Medical Preparedness – Burn Treatment

There will be times when no professional medical expertise is available. You’ll have to take care of yourself, your family, or your team, the best way you know how. When it comes to treating burns most people will aggravate the situation due to a lack of knowledge. There are many things that can cause burns, from heat sources to electrical wires, even UV radiation from the sun. Burn treatment isn’t overly complicated and should be learned by everyone.

The very nature of burns forces us to follow the same first aid steps, regardless of the degree of the burn. Remain Calm, as the book says ‘Don’t Panic’, otherwise the potential for mistakes increase exponentially. We certainly don’t want the effected person to go into shock, so always do your best to not panic, and help the effected person remain calm.

1. Limit the damage:
Remove clothing from the burned area, cut clothing off if need be. Cleanse the effected area by applying cold distilled water over to the affected area, ensuring you wash away any foreign substances, chemicals or the like. Never use ice on burns as it will limit the blood flow to the area and slow the natural healing process. Nor should you use ingredients such as oil, grease or butter, as they will retain the heat, merely amplifying the pain, and slowing the healing process.

2. Apply a soothing/cooling aid:
If you’re not readily able to use a standard burn treatment cream, you can alternately use aloe-vera or honey to treat a burn. Gently apply to the burn without rubbing. Aloe-Vera moisturizer, anti-inflammatory and mild antiseptic effects have been used to treat burns for generations.

3. Assess the damage:
This is the time when you decide how bad things are and what risk are you willing to take to search for medical care. Most burns are not life threatening, unless they pose a risk to airways or effect more than 10% of your skin. The risks increase exponentially if the person suffers from a chronic disease or for very young/very old persons.

4. Sometimes we need professional medical care.
3rd degree burns or when the affected area is greater than 5% of the total skin surface area, the body will have a much harder time healing and a much greater chance of infection or the onset of Gangrene. If more than 10% of the total skin surface area is affected the situation is very much life-threatening. In these situations it is best to seek immediate professional medical care.

A Few things to be mindful of: Where is the burn located? Is it on the face or neck, could it potentially cause respiratory-tract damage or interfere with the effected persons airways?

Will subsequent swelling after the initial burn potentially block off the effected persons airways.?

How deep into the epidermis (your skin) does the damage from the burn go?

Are there blisters, portions of charred or blackened skin?

How much of the skin is/was burned?

Note: You can estimate the percent of skin damaged, by measuring with the patient’s dominate hand, it counts for roughly 1% percent.

Is the effected area more than 10% of the person’s skin? This could very well mean that the affected person is in a life-threatening situation, They require immediate professional medical care.

Note: Even burns that just cover 5% of the skin surface could potentially pose several medical problems from mild complications minor dehydration, to full-fledged life threatening issues, such as shock or potential heart failure.

What are the classifications of burns? Burns are classified as first, second, or third-degree, depending on how deep and severe they penetrate the skin’s surface.

1st Degree Burns: First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color.

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The following are the most common signs and symptoms of a superficial first-degree burn. However, each effected person may experience symptoms differently. Symptoms may include:

  • Redness, possible minor swelling
  • Dry itchy skin
  • Skin that is painful to the touch
  • Pain normally lasting 48 to 72 hours, before subsiding
  • Peeling or Flaking skin in the effected area

Acetaminophen or ibuprofen if available can assist with the pain, and the possible swelling to a degree. You can add cool compress to the effected area. If required apply aloe-vera to moisturize the skin, and help pull some of the heat from the effected area. If Acetaminophen or ibuprofen are not available, you can mix a few drops of lavender essential oil in two teaspoons of honey. Apply on the affected area 2 to 3 times a day. The burn should heal in a few days without sloughing of the damaged top layer of skin.

2nd Degree Burns: Second-degree burns (also known as partial thickness burns) involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful. Each person may experience symptoms differently.

