Burns-First-Second and Third Degree

We usually think of a burn as an injury to the skin caused by heat. However, a severe burn may involve other tissues as well as the skin. It can be caused not only by heat but by chemicals, electric current, or radiation such as X rays, a nuclear reactor, or an atomic bomb. In severe burns the patient's life is in danger from shock, loss of fluid, and disturbance of chemical balances.

A. Ordinary Burns Caused by Heat.
The severity of a burn (and, thus, the method of its treatment) depends upon the depth to which the tissues have been injured. The victim's welfare depends also on how much of the body's surface has been involved by the burn. Burns are classified as first -degree, second degree, and third-degree.

First-Degree Burns. In a first-degree burn only the outer layer of the skin is damaged. There is pain, redness, and possible swelling, but no blisters. Mild sunburn or mild exposure to steam, hot water, or direct heat are examples. No scar is formed when healing occurs.

WHAT TO DO
Treatment for a first-degree burn is to relieve pain. It is best accomplished by applying a non greasy burn ointment which contains a mild anesthetic to deaden the pain, or the burned area may be patted lightly with a paste prepared by stirring baking soda into water. Immersing the burned part in cold water also helps relieve pain.

Second-degree Burns. In a second degree burn, not only is the surface layer of the skin involved, but also, to some extent, the deeper layers. Tissue fluid escapes into the damaged tissues causing blisters which are easily broken. Because of a breakdown of the skin's surface layer, infection may develop. Severe sunburn is a common example of a second-degree burn. Inasmuch as the skin is not totally destroyed in a second-degree burn, it can still heal without extensive scar formation.

WHAT TO DO
If large parts of the body are involved in a second-degree burn, the victim should be hospitalized. Extensive burns can cause complications such as shock or infection.
First-aid instructions given here for second-degree burns are intended only for burns that cover a relatively small part of the skin surface and, also, for the immediate care of the more extensive burn until the victim can be hospitalized. The treatment should be aimed toward
(a) prevention of shock
(b) relief of pain
(c) control of infection
(d) proper care of the wound.

To reduce danger of shock, the victim should be placed in a reclining position, feet slightly elevated. He should be kept comfortably warm but not overheated. In view of possible swelling, finger rings, bracelets, and similar items should be removed, even from parts not involved in the burn. The victim should be given reasonable amounts of fluid by mouth every fifteen or twenty minutes -this to replenish the body fluid lost from the burned area and also to make it easier for the kidneys to handle their extra load of toxins. Half normal saline solution (one level teaspoon salt to a quart of water) may be given orally, especially if hospital care is delayed and the victim is not vomiting.

Pain is most safely relieved by immersing the affected part in cold water, if this is feasible, adding chips of ice to the water to keep it cold. When not feasible, clean compresses wrung from ice water and changed frequently can be laid over the burn area. Oil or greasy ointments should not be used.

Clothing should be removed or cut away from the burned area. In a severe burn when fragments of clothing still adhere to the burned tissue, a clean dressing can be placed over the area without removing all fragments until the victim arrives at the hospital. When the burned area is relatively small and it seems feasible for the first -aider to clean the wound, he may do this gently, using warm water and sterile soap. Try to avoid contaminating the wound. Dressings should be either sterile surgical dressings or portions of light cloth which have been recently ironed. Aside from keeping the wound clean, infection is best controlled by using antibiotic drugs under a physician's direction.

Third-Degree Burns. A third-degree burn involves destruction of the entire skin of the involved area. In severe cases the deeper tissues, such as muscle, may also be damaged. Often charring of the deeper tissues takes place, also of the skin margins around the damaged area. Since the skin is destroyed, it cannot regenerate by itself at the center of the wound, and skin grafting is advised. Otherwise, the tissues at the margins of the injury contract as they heal, Causing heavy, misshapen scars.

