Degrees of Burns:
The skin is red and painful with some minor damage, but no blisters; think sunburn.
The skin is red, blistered, swollen, and painful. The burn area might also look wet and shiny or be white/discolored in an irregular pattern. There is no nerve damage in 2nd degree burns.
The skin has been burned all the way through. It may be dry and leathery to touch and change color to black, white, brown, or yellow.
The burn will feel numb because nerve endings have been destroyed. Skin will not regrow because the cells responsible for regrowth have been destroyed.
Mild burns are treatable at home, and do not require transportation to a hospital. 3rd degree burns are never mild.
If you don’t know whether it needs treatment at a hospital, call 911 and ask the dispatcher.
How to treat mild burns:
- Hold the burn under cold water for 15 minutes to remove the heat and prevent swelling.
- Smear burn cream liberally over the whole burn area. B&W Ointment works better than aloe or other burn creams I’ve tried.
- Cover the burn with a sterile bandage.
- Change the bandage 1 - 4 times per day as needed.
Severe burns require treatment at a hospital emergency room. If you do nothing else, call an ambulance or drive them to the hospital yourself.
Not all burns are the same, so the first thing to do is classify the burn as chemical or thermal/electrical.
The procedures listed here are recommended in the New York State prehospital treatment protocols.
Chemical burns are caused by reactions between your skin and acids or bases.
Acids are most commonly associated with burns, but bases can be more dangerous because they will burn you without you even feeling it. This is because acids work by ripping apart pieces of your cells, while bases turn your fat cells into soap and dissolve them away.
As an analogy, an acid is like cutting a cake with a knife while a base is like holding the cake under the faucet and watching it gently crumble away.
When acids and bases get on your skin make sure you flush them with a lot of water. Using a little can be worse than using none at all because acids and bases can react with water producing a lot of heat. Once you start flushing with water do not stop.
How to treat chemical burns:
- It is especially important to wear nitrile gloves when dealing with chemical burns to ensure that you do not contaminate yourself.
- Try to clean off as much of the chemical as possible before flushing with water. Remove any contaminated clothing or jewelry from the patient. This will minimize any reaction that the water has with the chemical.
- Flush any burns with water for at least 20 minutes.
- Cover the burn with a sterile bandage.
- If possible, bring the chemical’s container with you to the hospital; if not possible, write down the name.
- Keep the patient warm on the way to the hospital because burns cause the body to lose heat quickly, resulting in hypothermia.
Special Considerations for Eyes
- If chemical burns are in one eye, do not let the flush water from the contaminated eye drip into the uncontaminated eye.
- Even if only 1 eye is contaminated, cover both eyes with a bandage. Our eyes do not move independently, so looking around with the uncontaminated eye causes the contaminated eye to move as well.
Strong Acids and Bases
Most acids and bases are weak, and cause limited damage when you get them on your skin. The list below contains all of the strong acids and bases that will burn you.
Acids with Special Considerations
- Carbolic Acid or Phenol: If acid is on skin, clean with alcohol before flushing with water. If acid is in eye, flush with extra water instead of alcohol.
- Sulfuric Acid: Flush with soapy water to help remove the acid. Sulfuric acid heats up when it reacts with water, so use extra water. Sulfuric acid is found in lead-acid batteries
- Hydrofluoric Acid: If acid is on skin, flush with sodium bicarbonate(baking soda) solution, then flush with large amounts of water. If acid is in eye, flush with extra water instead of baking soda
- Metal Compounds: Cover with mineral oil
Thermal and Electrical Burns
Thermal burns can be caused by fire, hot metal, food, liquids, etc. Electrical burns can be caused by electrical wires, lightning, and other sources of electricity. Both types of burns are treated the same:
- Place the patient in a position of comfort. If there is a potential spinal injury do not do this.
- If the patient was burned by fire; has throat burns; is found in a confined space; or was burned by superheated gases, administer supplemental oxygen.
- Remove any constricting items like rings or bracelets. Also remove any smoldering clothing that is NOT stuck to the patient. Do NOT delay transportation to the hospital to remove these items.
- Check for hypoperfusion (shock).
- Determine the burn thickness and percentage of body surface area. 1st and 2nd degree burns are partial thickness while 3rd degree burns are full thickness. Percentage of body surface area can be determined by the Rule of Nines.
- If the burns are partial thickness and covering 10% or less of the body, wrap them in a MOIST sterile bandage.
- If the burns are full thickness or covering more than 10% of the body, wrap them in a DRY sterile bandage.
- Keep the patient warm. Burn victims lose heat rapidly and can become hypothermic.
Rule of Nines
To determine the severity of burns we use both the burn’s thickness and the total percentage of body surface area. This information should be given to the 911 operator if you are driving the patient to the hospital.
The Rule of Nines is a standard estimation used to determine the percentage of a patient’s body surface area that’s been burned. The below diagram shows the total body surface area divided up by percentage.
An alternate way to determine burn surface area is to compare it to the palm of the patient’s hand. The palm is approximately 1% of the total body surface area.
Burn Care Products
B&W (Burns and Wounds) ointment is an ointment that can be applied to 1st and 2nd degree burns after the heat has been removed with cold water. The ointment stops pain and inflammation and prevents infection. It needs to be wrapped with a secondary dressing.
Medihoney gel is a honey-based gel like B&W ointment, but it is not specifically designed for burns. Medihoney's real power lies in its ability to combat infections because it uses a specific honey with unique antibacterial properties.
Iodosorb gel works similarly to Medihoney gel, but it uses iodine as the antibacterial agent. It slowly releases the iodine into the burn or wound bed to kill bacteria while leaving the body's repair cells unharmed.
Puracol Plus and Puracol Ag use collagen to provide an ideal environment for wound healing. Puracol Ag uses silver to combat infected wounds. They are expensive, but severe injuries may warrant the cost.
Tips and Suggestions:
- Do not neutralize acids or bases on your skin with baking soda and vinegar. Acid-base reactions can produce heat and cause worse burns.
- Remove any jewlery from burned areas immediately. Once swelling occurs the jewlry may need to be cut off. Also, metal can hold heat and continue to burn the patient after the fire is out.
- Leatherman Raptor trauma shears have several tools specifically designed for removing rings, jewelry, and restrictive clothing from burn victims.