Burn

burn is caused most commanly by fire (dry heat). It also can caused by friction, chemicals, electricity or radiation. 

*friction - occurs when skin is scraped off by contact with a surface such as roads, carpets, or other hard floor surfaces.

*Chemical - Most chemicals that cause burns are either strong acids or bases. Chemical burns can be deceiving, however. Some agents can cause deep tissue damage not readily apparent when you first look at it.

*Electrical - often cause serious injury inside the body. Look for an entry and exit point as this is often a 

                   characteristic of this type of injury.

Depth of burns.

• Superficial (first degree) - The skin is red, hot and painful but without blisters. Damage is superficial and temporary.
• Partial-thickness (second degree) - The outer layer of skin is damaged. The skin has blisters besides being red, hot and painful.
• Full-thickness (third degree)- All layers of the skin are damaged. The skin may be pale and leathery, or charred. It is relatively painless on the point of the burn because the nerves are damaged. The pain experienced will more then likely result from the surrounding burns which are of lesser degree.

ComplicationsInhalation burns -- there may be burned lips, mouth, and throat.

1. Face may be reddened or burned.
2. Patient may have difficulty breathing or coughing. (consider the use of Salbutamol)
3. Soot around mouth and nose
4. Nose hairs, eyelashes, eyebrows may have singeing 
5. Airway oedema

Electrical burns with high voltage (>1000 V) or high amperage commonly damage multiple organ systems, and may be associated with cardiac arrest.

In the case of severe burns the patient may be in shock (falling blood pressure, severe fluid and blood loss) and possibly will be hysterical. 

Burns are at increased risk of being infected.

Management

GO DR SHAVPU ACBC 

Safety:  

• Only put out a fire if safe to do so.
• Be sure not to contaminate yourself when dealing with chemical burns

Cool the burn with water. (Ensure that the cooling process does not become excessive as this can cause shivering and possibly hypothermia), Administer entonox for pain relief, Remove items of clothing or jewellery that are hot and wet and not stuck to the skin, Cover the burn with a sterile dressing (cling film is good as it provides an air free environment which stops the nerves becoming stimulated, thus reducing pain), Do not apply creams or lotions, Do not burst blisters, treat for shock if necessary, cover unburned areas with a blanket to prevent the patient becoming too cold. 

When dealing with chemical burns - Remove the patient from the affected area (If safe to do so, otherwise wait for the fire service), Remove any contaminated clothing while preserving the patients dignity, Brush off any powdered chemical, Wash the contaminated body part with water for 20 minutes (be aware not to get chemical onto an unaffected part of the body). Phosphorus burns should be kept continually wet.

Secondary survey
ASHICE (consider)

Transport to hospital Consider transporting to a burns unit if a local one is available.