- First Aid
Burns treatment - Thermal, Chemical and Radiation in Humans, Cats and Dogs.
Each year, in the UK around 250,000 people attend hospital accident and emergency (A&E) departments with burns and approx. 13,000 of these are admitted suffering from serious burns and scalds with around 300 dying. In America this figure is closer to 500,000 with over 3000 deaths.
There are many different types of burn, each requiring different care and treatment. In order to treat them successfully we need to be able to identify the circumstances and administer the correct sort of immediate care.
Firstly let’s look at the different burn types and their causes:
Thermal burns (Fire) - This can be broken down further into:
Superficial burns. These affect only the surface of your skin (epidermis) which will be red and painful, but without blisters. Mild sunburn is an example of a superficial burn.
Partial-thickness burns. These are deeper burns that penetrate your epidermis and into the dermis to varying degrees. If the damage to your dermis is minor, your skin will remain pale pink but painful, with blisters. Deeper burns to your dermis will cause your skin to become dry or alternately moist, blotchy and red. Deep partial-thickness burns may or may not be painful, depending on nerve damage and they may blister.
Full-thickness burns. In this case all layers of your skin are damaged. Your skin will look white, brown or black and dry, leathery or waxy. As the nerves in your skin have been destroyed, in the case of full-thickness burns, you won't feel any pain or have blisters.
If the burn is from a resinous type of material, leave until cool, do not attempt to remove it from the skin otherwise you will cause severe damage and open the wound to infection. It will be sterile underneath and the resin will flake off safely over the next few days.
If the person is on fire and no fire blanket is available then a dry powder extinguisher can be used making sure the face and nose is covered. A Co2 extinguisher could be used with great care, similarly covering face and nose and ensuring the area is not frozen by the discharge. These should only be used as a last resort if rolling; smothering with a blanket etc. is not effective.
Fourth degree burns. Mercifully this is relatively rare and results in destruction of all layers of skin, nerves, muscles and even bone. In most cases, if the patient survives, then amputation is likely to be the only remedy.
Thermal burns (Scalds)- Unlike burns caused by dry heat (fire), scalds are caused by hot water, liquids or steam. The treatment in both cases is effectively the same.
Thermal burns (Extreme cold) - This will produce burns which are more commonly referred to as frostbite.
Electrical burns - Electrical burns tend not look as serious, but they can be very damaging as they can affect the muscle. Anyone who has an electrical burn should seek immediate medical attention at a hospital. If the victim has been shocked by a low-voltage domestic source (from 110–230 volts) ensure that the electricity supply has been safely switched off or remove the person from the electrical source using a non-conductive material, such as a wooden stick or chair. Do not; however approach a person who is still or suspected to be connected to a high-voltage source (1,000 volts or more).
Chemical burns - These can be either acid or alkali and sources range from battery acid (sulphuric acid) through to oven or drain cleaners (caustic soda). Make sure you also do not touch the material with bare skin. Remove any contaminated clothing, watches or jewellery (before the area starts to swell). If affected irrigate eyes with copious amounts of running water and neutralise the whole affected area with water otherwise the burning will continue. If it is a chemical powder then gently brush it off the skin before running the skin under the water.
Radiation burns -
Sunburn. This can result in hot, red and painful skin, move into the shade or preferably inside.
Arc welding. The inexperienced may not associate MIG or Arc welding with burns. Most understand using a shield to protect the eyes but do not wear suitable gauntlets and flame proof clothing to protect the arms and other exposed skin area from sparks and radiation. Ensure that there are no onlookers or animals in the area otherwise they also will suffer from radiation burns to the eyes or skin.
The burns associated with radiation are normally assessed in the same way as thermal burns. Patients undergoing cancer radiation treatment can suffer burns and I have covered this subject in a different hub.
Animal burns - Cats and dogs can be burnt for all the same reasons as above, although there can be additional causes such as walking on hot surfaces or their inquisitiveness resulting in chemical burns.
Having identified the type of burn and its likely cause we can now look at the treatment that can be administered at home and that, that should be carried out by medical professionals
If we address the question of superficial burns first. These are the sort of burns caused by hot fat splashes, hot pans, minor contact burns with cigarette ash, scalding with hot water, etc. Don't burst any blisters that form on your burn because this makes them more likely to become infected. If you cover the burn with cling film, it may reduce pain and speed healing. The old fashioned method was to immediately run the burn under a cold tap to reduce any swelling or pain. Now it has been found that one of the most effective treatments for burns is the application of neat lavender essential oil (the only oil that can be applied directly to the skin) If done immediately after burning then blistering will normally not occur and pain will be reduced. It is also used if the burn covers a larger area then the lavender oil can be applied on a sterile dressing and changed every few hours. Large or deep burns will need immediate medical attention as the person may be in shock.
