Background

A burn is a type of injury that may either be caused by heat, cold, chemicals, electricity, light, friction, or radiation. Burns can be very variable as to the affected tissues, the severity, and the resulting complications. With substantial injury to the nerves of the body, bones, blood vessels, muscles, and epidermal tissues may all be damaged with consequent pain.

Several complications, some of which may be potentially fatal, may be experienced by a burn victim such as shock, infection, electrolyte imbalance, and respiratory complications, depending on the burn location and degree of severity.

Understanding the nature of human skin

The human skin plays an important role in the body’s fluid and temperature regulation. The moment enough area of the skin is injured, such ability to control the same may be lost. The skin acts as a protective barrier against bacteria and viruses that are spread throughout the world outside the human body. With the complexity of the skin’s anatomy, we can find three layers:

1. Epidermis - the outer layer of the skin.
2. Dermis - consisting of elastic fibers and collagen, where nerves, blood vessels, hair follicles and sweat glands rest.
3. Hypodermis or subcutaneous tissue - where the larger nerves and blood vessels reside. This specific layer is the most crucial in the regulation of body temperature.

The degree of damage that a burn can cause generally depends on its location, depth, and on how much body surface area it involves. As a general rule, burns affecting more than one percent of the surface of the body, around the size of a palm of the hand, must be referred immediately to a qualified physician.
 

 Classification and Treatment of Burns

Initial assessment of the burn, which includes knowing its cause, spells the difference in determining its severity. It is important to first distinguish the degree and extent of damage to the tissues of the body. The different degrees of burns are:

First-degree burn

This is the most minor instance, in which only the outer layer of the skin or the epidermis is burned or damaged. The skin usually turns red, sometimes accompanied by pain and swelling. Unless involving greater parts of the hands, feet, major joints, buttocks, or groins, this type of burn may well be treated at home.

Second-degree burn

A second degree burn is an injury that has gone through the first and the second layer of the skin, or reaching up to the dermis of the skin. Aside from the intense reddening of the skin, blisters appear on the burned surface. Such burns induce severe swelling and pain.

A second degree burn no larger than 3 inches (7.5 centimeters) in diameter is considered a minor burn. On larger burns or when the burned area is on the hands, feet, face, buttocks, groin, or over major joints, it must be treated as a major burn and must be afforded professional medical assistance immediately.

For first and second degree burns considered as minor burns, the following courses of action must be taken:

- Cool the burned area. Hold the burned area under cold running water for at least 5 minutes or until the pain dissipates. An alternative to this would be to immerse the burnt area in cold water or use a cold compress, to reduce swelling by spreading heat away from the skin, but never put ice directly on a burned area.

- Bandage and cover the burn. Using a gauze, not fluffy cotton, wrap the burn loosely, avoiding pressure on it, as bandaging would protect the burn from direct air contact, which induces pain on the blistered skin.

- Take oral medicines. Take over-the-counter pain relievers, which include aspirin, ibuprofen, paracetamol, naproxen, or acetaminophen. Avoid giving aspirin to children or teenagers.

Minor burns usually heal after the foregoing treatment. They may heal with slight pigmentary changes, differing from the original color of the adjoining skin. Be attentive to infection signs, which include swelling, oozing, fever, redness, and elevated levels of pain. Avoid re-injuring the burned area from exposure to the sun within one year by applying protective sunscreen lotion to it.

Remember to avoid using ice directly to the burned area as it may cause frostbite, which would further damage the affected skin area. Do not apply butter or other ointments to the burn as this could prevent proper healing. Likewise, avoid breaking blisters, as this may cause untoward infection to the burn.

Third-degree burn
Ironically, the third-degree burns are the most serious but are painless, and involves permanent damage to all the skin layers and tissues. Fat, muscles and even bones may be affected by this burn. The affected areas may appear charred black or dry and white. A victim of third-degree burns may also experience difficulty in breathing and poisoning by carbon monoxide ingestion or other toxic effects upon smoke inhalation.

Calling for emergency medical assistance is a must for cases of third-degree burns, and while such is being awaited, the following steps must be taken:

• Don’t remove the burnt clothing, but make sure the victim is already free from      smoldering materials and away from exposed smoke or heat.

• Never immerse large burned areas in cold water as this may cause shock to the victim.

• Check for signs of circulation, like breathing, coughing or movement, and in the absence of these functions, perform cardiopulmonary resuscitation (CPR) to the victim.

• Whenever possible, elevate the burned area or extremities above the level of the heart to minimize bleeding.

• Cover the burned area or areas with clean, cool, moist cloth or bandaging, or even moist towels.

 Prevention

Risk Factors

- Wooden stoves, exposed heat sources and damaged electrical cords
- Unsafe storage of flammable and combustible materials
- Reckless smoking
- Child abuse
- Hot water heater set at high settings
- Improperly heated foods and containers
- Excessive exposure to the sun

Preventive Care

- Installation and maintenance of adequate smoke or heat detectors
- Educating children on fire prevention and protection in schools
- Avoiding smoking and excessive alcohol intake.
- Wearing of flame-retardant clothing, especially by the children
- Readying emergency exit routes at home, in school, and the workplace
- Equipping individuals with knowledge through fire drills

People may feel that the risk of getting burned is highly unlikely, but we can never be too careful. Aside from physical complications, burns can also result in serious emotional and psychological distress due to scarring and deformity.