Burn And Scald

*Please take note of this topic as it is a popular questions that will come out in the examination.

DEFINITION
-Injuries caused by extremes of temperature, chemicals or radiation.

CAUSES OF BURNS AND SCALDS 
A BURN is caused by:
1) Dry heat - fire or hot objects.
2) Electrical burn - contact with electrical current or by lighting.
3) Friction - from a revolving wheel or fast moving rope.
4) Chemical burn - strong acids or alkalis.
5) Intense cold - liquid oxygen, liquid nitrogen and extremely cold metals.
6) Radiation - exposure to sun or radioactive substances.

A SCALD is caused by:
1) Moist heat - hot liquid or steam.

• The Rule Of Nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit.

DEPTH OF BURN

  A. Superficial burn injury

• 1^st degree burn
• Limited to the epidermis
• Presents with erythema and minimal swelling
• Mild discomfort
• Commonly treated on outpatient basis

B. Intermediate burns

• 2^nd degree burns
• Involves the epidermis and superficial portion of the dermis
• Often seen with scalding injuries
• Presents with blister formation and typically blanches with pressure
• Sensitive to light touch or pinprick
• Commonly treated on outpatient basis; heal in 1-3 wks

C. Full-thickness burns

• 3^rd degree burns
• Involves epidermis, and all layers of dermis, extending down to subcutaneous tissue
• Appears dry, leathery, and insensate, often without blisters
• Can be difficult to differentiate from deep partial-thickness burns
• Commonly seen when patient’s clothes caught on fire/ skin directly exposed to flame
• Usually require referral to burn surgeon; need skin grafting to heal.

SYMPTOMS AND SIGNS

• Severe pain at injury.
• Reddening of the skin. (Skin becomes red)
• Blister. (起泡泡）
• Destruction of skin.
• Shock.

Treatment for Severe Burn

• Start cooling the burn immediately under running water for at least 10 minutes
• Dial 999 for an ambulance.
• Make the casualty as comfortable as possible, lie them down.
• Continue to pour copious amounts of cold water over the burn for at least ten minutes or until the pain is relieved.
• Whilst wearing disposable gloves, remove jewellery, watch or clothing from the affected area - unless it is sticking to the skin.
• Cover the burn with clean, non-fluffy material to protect from infection. Cloth, a clean plastic bag or kitchen film all make good dressings.

Treatment for Clothing On Fire

• Stop the casualty panicking or running – any movement or breeze will fan the flames.
• Drop the casualty to the ground.
• If possible, wrap the casualty tightly in a coat, curtain or blanket (not the nylon or cellular type), rug or other heavy-duty fabric. The best fabric is wool.
• Roll the casualty along the ground until the flames have been smothered.

On all burns:

• DO NOT overcool the casualty; this may dangerously lower the body temperature.
• DO NOT remove anything sticking to the burn; this may cause further damage and cause infection.
• DO NOT touch or interfere with the injured area.
• DO NOT burst blisters.
• DO NOT apply lotions, ointment, or fat to the injury.

*Please refer to text book Lesson 12 for more information.