A burn is any injury to tissues of the body caused by heat, electricity, chemicals or radiation. About two million people suffer from burns in the United States each year. Burn injuries are the nation’s third largest cause of accidental death and cause 300,000 serious injuries and 6,000 fatalities each year.
The Miami Burn Center offers levels of care from outpatient services to the most advanced levels of critical care medicine. The center treats infants and adults with burn injuries, electrical burns, chemical burns, thermal burns, contact burns, scald burns, severe skin disorders, difficult or chronic wound problems, pre-existing medical disorders that could complicate wound management and pain management.
To help prevent injuries from burns use the following tips:
- Frequently check home smoke alarms to ensure they work properly.
- Teach children fire safety and fire escape plans.
- Plan, practice and know the fire escape routes from your home. Practice the same when staying at hotels, traveling in trains, buses and airplanes.
- Teach children the dangers of playing with matches, flammable materials, and fireworks.
Most firework accidents are preventable and occur when fireworks are improperly used. The following safety tips should be utilized when using fireworks:
- Never allow young children to play with fireworks.
- Read and follow all warnings and instructions on fireworks.
- Place fireworks on a smooth, flat surface away from buildings, dry leaves, and flammable materials.
- Keep a bucket of water handy in case of malfunction.
- Keep pets inside when fireworks are being ignited.
In a continuing effort to increase burn awareness in the community, the Miami Burn Center provides burn education to a variety of groups:
- High-risk industry employees (electrical facilities, paper mills, etc.)
- Elementary, middle, and high school students
- Nursing, occupational/physical therapy student groups
- Firefighters, EMS, paramedics and other safety/rescue personnel
Burn First Aid
When a burn occurs, it is human instinct to attempt to treat the victim immediately. However, some first aid decisions can actually harm the victim and complicate the burn injury.
First aid assistance for major burns:
- Do not apply ointment, butter, ice, medications, fluffy cotton, adhesive bandages, cream or oil spray. These can interfere with the healing process.
- Do not allow the burn to become contaminated. Avoid coughing or breathing on the burn.
- Do not touch or peel blistered and dead skin.
- Do not give the victim anything to ingest if he/she has a severe burn.
- Do not immerse a severe burn in cold water or apply cold compresses. This can cause shock.
- Do not place a pillow under a victim’s head if he/she has an airway burn because the airway could close, blocking the flow of air into the lungs.
Call emergency assistance immediately if:
- The victim has a severe or extensive burn
- The victim has a chemical or electrical burn
- The victim shows signs of shock are present
- Airway burn has occurred
Treatment of Minor Burns
- If a minor burn occurs, there are several steps you can take for immediate treatment of the burn. Run cool water, not ice water, over the areas where the skin is unbroken. Soak the burned skin in this cool water. Keep the burn under water for at least five minutes. Do not apply water if the burn occurred in a cold environment. Instead, use a clean, cold and wet towel to reduce the pain.
- Cover the burn with a sterile bandage or clean cloth and protect it from pressure and friction.
- Over-the-counter pain medications may help reduce inflammation and swelling as well as help with the pain.
- Minor burns usually heal without more treatment. Treat a burn as a major burn if the area is more than 2 to 3 inches in diameter or if it is located on the hands, feet, face, groin, buttocks or major joints.
Treatment of Major Burns
- If a major burn occurs, there are several steps you can take to immediately treat and care for the burn. “Stop, drop and roll” is a helpful tool if your clothes catch on fire.
- If someone else has caught fire, douse them with water, wrap them in a thick, non-synthetic material such as wool or cotton or lay them on the ground flat and roll them.
- If clothing cannot be removed from the victim make sure the victim is not in contact with smoldering materials.
- If the victim has stopped breathing or his/her airway is blocked, open the airway and perform rescue breathing and CPR as needed.
- If the victim is breathing, cover the burn area with a moist, cool sterile bandage or clean cloth. Do not apply ointments and be careful not to break burn blisters.
- Separate the victim’s fingers and toes with dry, sterile, non-adhesive bandages.
- Protect the burned area from pressure and friction by elevating it. To prevent shock, lay the victim flat, elevate the feet 12 inches and cover the victim with a coat or blanket. Do not put the victim in this position if he or she is uncomfortable or if you suspect a head, neck, back or leg injury.
- Until medical help arrives, continue to monitor victims’ pulse, rate of breathing and blood pressure if possible.
Skin & Wound Healing
Your skin is the largest and one of the most important organs of your body. It is composed of many layers of skin cells. New skin cells are generated on the inside of the skin as old skin cells on the outside die and shed. In this way, your skin is constantly renewing itself from the inside.
Contained within the layers of the skin cells are:
- network of blood vessels that nourish the skin cells, the structures that grow like hair
- a web of nerves that sense temperature, pressure and pain
- glands which secrete oils and sweat
Some of the functions of your skin are to:
- cover and protect you from infection
- enclose and control the fluids within you
- control the temperature of your body
- secrete fluids like sweat to cool you and oils to lubricate your skin
- sense pain, temperature, texture, etc.
How Skin Heals
A skin wound heals from the bottom up and from the edges inward. In the first stages of healing, the basic connective tissue of the skin collagen expands into the wound area. This builds the framework to support the rebuilding of the skin.