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The most common signs and symptoms of a partial thickness or second-degree burn may include:

  • Blisters
  • Deep redness
  • Burned area may appear wet and shiny
  • Skin that is painful to the touch
  • Burn may be white or discolored in an irregular pattern

Second-degree burns usually heal in about three-four weeks, as long as the wound is kept clean and protected. Deep second-degree burns may take longer to heal. Wound cleaning and dressing changes may be painful. In these cases, an analgesic (pain reliever) may need to be given. In addition, any blisters that have formed should not be burst. Once a blister has started leaking or has burst you have to do the following:

  1. Debride the blister: Wash the effected wound with soap and water, than let dry around it. Don’t apply the towel directly on it as it will leave residues on the burned area.
  2. Apply antibiotic ointment if available or honey (not for babies or children under the age of 24 months)
  3. Apply a gauze and tape dressing, you have to keep the wound clean and protected to limit potential scarring.

Repeat these steps every time you change the bandage. Change the dressing daily or when it gets wet or dirty.

3rd Degree Burns: Third-degree burns (also known as full thickness burns) destroy the destroys the outer layer of skin (epidermis) and the entire layer beneath (the dermis) and may go into the subcutaneous tissue. The burn site may appear white or charred.

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The most common symptoms of a full thickness, or third-degree burn may include:

  • Dry leathery, or scaly looking skin
  • Black, white, brown, or yellow skin
  • Swelling, mild to severe.
  • Lack of pain due to nerve endings having been destroyed.

Large, full thickness, third-degree burns heal slowly (45+ days) and poorly (ie. large areas of scarring, deformation of muscle, loss of fat/muscle layer) without professional medical care. Due to the epidermis, hair follicles, and potentially other layers of the dermis having been destroyed, “New skin may NOT grow back.”

  1. Cleaning and debriding (removing dead skin and tissue from the burned area).
  2. Intravenous (IV) fluids containing electrolytes.
  3. Intravenous (IV) or oral antibiotics if an infection develops.
  4. Antibiotic ointments or creams if possible.
  5. A warm, humid environment for the burned area.
  6. Nutritional supplements and a high-protein diet.
  7. Pain medications.

Note: Debridement of the dead blackened skin will most likely not be painful the first time, but any of these effected areas found during the healing process that show signs of blackening need to be removed. This will be extremely painful, and can lead to the person going into shock, or secondary infection, always be mindful of those signs.

Debridement: How to remove dead skin and when to do it:

Debridement is the removal of unhealthy tissue from a wound to promote healing. It can be done by surgical, chemical, mechanical, or autolytic (using your body’s own processes) to remove of the effected tissue.Debridement is used to clean dead and contaminated material from your wound to aid in healing. The procedure is most often done for the following reasons:

  • To remove tissue contaminated by bacteria, foreign tissue, dead cells, or crusting.
  • To create a neat wound edge to decrease scarring
  • To aid in the healing of very severe burns or pressure sores (decubitus ulcers)

How to debride burst blisters:
When a blister pops, begins to leaks, or starts to ooze, you’ll have to remove the loose, dead skin. This may be something that is required daily. Wash and debride with sterile tweezers as needed. Never burst a a clear fluid filled blister on your own, these are the bodies way of beginning the natural healing process. If the blister appears to be filled with pus, or blood, it will need to be debrided, to prevent the onset of infection that will spread. Use a pair of sterile scissors, paying close attention not to cut into healthy tissue that will quickly bleed and can lead to secondary infection.

Complications are rare, but no medical type procedure is completely free of risk. A list of possible complications, which may include:

  • Pain
  • Bleeding
  • Infection
  • Delayed healing
  • Removal of healthy tissue with mechanical debridement

Factors that may increase the risk of complications include:

  • Infection
  • Pre-existing medical conditions
  • Smoking
  • Diabetes
  • Use of steroid or other immunosuppressive medicines
  • Poor nutrition
  • Poor circulation
  • Immune disorders

Surgical Debridement: This type of debridement is done in an ideal situation, in a sterile environment using a scalpel, forceps, scissors, and other medical instruments. It is used if your wound is large, has deep tissue damage, or if your wound is especially painful. It may also be done if debriding your wound is urgent. The skin surrounding the wound will be cleaned and disinfected. The wound will be probed with a metal instrument to determine its depth and locate any foreign matter. You’ll need to cut away dead tissue. The wound will be washed out to remove any free-standing tissue. Sometimes, cutting away the entire contaminated wound may be the most effective treatment.The procedure should be done slowly (time permitting) to avoid causing additional pain. The tissue being cut away should have no feeling but touching the tender living skin beneath it will cause pain

Surgical debridement, is normally performed under general anesthesia to alleviate unwarranted pain during the procedure. Even when using a local anesthetic or a mild sedative is given, some still report moderate discomfort. Often, there will be soreness while recovering from the procedure. Pain medicines may be given to help relieve pain.

