Burns and scalds are everyday injuries which mainly involve the skin. The injuries vary from minor to life-threatening. People tend to manage these injuries themselves and seek medical help when the damage on the skin is more serious. Burns and scalds are preventable to some extent although the nature of life is that accidents always happen.
A burn is in an injury caused by heat. Scalds are also burns but hot liquid or steam are the culprits. Burns occur in the home, at work, on the beach – anywhere there is contact with heat. They can have a terrible impact on people’s lives especially if they cause extensive injury or if the injury is in a visible part of the body. Doctors have guidelines about how to manage burns so that the patient gets the best treatment possible and future problems are reduced. Burn injuries are not limited to the skin. Internal tissues such as the respiratory airway can be damaged.
Direct heat such as accidentally brushing a finger over a hot oven plate or spilling hot water over an arm are not the only types of burns. A chemical injury (e.g. acid) can cause life-changing burns, as can electrical injury. In the UK, up to 1 in a 100 people are thought to sustain a burn injury each year. Of these, 1 in 10 need admission to hospital and 1 in 10 of the people admitted will have life-threatening injuries. Electricity causes burns, as does the sun and radiation (for example treatment with radiotherapy).
Pain is the main symptom and varies according to the severity of the burn. If a burn is very deep and destroys nerve tissue, there may not be any pain at all. Itch at the burn site is also another symptom especially as the burn heals. Burns may become infected because the breakage in the skin barrier allows bacteria to go into the wound. Infection may delay healing of the burn and there may even be a discharge of pus.
Burns are divided into four types – first, second, third and fourth degree. First degree burns are superficial. The skin will be red and tender. Second degree burns penetrate the skin more deeply. Third degree burns penetrate and damage the full thickness of the skin. Fourth degree burns may damage muscles and deep tissues – in fact any structures lying underneath the skin which come in direct contact with the heat.
Burns can leave a legacy of skin discolouration and scarring when they heal.
When a burn or scald occurs, there is the temptation to panic. Removal from the heat source and cooling the burn are two important first aid measures. Flames should be extinguished and hot clothing removed. Clothing should be safely removed if involved in chemical burns. Running water should be poured generously over the affected part for 20 minutes if possible. The water should not be below 7̊C. 15̊C is the ideal temperature. Doctors should send burns involving 10% of more of the body to hospital. Here the treatment of the burn will involve not only dressings but other therapy may be needed if the burn is extensive and there is a risk to life. Inhalation of hot substances as in a fire can cause terrible damage to the airways. The victim may appear fine initially but can afterwards have breathing problems if the damaged airways begin to go into spasm.
Antiseptic cream should be enough to treat a minor burn. In a hospital Accident & Emergency Department, silver sulphadiazine cream, paraffin dressings and tetanus vaccine are used for deeper burns.
Sometimes antibiotics may be required to treat or prevent infection of the skin. Victims of extensive burns or of burns in a visible area may need cosmetic surgery at a later date.
Accidents are part of life and are often preventable when viewed with the benefit of hindsight. The best prevention is probably anticipation. Looking out for potential hazards in the environment is a start. Keeping hot cups of fluid and kettle leads out of the range of little children is important. Using oven gloves when handling hot dishes could reduce many of the burns that occur at home. Safety standards at work must be scrupulously maintained where workers are exposed to chemicals. Electrical wiring and appliances in every environment should be kept safe. Applying high factor sunscreens is a must when exposed to the sun.
In: General Medicine,