Introduction

BURN

A burn is an injury resulting from heat, chemical, electrical, or radiation energy or a combination of these agents.

TYPES OF BURN

1. Chemical Burn

A chemical burn is irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. Chemical burns can occur in the home, at work or school, or as a result of an accident or assault, most chemical burns are caused by either strong acids or strong bases, for example, hydrochloric acid or sodium hydroxide. Acids damage and kill cells by coagulating cells while bases liquefy cells. A variety of common household products that may cause chemical burns are as follows:

1. Bleach
2. Concrete mix
3. Drain or toilet bowl cleaners
4. Metal cleaners

Signs and symptoms of chemical burns

1. Redness, irritation, or burning at the site of contact
2. Pain or numbness at the site of contact
3. Formation of blisters or black dead skin at the contact site
4. Vision changes if the chemical gets into the eyes
5. Cough or shortness of breath
6. Vomiting

Immediately call121 if a person has a severe injury, any shortness of breath, chest pain, dizziness, or other symptoms throughout the body. Protect yourself and make sure that you are not exposing yourself to the same chemical.

1. Remove the injured person from the accident or exposure area.
2. Take appropriate care not to cause further injury to the patient.
3. Remove any contaminated clothing.
4. Wash the injured area to dilute or remove the substance, using large volumes of water. Wash for at least 20 minutes, taking care not to allow runoff to contact unaffected parts of anyone's body.
5. Gently brush away any solid materials, again avoiding unaffected body surfaces.

Chemical Eye Burn Treatment

1. Wash your eye before taking any other action and continue doing so for at least 10 minutes, so as to wash maximum chemical from the eyes The longer a chemical is in your eye, the more damage will occur.

•  If it occurs in the workplace you would be placed in an emergency eyewash or shower station.
• Your eye should be washed with sterile isotonic saline solution. If sterile saline is not available, use cold tap water.
• If you are at home and do not have a special eyewash, step into the shower with your clothes on to wash out your eye. 
• Even though it may be uncomfortable, open your eyelids as wide as possible as you rinse them out. 
• If there is an alkali or hydrofluoric acid burn, continue washing the burned part until a doctor arrives or you have been taken to a hospital's emergency department.

 ELECTRICAL BURNS

Electrical injuries are associated with high or low voltage the latter being defined as less than 1000 volts and either DC or AC current. Electrical injuries from DC are unusual unless very high voltages and currents are involved. Lightning is an example of this. Electrical burns injuries are more severe than is apparent from external appearance. High current flow may be associated with an entry and exit wound where the current density is highest, but most of the damage is to the deep unseen tissues which can be severely and extensively damaged by heat. The flow of current through the heart, particularly AC may cause cardiac arrest.

First Aid 

1. Call emergency services.
2. Do not touch the "electrified person" with bare hands.
3. remove the plug of the appliance or turn off the main power switch from the power board.
4. Try to remove the person from the electrical source by the dry wooden object, such as a broom handle, to push the person away from the electrical source.
5. Never use anything wet or made of metal.
6. These burns can affect the electrical activity of the heart and cause heartbeat changes or even heart failure.
7. If the person is not responding, start CPR

Management

1. Rinse the burns with water, and apply a bandage.
2. There may be burns where the electrical current entered the body and where it left the body.
3. Call doctor. If have a visible burn to the skin, and evaluation by your doctor is usually needed.

 Inhalation injuries

The heat generated during combustion can cause significant thermal injury to the upper airway. Particulate matter that is produced during combustion (soot) can mechanically clog and irritate the airways, causing reflex bronchoconstriction. Noxious asphyxiant gases released during thermal decomposition are

1. Carbon monoxide (CO)
2. Hydrogen cyanide. Other byproducts produced by the combustion of furniture and cotton are aldehydes.
3.  Rubber and Plastics result in chlorine gas, ammonia, hydrocarbons various acids, and ketones produce injury. Exposure to metal fumes and fluorocarbon

First Aid For Inhalation Injuries

Airways

Check for exposure to heat and thermal injury to the nose, mouth, face, and singed hair. Consider smoke involvement if soot is on the face and in sputum, although smoke inhalation is possible without evidence of soot.