Mechanical Debridement: This form of debridement involves a variety of methods to remove dead or infected tissue. It may include using a whirlpool bath, a syringe and catheter, or wet to dry dressings. Wet to dry dressing starts by applying a wet dressing to your wound. As this dressing dries, it absorbs wound material. The dressing is then re-moistened and removed. Normally most of the effected tissue comes with it.

Mechanical debridement often causes tolerable levels of pain. Once again pain medicine can be given before changing the dressing to help manage pain if required.

Potential Complications during After Care!

  1. Infection: To minimize infection be certain to clean the effected and surrounding area by gently washing it with soap and distilled water. Keep the burnt areas moist using honey and an absorbent dressing, you will need to do this twice a day. An infected area usually oozes and the skin around the wound will be warm and red. If you notice pus in the burn or redness spreading around it, red streaks or the person has fever, it’s time to administer antibiotics. If you don’t have any apply a 50/05 mixture of aloe-vera and honey to the area.
  2. Swelling: The skin retains fluid and damaged or burned flesh causes influx of white blood cells to fight infection which leads to fluid build up. This will cause dramatic swelling in the surrounding tissue and it becomes a serious problem for face and neck burns. For the arms and legs, the swelling can cut off blood supply to the appendage below the area of swelling. To minimize or prevent the swelling, avoid wearing restrictive clothing or jewelry and keep the affected area elevated above heart level when at all possible.
  3. Severe dehydration: Burns cause a tremendous loss of fluids, including electrolytes. This happens mostly when the swelling occurs and if the burn covers more than 10% of the body surface there is a high risk of severe dehydration. The best replacement fluid can be made by adding a half-teaspoon of salt and a half-teaspoon of baking soda in a quart of water. Drink one gallon of this per day at minimum. Add a quart  for every percent of surface area burned over 10%. If the burn area is 20 percent or more you need professional medical care and special fluids, with this level of damage in a non-professional medical environment death is practically insured.
  4. Gangrene: The progressive death of bodily tissue resulting from a lack of oxygenated blood supply. When the blood supply is cut off for any reason, for any prolonged amount of time, our tissue does not get enough oxygen and begins just like us when we don’t have enough oxygen, the skin begins to die.

Gangrene can be internal or external. The two most common types of gangrene are:

  • Dry gangrene: Lack of oxygenated blood supply which leads to tissue death.
  • Wet gangrene: A rarer wet type, called gas gangrene, develops from specific bacteria deep inside the body. Gas gangrene can be a result of numerous types of trauma. Usually occurs when the tissue is infected with bacteria from an injury. The tissue becomes moist and breaks down..

Symptoms of Infection due to Gangrene:

External gangrene may cause:

  • Color changes, ranging from white, to red, to black
  • Shiny appearance to skin
  • Foul-smelling, frothy, clear, or watery discharge
  • Sloughing off of skin
  • Severe pain followed by loss of feeling in the affected area

Internal gangrene may cause:

  • Fever and chills
  • Confusion
  • Nausea and vomiting
  • Diarrhea
  • Light headed or fainting, which may be caused by low blood pressure

If the gangrene is widespread, sepsis can occur, which in a non professional medical environment will more often than not, lead to death.

DISCLAIMER: The information given and opinions voiced in this article are for educational and informational purposes only and should not replace medical advice or be construed as the practice of medicine. No provider-patient relationship, explicit or implied, exists between the publisher, authors and readers. As many of the strategies discussed here shall be less effective than proven present-day medications and technology, the author and publisher strongly urge their readers to seek modern and standard medical care with certified practitioners whenever and wherever it is available. The Author and publisher shall be held liable for the use or misuse of any of the items covered within.

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