Burns/Scalds

Burns/Scalds

It is widely believed that those who experienced the traumatic incident at a famous pub years ago saw a frightening image. Treatment of burn wounds can be a difficult process due to the high risk of infection, and the associated pain and suffering for the patient. To help everyone better understand burns and scalds, we have gathered the necessary information for everyone to read.

Burns/Scalds

General Characteristics

Scald burns are a common accident among both children and adults. If it is a minor burn, it may cause a burning pain that is bearable and will eventually subside without treatment. However, if the burn is extensive, it may lead to complications that can cause disability or even death.

Cause

Burns and scalds can be caused by negligence, knowingly or unintentionally, as well as various accidents.

1.            Heat sources include boilers, flasks, kettles, steam, hot oil in pans, stoves, lanterns, cigarettes, firecrackers, and hot objects.

2.            Electrical shock is a potential source of harm.

3.            Acids and alkalis are hazardous chemicals.

4.            Ultraviolet light, radium radiation, cobalt radiation, and atomic bombs emit dangerous levels of radiation.

Symptoms

Symptoms depend on the size, depth, and location of the wound.

1.            Size is an important factor in assessing the severity of a wound. Large wounds (covering a larger area of skin) are more dangerous than small wounds, as they can lead to dehydration, protein, and electrolyte loss, and even shock. They also pose a greater risk of infection and septicemia, which can be fatal. The size of the wound is typically measured as a percentage of the patient's total body skin area. For example, a wound the size of one palm is equal to 1% of the body skin area, while a wound of 10 palms is approximately 10%. This is a convenient way of measuring the size of wounds in adults.

2.            The depth of the skin can be classified into the epidermis and the dermis.

We classify burn wounds into 3 levels as follows:

a.            A first degree burn wound

is an injury to the outermost layer of skin, the epidermis. It is caused by exposure to hot water,

boiling steam, heated objects, or sunburn (tanning). Symptoms of a first degree burn wound include slightly red and swollen skin, burning pain, and no blisters or peeling skin. These wounds usually heal on their own without leaving any scars and are not fatal.

b.            Second-degree wounds refer to skin lesions that involve the destruction of the entire layer of the epidermis and the superficial dermis. These wounds are typically caused by scalding liquids or exposure to flames, and present as red and blistered skin with small and large blisters that may eventually peel off to reveal red flesh with lymph. They can be quite painful and can lead to loss of water, proteins, and minerals, as well as the risk of infection. If not treated properly, these wounds may leave scars. However, with proper treatment, they can heal quickly and without scarring.

c.             Third degree wounds refer to lesions which destroy the entire epidermis and dermis, including sweat glands, hair follicles, and nerve cells, resulting in an area of red or red and white flesh, or charred material. These wounds are usually caused by fire, hot objects, or electric shock and can lead to dehydration, infection, and severe scarring. In some cases, the difference between second and third degree wounds may not be clearly distinguishable in the early stages, though both of these wounds are considered deadly and should be calculated by the percentage of the wounded skin.

3.            Wounds on the face can lead to severe scarring and disfigurement, and if they touch the eyes, can even cause blindness. Wounds on the hands and crooked joints can also cause scarring of the knuckles and other joints. Inhaling smoke during an accident can cause inflammation of the airways, leading to bronchitis and pneumonia, which can be so severe that it can lead to death.

First Aid

If a person has suffered a burn injury, it is important to act quickly to provide treatment before seeking hospitalization. The following steps should be taken:

a.            First Degree Burns

1.            Immediately apply cold water or ice to the affected area for at least 20 minutes or until the burning pain subsides. To reduce pain and prevent further tissue damage, you may use cold water, soak in ice water, use a clean cloth moistened with cold water for compression, or use plastic bags filled with ice and water.

2.            Cover the wound with a bandage or a clean cloth.

3.            If you continue to experience pain, burning, or blistering, seek medical attention.

b.            Second Degree Burns

1.            Immediately apply cold water or ice, using a clean cloth to dry the area and cover it with a clean gauze.

2.            If the wound is wide (10-15%) or located on the face (including the mouth and nose), eyes, ears, hands, feet, or reproductive organs, which can cause a shock or be easily scarred, the patient should be taken to the hospital immediately. While waiting for the hospital, initial assistance can be provided as follows:

2.1 Remove any clothing from the burned area, or scalding water. If the clothing is difficult to remove, it

should be cut into pieces, but do not pull it off if it is tightly attached to the wound as this may cause a lot of pain. Cover the area with a clean cloth.

