Burns
Contact injuries to the skin and deeper tissues caused by exposure to flames, hot liquids or solids, radiant heat, caustic chemicals, electricity or electromagnetic (nuclear) radiation.
Every year, in the United States, approximately two million people suffer serious burns; of that total, 115,000 are hospitalized and 12,000 die. Children are most commonly burned by scalding liquids in the kitchen or bathroom. Fire is the second most common cause of burns.
Burns are classified as first, second, or third-degree according to their severity.
- First-degree burns damage only the outer layer of skin (epidermis); they cause redness, mild swelling, and stinging pain.
- Second-degree burns affect the second skin layer (dermis); they are more painful and are marked by the appearance of blisters.
- Third-degree burns destroy both the epidermis and dermis and may also damage underlying tissue; the skin appears charred or white and lifeless and may be insensitive to pinprick. Third-degree burns may be less painful than second-degree, due to destruction of nerve endings.
The depth of a burn, its extent (percentage of body surface), and the age of the victim determine its severity. For burns of similar extent and depth, persons under one year and over 40 years of age have a higher mortality rate than those between the ages of two and 39 years. In children, burns affecting 10% of the body require hospitalization.
A reasonably accurate guide to determining the extent of burns is the "Rule of Nine:" head and neck account for 9% of body surface; each arm and hand, 9%; each foot and leg, 18%; anterior and posterior trunk, including buttocks, 18% each; and perineum, 1%.
First Aid
First aid for burns requires application of plain cool water as soon as possible after the burn occurs. Soothing ointment may be applied to minor burns, but never to serious burns. Chemical burns should be washed immediately with copious amounts of cool water, then neutralized with an appropriate chemical agent (e.g., dilute sodium bicarbonate solution for acid burns, vinegar for alkali burns).
Do not apply butter or oil to burns, as they hold in the heat and may damage the skin. Broken blisters can lead to infection, so, if possible, do not break them or allow the child to break them. If the burned area reddens further, oozes, or smells bad, take the child to a doctor immediately.
First and second-degree burns involving less than 10% body surface in children will usually heal well in two weeks. The wounds may be left open to dry or covered with sterile gauze. Burns heal best if the affected part can be immobilized and elevated to decrease the flow of lymph and limit the spread of infection (a major cause of death from burns).
Burns involving 15-25% of the body surface are treated in the hospital, so that intravenous fluids may be administered. These replace lost tissue fluids and provide nutritional support.
Burns of more than 25% of the body surface are generally treated in specialized burn centers, where patients can be kept in sterile wards to avoid complications such as infection, dehydration, pneumonia, and kidney failure. Wounds are covered by skin grafting as soon as possible.
Research is currently underway to grow skin in tissue culture to cover large wounds from small donor sites. Temporary grafts from other humans and pigs can be used. Although they are eventually rejected, these grafts protect the wound until healing occurs. An artificial skin that would serve as a permanent scaffolding for dermal regrowth is being tested.
Deep burns cause extensive scarring that may result in severe disfigurement and limitation of joint motion. Plastic surgery can often reduce the effects of the scars and ameliorate the psychological problems which often occur with serious burn scarring. Children who have suffered disfiguring burns will have difficulty returning to the classroom. Some hospitals have school re-entry programs to prepare the burn survivor's classmates for his or her return. Children need to understand the nature of the child's injuries, any scars or special clothing the child might have, or simply if the burn victim can still play with them. A nurse from the hospital can help children accept the burn survivor by explaining the child's injuries and what the child is going through.
Schools usually have safety programs designed to make children aware of burn and other safety hazards. Parents can reinforce this by warning children about burn dangers such as boiling liquids or chemicals. Small children should never be left alone around potential burnhazards. To prevent scalding in the kitchen, turn pot handles away from the stove's edge. To prevent stove fires, keep all flammable materials (food packages, curtains, towels, potholders, etc.) away from the stove. Check pilot lights on gas stoves to make sure they are working properly. It is also important for a household to have a fire escape plan. Over 50% of burns are considered to be preventable.
For Further Study
Books
American National Red Cross. First Aid for Burns. Washington, DC: American National Red Cross, 1977.
Bernstein, Norman R., Alan Jeffry Breslau, and Jean Ann Graham, eds. Coping Strategies for Burn Survivors and Their Families. New York: Praeger, 1988.
Munster, Andrew M. and staff of Baltimore Regional Burn Center. Severe Burns: A Family Guide to Medical and Emotional Recovery. Baltimore: Johns Hopkins University Press, 1993.
Stouffer, Dennis J. Journey through Hell: Stories of Burn Survivors' Reconstruction of Self and Identity. Lanham, MD: Rowman & Littlefield, 1994.
Audiovisual Recordings
Metropolitan Life Insurance Company. Burns. Evanston, IL: Journal Films, 1980.
(Videorecording.)
Stein, John M. The Doctor Talks to You about Burns: A Discussion. Bayside, NY: Soundwords, 1978.
(One audio cassette. Discusses various kinds of burns, medical techniques for treating burns, and the development and growth of burn centers. For ages 16 to adult.)
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