WHAT TO DO
The general plan for handling the victim is the same as that for a second degree burn. Combat shock by keeping the patient in the reclining position, feet slightly elevated, even while he is being transported to the hospital. Very little should be done to the burned area except to remove foreign material and keep it covered with clean cloth or sterile dressings. Even during first aid, the patient should receive frequent drinks of water. If he is given medicine, such as one or two aspirins for relief of pain, the time and amount should be noted on a piece of paper and this pinned to the patient's clothing or covering sheet for the doctor's information.

B. Burns Involving the Lungs or Air Passages. Many severe burns caused by explosions or blasts of hot air include damage to air passages and lungs. Such damage is indicated by singed hairs inside the nostrils, persistent coughing, hoarseness, and spitting of blood or particles of carbon. The most serious symptoms may occur several days after the burn. There may be such swelling of the lung tissues as to endanger the victim's life. The air passages may become swollen, and the physician may have to perform a tracheotomy. Patients whose lungs have probably been damaged should be observed closely in the hospital for several days, even though they feel reasonably well.

C. Burns Caused by Atomic Blasts.
view Wartime Disaster.

D. Burns Caused by Chemicals. It used to be assumed that the first thing to do in a case of chemical burn was to apply the chemical antidote. Experience has taught, however, that in all types of chemical burns the first effort should be to flood the involved area with plain water. Otherwise, valuable time may be lost in waiting to find a proper neutralizing agent. Manufacturing plants, where chemicals are used have installed in strategic locations the necessary plumbing fixtures for emergency showers.

WHAT TO DO
1. Flood with running water the portion of the victim's body which includes the burned area. Do not wait to remove clothing.
2. Then remove the clothing from the involved area and treat the burned tissues with mild neutralizing solutions if the nature of the original chemical is known. In burns by acid, treat the area with a dilute solution of ordinary soda (two tablespoonfuls to the quart of water). If the burn has been caused by an alkali, treat the area with a solution of vinegar diluted half and half with water. Burns by carbolic acid (phenol) should be flooded with ordinary alcohol (rubbing alcohol is good). Then rinse with plain water.
3. When an eye is involved in a chemical burn, the eyelids should be held open while a gentle stream of water is used to irrigate the eye. After the rinsing, a mild ophthalmic ointment may be placed under the eyelid if such is available.
4. Subsequent treatment of chemical burns is the same as that for burns caused by heat.

E. Burns Caused by Electric Current.
Tissue damage from these burns is often much greater than can be seen by examining the site of injury. The greatest danger to life is interference with the action of the heart and the breathing apparatus. Damage to the heart is caused by the passage of the electric current through the chest, while that to the organs of breathing is caused by injury to the respiratory center in the brain stem.

WHAT TO DO
If the victim is still in contact with the electric circuit, first break the contact. This must be done carefully lest the rescuer also receive the current and become a victim.
Attention must then be given to the action of his heart and lungs. If he is not breathing or if his heart is not beating, resuscitation must be begun at once.
Minor electrical burns of the skin and underlying flesh are treated as are ordinary burns caused by excessive heat. Extensive electrical burns may require skin grafting.

F. Burns Caused by Radiation. Radiation burns may be caused by excessive exposure to X rays or from contact with radioactive substances as used in nuclear reactors, cyclotrons, linear accelerators, and atomic bombs.
The damage may be delayed so that the symptoms occur days or weeks after exposure. The degree of injury depends upon the amount of radiation absorbed, upon the rate of absorption, and upon the parts of the body exposed.

WHAT TO DO
 First-aid treatment of a radiation burn involving the superficial tissues of the body is similar to that for burns caused by heat. In addition, attention should be given to the systemic effects of the radiation. Transfusion of blood may be advisable to help combat anemia. Exposure to radiation also reduces a person's resistance to infection. Thus, antibiotics or other means of combating infections should be used.

Source
Modern Medical Guide
Harold Shryock, M.D
Pain Management: Pain Caused By Burns