2.2 Raise the wounded part to a higher level than the heart.

2.3 If there is a bracelet or ring, it should be removed to prevent the finger or wrist from swelling and making it difficult to remove.

2.4 If the patient is thirsty or it will take more than 2 hours to reach the hospital, they should be given an electrolyte-sugar solution or orange juice with salt. They should drink 1/4-1/2 at a time, then every 15 minutes.

2.5 Cover the patient's body with a thin, clean cloth and have the patient lie with their feet raised slightly.

2.6 Give the patient 1-2 tablets of paracetamol to relieve pain and, if necessary, 5 mg diazepam in 1/2-1 tablet.

c.             Third Degree Burns

If a wound is deep enough to be fatal, it is important to seek medical attention as soon as possible, especially if its size is greater than 10% (in children) or 15% (in adults) prior to hospital admission. In the meantime, first aid may be given for first and second degree wounds.

Treatment

A physician or public health officer working in a hospital may provide the following treatments:

a.            First Degree Wounds

Clean the wound with water and soap, pat dry, and cover with a sterile bandage. Seek medical help if it is a deep wound, as it may require stitches or antibiotics. Apply a topical antibiotic ointment to the wound and change the bandage regularly. Give pain relief medication if needed.

b.            Second or Third Degree Wounds:

1.            The patient should be hospitalized as soon as possible in the following cases:

•             Third degree wounds larger than 2 palms (2%)

•             Second degree lesions larger than 10 palms (10%) in children or 15 palms (15%) in adults.

•             Wounds of eyes, ears, face, hands, feet, and genital organs.

•             Wounds in infants, young children and the elderly.

•             Inhalation of smoke during the incident.

•             Administering saline to counteract shock while en route to medical care.

2.            If there are no symptoms mentioned in No. 1, treatment may be given by:

•             Wash the wound with soap and water.

•             If there are only 2-3 small blisters on the palm, apply a disinfectant such as povidone iodine or fresh wound tincture (Merthiolate) and cover with gauze. The blisters will gradually dry and fall off on their own in 3-7 days.

•             If there are blisters on the limbs, back of hands, or feet, make a hole with a sterile (for example, soaked in rubbing alcohol) knife or scissors, and pat dry with sterile gauze. Apply povidone iodine or a tincture to fresh wounds, then wrap with a stretch cloth to let the inflated skin be firmly pressed. Within 2-3 days, the inflated skin will flake off.

•             If there is a large area of blisters, cut the blistered skin with sterile scissors. Wash with saline, pat dry and apply sulfamylon cream, Bactacin ointment, povidone iodine solution, silver sulfadiazine cream, or Predex spray. Use a bandage if it's on the face or body and keep the wound open.

•             Wash the wound and put medicine 1-2 times a day, then slow down as it gets better.

•             Give pain medication and tetanus prophylaxis.

•             If the wound does not improve within 1-2 weeks, or there is an infection, or general symptoms are not good (such as high fever, loss of appetite), send to hospital for treatment. If the wound is deep, it may be treated with a skin graft.

Suggestions

1.            For burns and scalds, immediately use cold water or ice, but do not use toothpaste, fish sauce, or balm.

2.            Small children and the elderly may be more vulnerable to scald burns even if the size of the wound is not large, so it is best to go to the hospital for all cases.

3.            To prevent scarring caused by wounds on the joints, use a joint splint in the affected area from the start.

4.            Complications of burns and scalds in the first 2-3 days may include dehydration and shock. If the wound is large, the doctor may administer Ringer's lactate saline solution at a dose of 4 ml per 1 kg of body weight per 1 percent of the wound area, half within the first 8 hours and the other half within the remaining 16 hours. Infection may occur 2-3 days after the wound (or after 1 week), and severe infection is usually seen with 2nd degree wounds of 30% or more in size and 3rd degree wounds of 10% or more in size.

5.            People with burn wounds and scalds should eat a lot of protein-rich food (such as meat, milk, eggs) to compensate for the protein lost through the wound.

6.            In cases of acid or alkaline wounds, immediately wash with tap water for at least 5 minutes, then seek medical treatment. Treatment for these wounds is similar to that of burns.

•             Young children should not be permitted to play in the kitchen.

•             Kettles, cooking pots, thermos flasks, lamps, matches, and other hot objects should not be left within a child's reach.

•             Cigarettes, lamps, blankets, mosquito nets, or any other combustible items should be kept away from each other.

•             Take extra caution to avoid any accidents. The most important thing is to have a fire protection system in place. It is also essential to know how to safely escape a fire. For all entrepreneurs, this is especially important.

Health Information from Vibhavadi Hospital