Burns commonly result from scalding by hot liquids, fire (particularly in areas where electricity is not available and paraffin stoves are used), electricity or chemicals.
Who is at risk?
Burns are still a leading cause of accidental death, especially in children. In the developed world they are second only to motor vehicle accidents as a cause of death. In spite of measures taken in most countries to prevent people from being burned a significant number of people still suffer fatal burns each year.
People most at risk are:
Those in homes without electricity where paraffin stoves and wood fires are used for cooking and heating
People in poor and overcrowded homes where basic facilities are lacking
Younger children who are left unattended in the kitchen while food is cooking on the stove-top
Younger children who are left unattended in the bathroom where hot tap water may scald them
How serious is it?
In very young children and babies, any burn is regarded as serious and should be seen by a doctor or nurse immediately.
Burns are classified in a specific way according to how much of the body surface is burned and how deeply into the skin the burn penetrates.
First degree burnsinvolve only the surface of the skin (epidermis) and look like sunburn. There is mild swelling, redness and pain. The damage to tissues is usually minimal and there is no blistering. The pain gets better in 48 to 72 hours and there is usually no scarring.
Second degree burnsinvolve injury to the full thickness of the epidermis and a portion of the layer beneath this – the dermis. Blisters form in second degree burns.
Superficial second degree burns– involving only a small depth of the dermis – are very painful because they affect a large number of nerve endings. If this type of burn is not infected, it will heal in seven to 14 days with little or no scarring.
Mid-level to deep second degree burnswill also heal on their own if kept clean and free of infection. They are less painful because there are fewer remaining nerve endings left. However, a deep second degree burn is serious and requires expert attention because the person will lose fluid and suffer other changes to the body’s physiology.
Third degree or full thickness burnsinvolve destruction of the entire epidermis and dermis, leaving no residual skin cells to heal the damaged area. These appear white (or black) and bloodless and are not painful. The area of the burn also feels leathery and hard. This type of burn can only heal with skin grafting and contraction of the wound to cover the damaged area. These burns leave deep scars.
The amount of the body surface which is involved is also important in assessing how serious the burn is, since all treatment is calculated using an estimation of the extent and depth of the burn surface.
As a rule of thumb – the open hand of the person equals one percent of the person’s body surface area.
If more than five percent of the body surface of a child under the age of two is burned, that child should be admitted to hospital. In children over the age of two, the rule is that the child should be admitted to hospital if more than 10 percent of the body surface is involved.
People of any age should be admitted to hospital if:
The face, the genital area, the hands, the feet, the creases of the joints are burned and if any burn involves the whole circumference of a limb or the body.
The burn is infected.
The burn has not healed within 14 days.
The burn is caused by an electric current.
The patient has inhalation burns.
Never leave your child alone in a room with a wood fire, a paraffin stove or in the kitchen with pots on the stove. Keep kettles, toasters and similar appliances far back on working surfaces so that they cannot be pulled down.
Always make sure that electrical appliances are safely earthed and that plugs have child-proof covers if they are not in use.
Store erosive chemicals out of reach of children.
Always use flame proof materials for bedding and clothing.
Set the thermostat of your hot water tank at a level where the water is hot enough for your washing machine and dishwasher, but not hot enough to scald as it comes out of the tap. Your electrician will be able to do this for you.
Submerge the burned area in tap water – you can also cover it with a wet, clean cloth, particularly if the burn is on the face. You can take paracetamol for pain.
If this is a first degree burn, wash the area gently with soap and water. You can cover it with an antiseptic cream and a dry gauze bandage which should be changed once a day. This type of burn should heal in 14 days.
Never use butter, grease or oil on a burn. Do not burst blisters since they are important in helping the skin heal.
If the burn is more serious as described above, seek medical attention immediately, after cooling the burn with water and covering it with a clean, damp cloth.
In a serious burn the person will be admitted to hospital where fluids will be given through a drip (intravenously). In the early stages of treatment the person may also have a tube passed into the stomach (nasogastric tube) to prevent vomiting.
Dressings will be applied and changed regularly. If there is infection, antibiotics will be given, usually through a drip.
In the case of severe third degree burns, skin grafting is carried out since the skin cannot heal on its own. This is often done almost immediately, once the person's condition is stable, since covering the wound early prevents further fluid loss and reduces the chances of infection.
The body requires an enormous amount of energy to recover from a serious burn, so people are given a special calorie supplementation programme in hospital to maintain their body weight.
Pain is controlled using the strongest drugs necessary.
Burns from lye, acids, or other harsh chemicals may look much like sunburn. Remove clothing, cutting it away if necessary to avoid spreading the chemical to other parts of the skin. Rinse the burned areas with cool running water for 20 minutes, and wash gently with soap.
If the person swallowed or inhaled any of the chemical, call a poison information centre immediately and follow their instructions. If the chemical splashed into his eyes, flush the eyes for 20 minutes with water poured from a pitcher.
Don't apply lotions or ointments to the burned skin, which may worsen the pain. If the burned area is large, cover it with a clean, damp sheet. Call the doctor immediately after providing first aid.
When to see your doctor
If a small child or baby is burned, see the doctor even if you think that the burn is minor.
If the burns are on the face, the hands or feet, the genital area or the creases of the joints or if the burn involves the whole circumference of the limb or body.
If a burn has not healed within 10 to 14 days.
If a burn, even a minor one, becomes infected.
If the burn is black, charred, or white and/or covers an area greater than the chest.
If the person has received any sort of electrical or chemical burn.
Reviewed by Prof H. Rode (Charles FM Saint, Professor of Surgery, Red Cross Children's Hospital)