Burn is an injury to the skin or tissue caused by heat (hot liquid), electricity, chemicals, friction, or radiation.
Skin is part of our body’s defense system, which protects us from infections. Burn damage to the skin can lead to infection, fluid loss, and electrolyte abnormalities.
Burns can be classified as first-, second-, or third-degree, depending on the percentage of body surface area (BSA) involved, the depth, and the location of the body involved.
The system used to estimate body surface area (BSA) in percentage is the “rule of nines.”
RULE OF NINE
- Head and neck: 9%
- Arms and hands: 9% each
- Chest, stomach, upper back, and lower back: 9% each
- Legs and feet: 18% each
- Genital area: 1%
First-degree burns only involve the epidermal layer having pain, and redness of the skin which generally heal within a week.
Second-degree burns are divided into two categories, superficial thickness and deep thickness. Superficial second-degree burns extend from the epidermis to the superficial dermis and include Pain, skin blistering, and intact capillary refill are characteristic.
Deep-thickness burns extend into the deep (reticular) layer of the dermis and damage hair follicles, sweat glands, and sebaceous glands.
Third-degree burns include the entire thickness of the skin which is painless, feels leathery, and appears pale.
Fourth-degree burns extend through all layers of the skin and involve muscle and bone.
What to do in a burn, you can take the following first aid steps:
- Remove clothes, and jewelry that irrigate the burn
- Cool the burn with cool or running water to reduce the temperature of the burn
- Cover the burn with clean clothes
- Treat pain with or ibuprofen (pain killer)
What not to do in a burn patient
- Do not touch the patient before ensuring your safety (switch off the electricity, wear gloves for chemicals burn, etc.)
- Do not apply ice, oil, Colgate, or any paste on the burn.
- Do not touch blisters until topical antimicrobials can be applied.
- Do not apply anything directly to the wound because it may become infected.
Management
The health guide should resuscitate and stabilize the patient cover the burned areas with a clean, dry sheet, administer rapid painkillers, and start fluid resuscitation. Before starting fluid resuscitation should estimate how much body surface area burned.
Parkland formula is used to estimate fluid requirements in a burn patient. The patient’s weight in kg is multiplied by the percent BSA involved, this number is multiplied by 4.
- The fluid of choice should be ringer lactate in the burn condition
- Total calculated fluid should given in 24 hours, half amount of fluid should be given during the first 8 hours and the remaining amount of fluid should be given over the next 16 hours.
- Application of topical antimicrobials like 1% silver sulfadiazine, bacitracin, or triple-antibiotic ointment.
- Daily dressing changes and watch for any signs of infection.