Burn:Insight for First-Aid & self-care

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1.Burn due to any cause transmits heat to a particular point or area of contact on our body. From this point or area of contact the heat spreads in all direction. Even if we remove the burning agent ,the transmitted heat continues spreading and damaging adjoining parts until its intensity to damage gets reduced in the process. Take an example of wax. When we make a contact by flame to a lump of wax and remove the flame, it continues to melt even after removal of flame from the wax. This I call after effect of burn. Similar after effect as I said earlier, occurs in our body, after removal of burning substance. To curtail this after effect we need to take out excess heat transmitted in the process of burn.

So, this is wise to put cold water or apply ice ASAP after burn .In my life I have seen many learned persons who are not in favor of putting water or ice after burn. Some of them believe that this application of water causes blisters to form. Sorry! this is not correct belief. Blister is formed due to damage of skin and reactions caused by that damage.

So, once more I should remind !  Apply Water immediately after burn and in the condition where large area was in contact of flame, ;it is better to shower whole body for twenty minutes at least to remove excess transmitted heat and reduce after effects. The application of water has only motive to remove excess transmitted heat energy which can harm further as after effect. Application of water after delay of two hours has no value.

2.Our body is protected by a boundary wall from all sides called the skin.It has got many protective functions. First-it protects us from many disease causing germs. Those germs cannot enter our body if our boundary wall(skin) is intact. Second it also insulates our body from heat and cold with the help of fat layer under it. Third it also protects our body from losing internal water directly outside by drying.

3.Burn causes damage to the skin in proportion to the amount of heat transmitted through an area or a point of skin.The damage of the boundary wall (skin) of your body allows external germs to pass easily to your body and you can have serious life threatening infections. Apart from this ,there is loss of water from the body from the damaged area, which results in dehydration of body, so it is wise to allow the person with burn to take plenty of water, Oral Re-hydration Solutions (ORS) to protect his life.

4.Our bodies internal temperature or core temperature is constant and maintained around 98.6 degree F or 37 degree C.

This is maintained as such even if we go to the polar region ,because nature has provided birds and mammals an excellent heat regulating system.

So ,if the area of burn is more the internal body heat loss directly to the external environment is more and the person feels cold and shivering due to loss of insulation in damaged skin.

So, the burn wound should be covered by antiseptic dressing with changing frequency every alternate days. This minimizes the germ entry to the body, loss of internal heat from the body and loss of water by direct evaporation from the body.

5.Just after burn, there is intense pain and in many case the person may die from the pain and inflammation, so after application of water, or ice, the person should be given NSAIDS orally or preferably Injection apart from this a single dose of dexamethasone may be given to save the person from severe inflammation and one dose of tetanus toxoid and proper antibiotic coverage(WARNING! Use under expert medical guidance).

6.Since such patients require meticulous care and monitoring, so they should be admitted in specialized burn unit.

7.Ler us revise our approach -Just after burn wash affected area with cold water or tap water for five minutes.

-Cover the affected area by antiseptic dressing.

-Anti Inflammatory and dexamethasone for pain.

-Prophylactic antibiotics for infection

-Oral water, fluids or ORS

-Tetanus toxoid

-Hospitalization in burn unit.

Note- dexamethasone may increase the chance of secondary infection, but for initial intense inflammation in a single dose may be life saving and this should not be repeated subsequently. And this should be given strictly under qualified doctors’ guidance.

8.Burn causes damage of our body cells. Proteins are required to repair our damaged body structures. So we should take adequate protein in diet. I have said about sources of protein. I again repeat here soybean is the best source of protein for vegetarians and egg white of boiled egg for non vegetarians. Here I need to say I stress on boiled egg because raw egg white contains a chemical avidin which blocks a vitamin-B complex component biotin. So raw egg white can cause you biotin deficiency and resulting hair loss. Apart from this raw egg may be a source of infection of TORCH diseases ;Toxoplasmosis ,Rubella, Cytomegalovirus and Herpes simplex virus. Those TORCH disease germs transmitted from bird to its egg.

Other form of egg preparation like omelet burns the nutritive value of the egg.

So the protein intake should be adequate to repair the damage of your body.

9.Toxic materials generated due to burn may cause damage to the kidneys, so urine output should be monitored in the burn patient. And fluid should be taken adequately to maintain the body water level and urine output adequate.