Once the collagen structure is in place, the expanding network of blood vessels migrates to it. As the nourishing blood supply advances, the skin and nerve cells follow. If enough of the structures residing in the skin survive the injury, then hair pigment, oil and sweat glands may regenerate. If they don’t, then the new skin may lack these features.
The depth of the wound determines how well it will heal. Most wounds do not penetrate completely through all the layers of the skin (partial thickness) and will heal eventually. If the skin has been destroyed (full thickness) over large areas, such as in severe burns, it can’t grow back properly.
The healing of large wounds may be complicated by other factors. Infection can slow the healing process or even lead to further tissue destruction. Additionally, as a wound heals, the edges are drawn together by a process called contracture. On a small scale, the process of contracture helps close small cuts and injuries to skin. But when it occurs in a large wound, particularly those over joints or mobile areas (neck, shoulder, elbows, hand, etc.), this tightening of the newly healing skin can limit or even freeze movement of the affected area.
Facts About Burns
The following are the three types of burn degrees:
- first degree
- second degree
- third degree
First-degree burns affect the outer layer of skin, which is called the epidermis. They are moist, red in color and cause pain, redness and swelling. First-degree burns are partial-thickness burns because of their depth. They will heal spontaneously. A sunburn is an example of a first-degree burn.
Second-degree burns are also partial-thickness burns. The second-degree burn is a serious burn that causes destruction of tissue layers deep into the skin. Second-degree burns involve destruction of both the outer and the underlying layers of skin. It effects all of the epidermal layers and extends into the dermis.
These burns are classified as either superficial or deep.
- Superficial burns effect the outermost part of the dermis, which causes pain, is hypersensitive to touch, and usually causes blisters and redness.
- Deep burns cause damage to the deepest layers of the dermis. They appear like the superficial burns but usually are dry and white. These burns are usually painful, may take three to four weeks to heal, and may result in thick scarring.
These burns are usually caused by contact with hot liquid and flames. The burned area looks like blisters and the skin is often cherry red or pink. Second-degree burns are usually treated without surgery but sometimes need skin grafting.
The most serious of all burns are third-degree burns, in which all the layers of skin are destroyed. Sometimes third-degree burns also affect underlying tissue. They extend deeper into the skin and destroy all of the epidermis and dermal layers, extending to the subcutaneous layers. This turns the skin brown or black, gives it a leathery appearance, and often causes the skin to separate from the surrounding tissue. The nerve endings are destroyed from the burn and therefore these burns usually are not painful.
Third-degree burns are typically caused by contact with hot liquid, flame or electricity. After being burned, the skin appears white, pearly or leathery. The skin must be replaced either through transplantation or grafting. Treating third-degree burns usually involves debridement, which is the removal of dead skin, and surgical skin grafting.
Types of Burns
The following are common types of burns:
- chemical burns
- electrical burns
- thermal burns
Chemical burns are tissue damage caused by exposure to a strong acid or alkali such as phenol, creosol, mustard gas or phosphorus.
Chemical burns result from the conversion of chemical energy to thermal energy. Emergency treatment includes washing the surface of the wound with large amounts of water to remove the chemical. As long as the chemical is in contact with the skin, the burn usually continues to progress.
An electrical injury occurs when an electrical current from an external source runs through the body as heat. Electrical burns are the result of tissue damage from heat of up to 5,000 degrees Celsius generated by an electric current. The heat causes extensive damage and usually follows the current, but it can damage other structures such as muscle and bone. This electrical current usually flows along the blood vessels and nerves.
This type of electrical current can cause the following three burns:
- contact burn injury
- flash burn
- flame burn
The points of entrance and exit on the skin are burned, along with the muscle and subcutaneous tissues through which the current passes. It is possible that fatal cardiac arrhythmia may result. In this situation contact your local burn center or emergency room immediately.
Thermal burns are the most common types of burns. These often occur from a host of reasons including but not limited to residential fires, automobile accidents, playing with matches, improperly stored gasoline, space heaters, electrical malfunctions, or arson.
Flame burns are often deep burns, causing partial- to full-thickness burns.
Hot liquid burns are not as deep as flame burns, but they can still produce deep burns. Examples of hot liquids which can cause burns include hot water, coffee, grease and hot soup.
Burns from touching hot objects vary in depth, since people’s reflexes cause them to react quickly. These burns can be caused by touching a stove, skillet or grill.
Flash injuries are burns that involve exposed parts of the skin and vary in depth depending on the proximity on the flash and the intensity. Automobile, gas tank and airplane explosions are causes of flash burns.
Sunburns can be extremely painful, but the pain is relieved as the wound is soothed and injury progression is stopped. Sunburns are usually superficial burns or first-degree burns. Although not always fatal, severe sunburns with persisting pain should always be assessed by a specialist.
Symptoms of Burn Injuries
It is important to treat burns immediately after they occur. Some symptoms include, but are not limited to:
- peeling skin
- red skin
- white or charred skin
Pain is not an indicator of the severity of a burn. Some of the most serious burns can be painless. Signs of shock are pale and clammy skin, weakness, bluish lips and fingernails, and a decrease in alertness.
Burns can become infected. Watch for increased pain, redness, swelling, drainage from the burn, swollen lymph nodes or red streaks spreading from the burn toward the heart.