GENERAL PRINCIPLES OF MANAGEMENT 

1. Ensure the safety of both first aiders and bystanders
2. Do not enter a burning or toxic atmosphere without appropriate protection
3. Stop the burning process-stop, drop, roll
4. A rescued person should be moved to a safe cool environment as soon as possible.
5. Assessment and management of the airway, breathing, and circulation takes priority
6. Call an ambulance to facilitate rapid transfer of casualties with significant burns and injuries to the hospital
7. Ascertain the mechanism of the burn injury to determine the likelihood of other coincident injuries or the inhalation of hot gases, flame, or toxic substances
8. Immediate cooling of the affected area with water may be necessary depending on the cause of the burn injury
9. If possible remove all rings, watches, jewelry, or other constricting items from the affected area without causing further tissue damage
10. Where feasible elevate burnt limbs
11. Cover the burnt area with a loose and light non-stick dressing, preferable sterile or clean dry lint-free material eg plastic cling wrap, handkerchief, sheet, and pillowcase.
12. DO NOT peel off adherent clothing or other substance
13. DO NOT use ice to cool the burn because frostbite may result
14. DO NOT break blisters
15. DO NOT apply lotions, ointments, gels, creams, powders

 THERMAL BURNS

Thermal burns include flame, scald blast (hot gas) inhalation injury, and direct heat contact.

Management

1. Smother flames with a blanket, coat, or other appropriate item and assist the casualty to lie on the ground or floor.
2. Immediately cool the area with cool water for up to 20 minutes to reduce further tissue damage and to help relieve pain. If water is not available, remove smoldering clothing if it is not stuck to the skin.
3. Synthetic fabric burns at a high temperature and melts into a hot plastic residue which will continue to burn the casualty.
4. Avoid pulling burnt clothing across the casualty’s face or unburnt areas.

 SCALD

A scald is a type of injury which is caused by hot liquids or gases. 

                                                      Scald 

First Aid for Scald

1. Immediately cool the burnt area with cool water for up to 20 minutes.
2. After covering the burn the casualty may then be warmed with a blanket. 
3. If cool water is not available, remove all wet non-adherent clothing immediately because clothing soaked in hot liquids retains the heat.
4. Take care when removing hot, wet clothing over the casualty’s face or unburnt areas.
5. Hot liquid may be retained in natural body creases e.g. neck, groin, thus delaying the dispersion of heat.

LIGHTNING BURNS

The mechanism for lightning burns can either be a direct strike or a side flash.

A direct strike will be associated with high current flow and heating.

 Lightning is direct current (DC) with voltages in the order of 100,000,000 volts and a current flow of up to 200,000 amps.

A side flash is a current flow between an object struck by lightning and a nearby person. This current can travel on the surface of the body causing superficial spidery patterned burns to the skin.

The priorities of management of lightning burns are

1. Commence resuscitation CPR if required
2. Cool superficially burnt areas with cool water
3. Assess and manage any other injuries

RADIATION BURNS

Radiation burns are caused by solar ultraviolet radiation (sunburn), welder’s arc laser industrial microwave equipment, and nuclear radiation.

 MANAGEMENT

1. Cool any locally burnt areas with water for up to 20 minutes.
2. Offer drinks of clear fluid.

PHOSPHORUS BURNS

 Phosphorus may be found in flares, fireworks, or made in chemistry labs. When exposed to the air phosphorus may ignite spontaneously. It is therefore important to keep the area wet, if possible by immersion in water. If forceps are available, remove any obvious particles. DO NOT USE FINGERS.

 HYDROFLUORIC ACID BURNS

 Hydrofluoric acid is used as a cleaning agent by jewelers, in glass etching, and in other industries. It is one of the most penetrating and tissue-reactive acids which cause a full-thickness skin burn and exceptional pain- even a small area or persistent pain needs urgent medical assessment. Early and copious irrigation with water is needed.

If available an early application of calcium gluconate gel to the affected area may form an insoluble salt and reduce further pain and damage.

DO NOT USE FINGERS

Calcium gluconate should be available at all worksites where hydrofluoric acid is used.

 BITUMEN BURNS

 Bitumen or any other hard, hot, stuck substance should not be removed from the casualty’s skin unless it is obstructing the airway because it may cause more damage. As it will hold much more heat, irrigation with cool water should continue for 30 minutes. If it is encircling a limb or digit consider scoring or cracking the bitumen.

 PETROLEUM PRODUCTS

Petroleum “burns” may cause chemical burns due to the direct toxic effects. Prolonged contact has been associated with organ failure and death. Copious irrigation with water is required.