10.Percentage of burn can be assessed by a common man by few methods described in the medical texts.

Easiest for you that the area of palm is equal to one percent of burn. Suppose the person who sustained burn in one side of palm has got one percent of burn.

Apart from this palm rule there is a more popular rule to assess the percent of burn called Rule Of Nine.

Consider the whole body into following units separately

1)Head and Neck. Total 9 %

2)Trunk  9+9 % front and 9+9 %back(trunk front includes chest and abdomen and trunk back entire trunk from behind) total trunk area 36 %.

3)Upper limb(arm, forearm and hand) 9% left upper limb and 9% right upper limb. Total upper limbs 18%

4)Lower limb(thigh, leg and foot)9+9% for the left lower limb and 9+9% right lower limb. Total lower limbs 36%.

5)Genital area 1%

So head and neck + Total trunk +Total upper limb +Total lower limb +Genital area

=                    9.     +    36.            +            18.               +      36.                    +       1

=      100 %

The percentage of burn is calculated to assess the survival outcome of patient after burn. It is interesting to note that if you calculate the burn percentage after 24 hour the percentage may be slightly increased in comparison to the calculation done immediately after burn. Further less than 30 % burn have survival potential 70%.You don’t need to memorize all that. I have just written for your curiosity regarding the percentage calculation. Further I have omitted the degree of burn which depends whether only outer surface of the skin has burnt, entire skin has burnt or deeper structure has burnt. Depending on the depth of thermal injury the degree is assigned like first degree burn, second degree burn or third degree burn.

Anti septic dressing which I said earlier is not accessible for many of you. Just a freshly washed and ironed cotton bedsheet can be used to cover the person from his toes to neck after you have provided first aid and arranging the patient to transport to hospital .If you live in a remote village and you have local rural medical practitioner there but no hospital for such patient and the patient is unconscious and it may take a one or two hours to reach the hospital; you may ask the local practitioner to insert an Intravenous cannula and start Ringer lactate, Normal Saline, or DNS Iv slowly and keep few bottles in the transporting vehicle, to change if there is a chance of busy traffic or delay for more than three hours. This may change the outcome of the burn patient. Apart from this if the rural practitioner can insert the foley’s catheter in urinary bladder and can attach a urobag to it, would be better.I know that such practices trespass the boundary of law in many countries, but life is more important than the law.

Burn person’s serum electrolyte level is required to be monitored. Serum potassium level is most important to watch because its increase and decrease from its normal range may kill the person quickly.

Apart from direct flame and hot objects there are many other things that can cause burn.

Suppose you descending rapidly from a pipe or rope bare handed, the friction of your sliding palm generates heat and your palms get burnt and you can have 2% burn. In that condition also you should immediately rinse your hand with tap water and should apply ice to remove excess heat transmitted to your palm or any body part burnt by friction .And the wound would be managed like other burn wounds.

Generally for first aid you can use framycetin ointment or silver sulphadiazine cream locally at burn wound after washing it with normal Saline solution. Some manufacturer add local anesthetic in silvesulphadiazine. That ointment with local anesthetic combination is effective in relieving burning sensation. In home care for minor burns one can use silvesulphadiazine alternate day dressing change after cleaning with normal Saline solution. In home care oral amoxycillin + cloxacillin plus metronidazole may be used after dose adjustment for age or body weight with precaution of alcohol abstinence for upto 72 hours of last dose of metronidazole.

Whenever you use antibiotics, you should take vitamin B-Complex capsule one per day or syrup for kids.

Apart from the above causes there may be chemical burn with strong acids or strong alkalis, sunburn due to exposure to intense sunlight. The chemical burn should be managed by dilution of effect by excessive wash in running tap water and neutralization principle, for acid burn you can use mild alkali for washing, such as milk is alkaline and can be used for washing acid burn after washing the wound in running tap water, similarly if chemical burn is caused by alkali, it can be cleaned with weak organic acid like vinegar diluted in water. Be careful not to apply such neutralizing substance in eyes. Eyes should be washed in plenty of tap water or normal Saline only if available as a part of first aid and it is mandatory to consult eye specialist urgently. 

Disclaimer :All the information above are educational in nature and readers are advised to follow the guidelines of your local qualified medical practitioners and act according to the legal binding of  their respective areas.

thank you!