First and Second Degree Burns

Burns

• Burns are caused by fire, heat, chemical agents, radiation, and/or electricity.
• Burns are classified as first, second, or third degree.

First Degree or Superficial Burns

• First-degree burns are the least severe type of burn.
• These burns involve only the top layer of skin, the epidermis.
• First-degree burns usually heal in 5-6 days without permanent scarring.
• The skin is usually reddened or discolored and there may be some mild swelling and pain.
• Common causes are sun exposure, brief contact with hot objects or steam, or exposure to weak acids or alkalis.

Second Degree/Partial-Thickness Burn

• Second-degree burns involve injury to the top layers of skin, including both the epidermis and dermis.
• A blister or vesicle forms and the skin is red or has a mottled appearance.
• Swelling usually occurs and the surface of the skin appears wet.
• Second-degree burns are painful, and may take 3-4 weeks to heal.
• Frequent causes include excessive sun exposure, sunlamps, artificial radiation, contact with hot or boiling liquids, or contact with fire.

Third Degree/Full-Thickness Burn

• Third-degree burns are the most severe type of burn.
• They involve injury to all layers of the skin plus the underlying tissue.
• The affected area has a white or charred appearance.
• These burns can be extremely painful or, if nerve endings are destroyed, relatively painless.
• Third-degree burns can be life-threatening because of fluid loss, infection, and shock.
• Frequent causes include exposure to fire or flames, prolonged contact with hot objects, contact with electricity, and immersion in hot or boiling liquids.

First Aid for Burns

• First aid for burns is directed toward removing the source of heat, cooling the affected skin area, covering the burn, relieving pain, observing and treating for shock, and preventing infection.
• Medical treatment is not usually required for first-degree burns and mild second-degree burns.

When to Seek Medical Care

• Medical care should be obtained if more than 15% of an adult's body surface is burned (or 10% for a child).
• The "rule of nines" is used to calculate the percentage of body surface burned.
• Medical attention is needed regardless of the percentage if burns are on the face, involve the respiratory tract, if the patient is under 5 or over 60 years old, or the result of electricity, chemicals, or explosion.
• All victims with third-degree burns should receive medical care.

Burn Treatment for First-Degree and Mild Second-Degree

• Cool the area by flushing with large amounts of cool water, but do not use ice or ice water on burns because doing so causes the body to lose heat.
• After the pain subsides, use dry, sterile gauze to blot the area dry.
• Apply a dry, sterile dressing to prevent infection, and use non-adhesive dressings if available.
• Elevate the affected part to reduce swelling caused by inflammation.
• Obtain medical help if needed.
• Do not apply cotton, tissues, ointment, powders, oils, grease, butter, or any other substances to the burned area unless instructed by a physician.
• Do not break or open any blisters that form on burns because doing so will cause an open wound that is prone to infection.

Severe Second-Degree or Third-Degree Burns

• Call for medical help immediately.
• Cover the burned areas with thick, sterile dressings.
• Elevate the hands or feet if they are burned, and if the feet or legs are burned, do not allow the victim to walk.
• Do not attempt to remove particles of clothing that are attached to burned areas.
• Watch the victim closely for signs of respiratory distress and/or shock.
• Provide artificial respiration and treatment for shock, as necessary.
• Continue to watch the victim closely until medical help arrives.

Chemical Burns

• Flush with large amounts of water for 15-30 minutes or until medical help arrives.
• Gently remove any clothing, socks, shoes, or jewelry that contains the chemical to minimize the area injured.
• Continue flushing the skin with cool water and watch the victim for signs of shock until medical help can be obtained.

Eyes- Chemical Burns or Irritating Gases

• Flush the eyes with large amounts of water for at least 15-30 minutes or until medical help arrives.
• If only one eye has been injured, be sure to tilt the victim's head in the direction of the injury so the injured eye can be properly flushed.
• Start at the inner corner of the eye and allow the water to run over the surface of the eye and to the outside.
• Continue flushing the eye with cool water and watch the victim for signs of shock until medical help can be obtained.
• Make sure that the water (or remaining chemical) does not enter the uninjured eye.
• Loss of body fluids (dehydration) can occur very quickly with severe burns, so shock is frequently noted in burn victims.
• Be alert for any signs of shock and treat the burn victim for shock immediately.

Summary of Care

• Remain calm while treating the burn victim.
• Reassure the victim.
• Obtain medical help immediately.

Heat Cramps

• Heat cramps are caused by exposure to heat.
• They cause muscle pains and spasms due to loss of water and salt through perspiration.
• Provide firm pressure on the affected muscle(s).
• Move to a cool area and rest.
• Take small sips of water or sports drink for electrolytes.

Heat Exhaustion

• Heat exhaustion is caused by exposure to heat and loss of fluids through perspiration.
• Signs/symptoms include pale, clammy skin, profuse perspiration (diaphoresis), fatigue/tiredness, weakness, headache, muscle cramps, nausea/vomiting, and dizziness/fainting.
• The body temperature is normal or slightly elevated.
• This condition must be treated ASAP or it can progress into heat stroke.
• Treatment includes moving to a cooler area, loosening/removing extra clothing, applying cool, wet cloths, laying the victim down and elevating the feet 12 inches, and giving small sips of cool water (4 oz. every 15 min.) if the patient is alert and conscious.
• If the patient vomits/develops shock/respiratory distress: get medical attention immediately.

Heat Stroke

• Heat stroke is caused by prolonged exposure to high temperatures, and is a medical emergency.
• The body cannot eliminate excess heat.
• The internal body temperature is ≥ 105°.
• Signs/symptoms include an inability to sweat and red, hot, dry skin.
• A rapid pulse may be present, but may stay strong and the victim may lose consciousness.
• Cool the body quickly because the patient can go into convulsions which may lead to death in a short period of time.
• The patient can be placed in a tub of cool water or the skin may be sponged with cool water, place ice packs on patient's wrists, ankles, axillary, groin.
• Be alert for shock at all times and call for medical help immediately.

Cold Exposure

• Exposure to cold external temperatures can cause body tissues to freeze and body processes to slow.
• If treatment is not provided immediately, the victim can die.
• Factors to consider are wind, humidity, and length of exposure.

Hypothermia

• Body temperature is <95°F.
• Elderly individuals are more susceptible.
• Signs/symptoms include shivering, numbness, weakness/drowsiness, low body temperature, poor coordination, confusion, and loss of consciousness.
• If prolonged exposure to cold continues, body processes slow down or stop, which can result in death.
• To treat hypothermia, get victim to a warm area, remove wet clothing.
• Slowly warm the victim to avoid dangerous heart arrhythmias and wrap in blankets/ put on dry clothing.
• Give warm nonalcoholic, decaffeinated beverages to conscious victims.

Frostbite

• Frostbite is the freezing of tissue fluids accompanied by damage to skin and underlying tissues.
• It is caused by exposure to freezing or below-freezing temperatures.
• Early signs/symptoms include redness and tingling.
• Continued exposure leads to pale, glossy skin that is white or grayish yellow in color; blisters; skin that is cold to the touch, numbness and possibly pain that gradually subsides until no pain is felt.
• Prolonged exposure results in confusion, lethargy, incoherence, shock, unconsciousness and death.
• First aid for hypothermia includes maintaining respirations, treating for shock, warming affected parts, and preventing further injury.
• Be aware of signs of shock at all times and obtain medical help ASAP.
• Do not use heat lamps or hot water above 104°F, rub or massage affected parts, causing gangrene, open/break or pop blisters.
• Do not allow the victim walk or stand if legs, feet or toes are affected.