Sunday October 26, 2008
Burn after reading, not
A first aid guide to tending burns.
MOST people recall their parents warning them not to play with fire. But many do not know what to do when these injuries happen.
In many cases, burns occur at home, often by contact with hot liquids, household appliances and kitchen tools, sometimes as a consequence of negligence or it could be purely accidental.
It can occur when a toddler knocks over a coffee cup or grabs the handle and spills a pot of boiling water on the stove. Even innocent household appliances such as curling irons can cause a serious burn to adults.
The treatment of burns depends on how severe they are. Burns may be first degree and limited to the outer layer of the skin, causing it to be dry, red and painful, but without blistering. Mild or moderate sunburn is an example of a first degree burn.
Dr Michael Tan ... The first step is to remove the individuals from the source of the burn, but not before checking your surroundings to ensure your safety. A second degree or partial thickness burn is more serious, and involves blistering of the skin. This type of burn is also painful and unlike a first degree burn, the affected skin will likely appear to be moist.
A third degree burn, also known as a full thickness burn, is when all of the skin layers have been penetrated and the burned area will be white, charred, firm and leathery. In this case, nerve endings are destroyed and the victim may not feel pain in the burned area.
“There are also deeper degree burns, which extend down to muscle and or bone,” said Dr Steven Chow, President of the Federation of Private Medical Practitioners’ Association of Malaysia (FPMPAM), who with St John’s Ambulance Malaysia (SJAM), is hosting free public sessions via the Citizen’s Action and Response in Emergencies (CARE), to train individuals to take care of themselves and others.
According to a study conducted by the Nationwide Children’s Hospital in Ohio, US, children aged three to 17 are more likely to be burned by fire while those aged two or younger are more likely to be hospitalised for burns to their hands or wrists from contact with hot liquids or objects.
The researchers strongly recommended the promotion of known strategies that are effective in preventing burns among children.
Examples include the installation and maintenance of residential smoke alarms, residential sprinkler systems, developing and practising an escape plan in case of fire, anti-scald devices on faucets, limiting water heater temperature and child-resistant cigarette lighters.
“But even with these preventative measures and under the watchful eye of parents or guardians, accidents can still happen. How you respond is what counts most,” said Dr Chow.
Dr Chow said that if a burn is not treated carefully, it can lead to infections or disfiguration.
This may lead the victim to feel self-conscious, embarrassed, frustrated and possess a negative body image, which if not addressed, may trigger depression.
Responding to minor burns
“The first step is to remove the individuals from the source of the burn, but not before checking your surroundings to ensure your safety,” said Dr Michael Tan, honorary secretary of the Private Medical Practitioners Association of Selangor/Kuala Lumpur and CARE programme director for Petaling Jaya.
For minor burns, the burnt area should be soaked in cold water for about 15 minutes by placing it under running tap water or by covering the area with a cold, wet towel.
“Symptoms will usually subside within a few hours, though they can persist for several days. Do not put ice, butter or any ointments on the burn and do not break any blisters that have formed,” advised Dr Tan.
Home-remedy skin soothers (like butter) on a burn can actually slow healing. Instead, just clean the area with plain soap and water and apply an antibacterial ointment. Next place a sterile dressing over the burned area and if the wound’s small enough, cover it completely with a sterile, dry bandage.
A doctor should be contacted for further instructions, explained Dr Tan, especially for second or three degree burns, which should almost always be seen by a health professional.
In many cases, many burns also need to undergo cleaning and debridement, which involves removing devitalised tissue around the wound, but this should only be done by a healthcare professional.
After debridement, an antimicrobial ointment, usually Silvadene (silver sulfdiazine), is applied to the burned area and it is covered with a gauze dressing.
“Because of the very small risk of skin discolouration, some doctors prefer to use alternative ointments on the face, such as Bacitracin. Silvadene should also be avoided in children allergic to sulfa drugs,” said Dr. Tan.
“Additional treatment will depend on the severity of the burn. It may include regular visits to the doctor for continued debridement (especially after blisters burst) as well as dressing changes every few days initially and then once a week, as the wound is beginning to heal.”
Dressing changes
The cleanings and dressing changes should be repeated twice a day for minor burns, unless advised otherwise by the doctor.
As part of the dressing changes, most minor burns should be washed with soap and water and patted dry. Next, an antimicrobial ointment is placed on the burn and non-stick gauze is applied over the area before a gauze roll is wrapped around it.
It is also advisable to see a burn specialist, if a burn is not healing within two weeks or if it becomes infected, developing redness and a discharge.
“For more serious burns that cover a large area of the body, it is best to have a medical professional attend to it. In these situations, you may just want to cover the burns with a clean dry sheet until professional help is available,” said Dr Tan.
Typically, a burn that covers more than 10% of the total body surface area (TBSA) of an individual is considered to be a critical burn, except for first degree burns.
A quick way to estimate the TBSA of a burn is to approximate how large the burn is as compared to the palm (not including fingers) of a the person’s hand as it is roughly 1% of TBSA.
Most serious burns, including second degree burns that cover more than 10% of the TBSA, third degree burns that involve more than 5% of TBSA or burns that involve the face, genitals, hands, feet or that cross a joint or totally encircle an extremity, should be referred to a specialised burn centre.
In the case of serious burns, hospitalisation, surgery and skin grafting may be required.
“Any electrical or inhalation burn (such as smoke, chemical, or extremely hot air or vapors) must be evaluated by a physician right away. These types of burns can have unusual complications despite mild symptoms at first,” Dr Tan said.
The next free CARE programme for the public will take place at 1Utama on November 1 & 2, 2008. To attend or arrange for a course, please contact Dr. Michael Tan at 03-7725 8633 or citizenresponders@gmail.com.
This article is courtesy of the FPMPAM and St John’s Ambulance Malaysia (SJAM) as part of the Citizen’s Action and Response in Emergencies (CARE), held in conjunction with SJAM’s 100th Anniversary, and is supported by 1Utama & Parkson.
This information is to be used as a guide and a resource, but it cannot replace real CPR or first aid training.
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