in estimating the surface area involved in a burn case.
|Head and Neck||…||=||9%||Two upper limbs||…||9% x 2||=||18%||Two lower limbs||18% x 2||36%|
|Chest (front & back)||…||9% x 2||=||18%|
|Abdomen (front & back)||…||9% x 2||=||18%||External genitalia||1%||1%|
(C) Dupuytren’s methods –of estimation of Burns:
Degrees of Burn (now obsolete): Ist degree: Epidermis. 2nd degree: Epidermis + Dermis. 3rd Degree: infected 2nd degree: 4th Degree: Skin + deep fascia + subcutaneous. 5th Degree: Muscle. 6th Degree: Bone.
General Symptoms of Burns:
When you feel symptoms of burn use some points of first aid for burns which have given in below picture.
- Intense pain
- Symptoms of dehydration, e.g., thirst, headache, vomiting chill. If dehydration is severe oliguria or even renal failure may occur.
General Signs of Burns
(1) Raw ulcerated areas with fluid are exudating.
(2) Signs of dehydration, e.g., dry tongue, urinary output less, etc.
(3) Area blister formation.
Investigation Related to Burns:
(1) R.B.C. count. : Prognosis: the red blood corpuscles count investigation can be helpful.
(2) Hemoglobin %
(3) Haematocrit – Radioisotope study that Haematocrit becomes 30% below normal for the first hour within the incident of injury and then falls by 1% everyday subPrognosis:
More than 20% of the body burnt is a serious case, more than 30% is a dangerous one, 60% and over usually turns fatal; children with 12% comes under serious burns.
Shock in Burns:
(1) Hypovolemic shock – this is the major cause.
(2) Psychogenic shock – from the fright of burning and the severe pain. Superficial burns are more painful because of exposure of the intact nerve endings.
(3) Septic shock – next to hypovolemic shock, this is the commonest cause of death. This usually occurs during the second and third week and is due to severe infection of the burn wound.
Complications Related to Burns:
(1) Hepatic failure and jaundice.
(3) Curling’s ulcer (acute duodenal ulcer).
(4) Keloid formation.
(5) Carcinoma in scar tissue (Marjolin’s ulcer).
(6) Corneal ulcer and Keratitis.
(7) Sepsis – it leads to septicacmia and toxaemia.
(8) Chest complication – Bronchitis, pneumonia, bronchopneumonia, etc.
(9) Stress ulser.
(10) Contracture and deformities.
Management of Burns:
(1) First Aid –
(1) The burnt area should be covered with a sterile dressing and a film bandage is applied.
(2) Morphine i.m. 15 mgm. Immediately.
(3) The patient should be covered with a blanket.
The Emergency treatment in a patient of the severe burn is the institution of resuscitative measures to overcome the shock and to prevent fatal complications. The immediate therapies are
(i) Relief of pain.
(ii) Intravenous fluid resuscitation.
(iii) Prophylaxis against tetanus.
(v) Emergency respiratory care.
(vi) Prophylaxis against tetanus.
(vii) Gastro-duodenal care.]
(2) Fluid replacement guide –
It may also be checked by Haematocrit values, urinary flow and whenever possible by blood volume estimation
Evan’s formula – (a) Colloid – 1 ml. 1%/1kg. (b) Electrolytes – 1 ml./1%1kg. (c) Water – 5%, Dextrose – 2000 ml. This is given in first 24 hours, e.g. a patient of 50 kg. With 30% burns require 1,500 ml. of normal saline or Ringer’s Lactate and 2000 ml. of 5% Dextrose in the first 24 hours. If blood is indicated, at least half of Ringer’s lactate portion is replaced by blood i.e. 750 ml.
(3) Definitive Treatment –
(1) Prevention of tetanus.
(2) Treatment of shock, Viz. Hypovolaemic shock, neurogenic shock, psychological shock.
(3) To prevent infections, apply anti-infective drugs; antibiotic ointment.
(4) Fluid Transfusion – all adults with burns exceeding 15% and all children with burns above 10% require fluid transfusion.
(4) Wound Management –
The patient is better taken to operating theatre and under sedation all clothes are removed. All blisters are opened, and burnt surface is washed with dilute Savlon followed by washing with normal saline. During dressings, the area of burnt surface is calculated by the “Rule of Nine”. Then burnt areas are covered with (a)Penicillin tulle or Vaseline gauze, (b) Furacin ointment, (c) Soframycin Ointment; after that over this sterile gauze and cotton applied and the areas are then bandaged tightly with the crepe bandage. Dressings may need replacement according to amount of soakage.
(5) Nutrition –
High calorie, high protein, adequate vitamins A. D, also Vit. C must be given with I.V. drip. Oral fluids are encouraged if the patient does not vomit. (3) Fluid Transfusion – all adults with burns exceeding 15% and all children with burns above 10% require fluid transfusion.
(6) After Treatment-
(a) Correction of deformities (b) Skin grafting is practically always necessary, viz. autograft or homograft, placenta graft etc. (c) Splintage – Burn over flexor surface, physiotherapy. (d) Correction of deformities. (e) Prevention of contracture and deformity by splints
Home Remedies for Burns:
1) Cold water, ice or cold compress: placing the affected burn area in cold water or cold compress or rubbing ice is very helpful in relieving burnt area.
2) Applying raw potato - raw potato has anti-irritation and property of soothing the burnt area. put a raw potato slice on the burnt area.
Home remedies for burns treatment are given in below picture which might be used in first aid for burns.
3) Aloe vera - cut aloe vera.rub on skin .it has cooling and soothing effects.
4) Honey - Spread honey.it reduces the chance of development of scars on the burnt area.
Homeopathic Remedies for treatment of Burns:
(1) Cantharis – Put 20 drops of Tincture in a gill of water and keep injured parts constantly wet with rage or saturated with the solution. Superficial ulceration caused by burns, with burning pain and lachrymation; titanic or epileptiform convulsion, followed by coma.
(2) Ars. Alb – In all burn as long as the pain is present, or when vesicles turn black, showing the tendency to gangrene, inflammatory swelling, with burning, lancinating pains, septic changes. Extreme thirst, drinking often, but little at a time, great anguish, restlessness and fear of death.
(3) Calendula – Hinders and prevents gangrene, promotes granulation and prevents disfiguring scars, favors cicatrization with the least possible amount of suppuration, prevent exhaustion from loss of blood and excessive pain.
(4) Aconite – Immediately after burn, (shock after burn), to counteract the nervous shock or when the reaction has taken place, and there is dry, burning heat of the skin, head hot and painful, face red; pulse hard frequent and contracted, great restlessness, fear of death.
(5) Carbolic Acid – When burn tends to ulceration and ichorous, highly offensive breath profound prostration; surface pale and bathed in cold sweat.
(6) Calendula – Hinders and prevents gangrene, promoters granulation and prevents disfiguring scars, favors cicatrization with the least possible amount of suppuration, prevent exhaustion from loss of blood and excessive pain.
Biochemic Remedies for Treatment of Burns:
(1) Kali Mur – Burns and scalds of any degree must be treated with this remedy, internally and externally.
(2)Ferrum Phos – May be applied at first till the pain ceases.
Home remedies for minor burns treatment are given in below picture which might be used in first aid for burns.