Burns: a guide to self-treatment – includes related article
Lynne Cascio
Many of the burns suffered by 2.5 million Americans each year occur at home and, with the proper assessment, can be treated on an outpatient basis.
Burns that generally can be managed in an outpatient setting include partial-thickness burns covering less than 15% of the total body surface (10% for children) and deep partial-thickness or full-thickness burns covering less than 3% percent of the total body surface. Patients should also be free from infection and any fire-related inhalation injury.
Very young or very old patients or those with circumferential burns on the neck, torso, or extremities should be considered for hospital admission. Burns on critical areas, such as the genitals, eyes, ears, feet or hands, also may need surgical referral.
Burn injuries appropriate for outpatient treatment should be cared for through the process of cutting, cooling, cleaning, chemoprophylaxis, and covering.
First, as much hot, burned, or chemicalladen clothing as possible should be removed from the patient along with any chemicals remaining on the skin. Clothing that is not easily removed or that sticks to the wound should be left for surgical removal.
Substances such as tar can be removed with mineral oil or orange solvent (a mineral oil and organic solvent mixture available from dental supply houses). When diluted with cold water, both are safer than ether and more effective than mechanic’s soap.
To decrease post-burn hyperthermia and pain, the would should be immediately cooled with moderately cool water (not iced). Using sterile saline-soaked gauze helps to prevent iatrogenic ice injury or hypothermia. Water should be about 53.6 [degrees] F (12 [degrees] C) but should not be used for more than 15 minutes every hour.
Certain treatments should be avoided. Butter should not be applied to any burn that has blistered or requires medical attention. Similarly, ointments and salves should not be used, and numbing or anesthetic sprays, which can sensitize the skin, should also be avoided.
Cleaning may necessitate anaesthesia. The burn should be rinsed thoroughly and cleaned with fluid such as a chlorhexidine gluconate (Hibiclens) solution or a half-strength povidone iodine (Betadine) solution. Embedded material can be flushed out with a large-gauge syringe or Water-Pik device.
To prevent infection, damaged tissue must be removed from more serious burns. Patients are usually more tolerant of a whirlpool bath than manual debridement.
Experts agree that broken blisters or those covering a full-thickness burn should be removed. Eliminating unbroken blisters is more controversial. Many recommend removal of cloudy blisters or those likely to break, but some argue that blisters protect against Staphylococcus aureus.
Those arguing for removal say blister fluid fosters the growth of microorganisms, increases the likelihood of inflammation, blocks the ability of white blood cells to fight infection, and impairs the post-burn fibrinolytic process.
The wound is dressed according to its severity. Skin lubricants, such as Eucerin or aloe vera cream or lotion, can be applied to first-degree burns (unbroken red skin, no blisters). No bandaging is needed, but a physician should be consulted if blisters appear. Patients should avoid extremely hot showers. If severe itching commences, anti-histamines are recommended.
Second-degree (blistered, weeping, partial-thickness) and third-degree (white or charred, full-thickness) burns should be treated with antibiotics until the wound closes. Burns should also be covered with a dressing to protect the wound and keep it dry.
Although silver sulfadiazine and povidone-iodine are both effective treatments for these more severe injuries, the first is easier to use and painless. Povidone-iodine penetrates best but causes pain, dries scabs, and decreases joint mobility.
Chlorhexidine hydrochloride may be useful when antibiotics aren’t enough. Topical epidermal human growth factor and new synthetic skin may also help the healing of wounds.
The burn should be covered with a 1/16-inch layer of antibiotic cream, such as silver sulfadiazine. Use a sterile tongue depressor or cover your hand with a sterile glove to apply the ointment. Cover with a nonstick dressing, such as Telfa, and wrap with gauze, making sure that it remains loose enough not to impair circulation. An overly tight dressing is signaled by numbness, tingling, or a change in skin color or temperature. Fever, chills, swollen glands or vomiting may indicate a problem with the underlying wound, and a physician should be called.
Burns on the hands or arms are wrapped differently. Each finger should be dressed individually, the gauze being wrapped in a spiral starting from the fingertip and moving into the hand. Wrap the hand separately from the fingers to allow for knuckle movement. Be sure to pad the palm and keep (interphalangeal) joints mildly extended. Use tape to hold gauze in place.
Consult a physician to determine correct positioning. Elevate to control swelling, using a sling when possible to hold injury above the level of the heart. The more severe burns should generally be checked daily, especially those on the hand.
Follow-up care should include daily bathing. Completely wash off the antibiotic and reapply one or two times a day. For large burns, a home whirlpool is helpful. Small burns may not need a dressing during the day, but one should be applied at bedtime, when going outside, or before performing household chores.
Because burns are prone to tetanus infection, tetanus immunizations should be brought up to date.
Burned skin may itch for weeks and may be susceptible to sun for up to a year. Antihistamines can control itching, and trimming nails may help to prevent scratching in children.
The discomfort of changing dressings can be reduced for children by using a bismuth-impregnated petrolatum material like Xeroform, which can be left in place, checked daily, and rewrapped with gauze. However, this technique increases the chances of infection.
Pain can be relieved through use of oral analgesics, such as acetaminophen with codeine. Demerol or other narcotics may sometimes be helpful as well.
Burn Prevention
and Treatment Tips
* To avoid sunburn, use sunscreens, wear
protective clothing and stay out of the
sun during the hours of greatest exposure
(10 a.m. to 4 p.m.).
* To avoid accidental scalds, turn hotwater
heaters below 124 [degrees]F. At this
temperature, burns do not occur until
after four minutes of exposure. In
contrast, burns occur after less than one
second of exposure to water at 160 [degrees] F,
after five seconds of exposure to water
at 140 [degrees] F and after 20 seconds of exposure
to water at 131 [degrees] F.
* In the kitchen, keep pot handles pointed
away from children. Cooking pots,
curling irons, irons and hair dryers hold
heat long after the heat source is
removed or turned off.
* Buy stove guards, automatic coffee
makers, fireproof of portable heaters and
full-glove (fingers to wrist) pot holders.
* Temperature-test all foods. Remember,
in particular, that materials heat
differently in a microwave oven. For
example, a baby bottle heated in a
microwave oven may feel warm, while
the formula inside may be scalding hot.
* Keep all chemicals and caustic agents
(including batteries, which can cause
chemical burns if ingested) up high and
locked away from children.
* Wear gloves and goggles when mixing
and using household chemicals, such as
oven cleaners.
* Dispose of oily rags. Store flammables,
including cigarette lighters and
matches, properly and do not smoke
around flammables.
* Use electrical outlet covers. Consider
installing switched outlets (which have
an on/off switch that is out of the reach
of children), ground-fault interrupters
(which shut off electrical current if an
appliance contacts water) and residential
indoor sprinkler systems.
* Install smoke detectors and check them
weekly; change batteries every six
months.
* Plan and practice a family fire evacuation
route. Remind children to crawl
below smoke and to feel closed doors;
if a door or its handle feels hot, the door
should not be opened.
* If a person’s clothing ignites, the person
should be wrapped (or should wrap self)
in a blanket or should roll on the ground.
COPYRIGHT 1992 Vegetus Publications
COPYRIGHT 2004 Gale Group