Lavender essential oil has been used in serious battlefield burns throughout the ages and is used in hospitals to treat victims of fires and bombings. If lavender oil is not available then rose oil or tea-tree oil can be used. I always keep a small bottle of lavender essential oil in the kitchen to deal with the usual minor burns. An aloe vera ointment or the gel from the fresh plant may also be applied to cool the skin and help prevent blistering.
Partial-thickness burns. These burns usually heal well, but can be serious, if a large area of skin is affected. In adults, partial-thickness burns affecting more than 50% of the body’s surface can be fatal and this percentage is less in children and the elderly. If the patient is distressed, in great pain or shock then an ambulance should be called immediately.
If professional medical care is not available then the following treatment should be used. The affected part should be dipped into a bowl of cold water and pure Lavender essential oil (or gently sponged). To cool the burn may take up to 2 hours and use a whole 10ml bottle of Lavender oil. Afterwards to the area apply a gel made from fresh aloe-vera (25ml) to which you add 20 drops of Ti-tree (tea tree) essential oil. At the same time take a strong painkiller. Cover the burn with cling film. Put the cling film in a layer over the burn, rather than wrapping it around a limb. A clean, clear plastic bag can be used for burns on your hand. Each day wash the area with Lavender essential water or Rose essential water (ensure it is essential water not oil) Then reapply the gel. If the area is too sensitive to touch then the essential water can be sprayed on. The complete treatment should take between 4 to 8 days.
It is essential to keep the air in the room as anti-septic as possible when open burns wounds are present. Using a cheap essential oil burner or fan unit use Pine, Lemon, Lavender, Eucalyptus Globulus and Frankincense. This will also produce a calming effect and help with shock.
Full-thickness burns. Never attempt to treat full thickness burns at home. All that you can do is to keep the patient warm to avoid shock, making sure nothing comes into contact with the affected area. This will cause serious dehydration due to loss of serum and IV fluids will need to be administered.
Frost-bite - Handle very gently and immerse or sponge area with tepid (not hot) water and allow the flesh to return to normal room temperature slowly. Cover the area with soft cloth and give warm drinks. After a while the patient should be encouraged to gently move fingers and toes but do not force the issue. Pain can be treated by paracetamol or ibuprofen, but don’t give aspirin to children. Do not give alcohol or use heat lamps or fan heaters.
Chemical burns (Acid or alkali). Wash off any chemicals from the skin using cool tap water for 20 minutes, or more. Remove any jewellery, watches or clothing that has been contaminated with the chemical. Use a cool wet towel or cloth to help relieve pain. Very gently pat dry and apply a dry, sterile dressing, or clean cloth. If you continue to experience a burning sensation, rewash the skin for several more minutes. Cover the burn with cling film. Put the cling film in a layer over the burn, rather than wrapping it around a limb. A clean, clear plastic bag can be used for burns on your hand. You should visit your local accident and emergency (A&E) department so that the burn can be assessed and, if necessary, receive further treatment.
Radiation or Sun Burn - Serious exposure to radiation from weapons, nuclear plant etc. is way beyond the scope of this guide. It must be treated by highly trained medics. All that you can do is to support the victim in standing in a running tepid shower or a spray attachment from a hose pipe. Do not allow them to become too cold before help arrives otherwise shock may set in. Avoid letting the radioactive material on the skin or in the rinse water from contaminating your own skin or clothes.
If we are talking about sun burn then firstly take a cool bath or shower to cool down the burnt area of skin. Dry by patting the area with a soft absorbent towel, do not rub, and then apply after-sun lotion to the affected area to moisturise, cool and soothe it. Do not use greasy or oily products. Pain can be treated by paracetamol or ibuprofen, but don’t give aspirin to children. Stay hydrated by drinking plenty of water or better still coconut water (not coconut milk).
Beware of signs of heat exhaustion or heatstroke, which can occur when the temperature inside your body rises to 37–40°C (98.6–104°F) or above. Symptoms to watch out for include dizziness, a rapid pulse or vomiting. The person should be taken quickly to a shaded place, given water to drink and their clothing loosened; they should start to feel better within half an hour. If they don’t, it could develop into heatstroke or shock. This then becomes a medical emergency, don’t delay and call your emergency number for an ambulance.
Animal burns - Cats and dogs suffer thermal burns in the same way as humans and the same four degrees apply. Because of their agility and inquisitive nature they are more likely to injure themselves accidentally. If you can do so safely, it is best to begin treatment for burns at home. Hair may be singed or missing in the case of first degree burns. Wrapping the cat in a towel may help to gently restrain your cat while you are treating or transporting them. Cats are naturally highly strung and will be frightened and will lash out and fight to escape. Unless in serious pain dogs are more likely to be cooperative but take care with large or powerful dogs, even normally placid family pets can be frightened or shocked.
For thermal burns:.First and second degree burns should be flushed with lots of cool water for about 20 minutes. This can be accomplished by covering the area with a wet cloth and pouring water gently onto the cloth, or immersing the burned area in cool water. Cats do not like sprayed water and will fight harder to escape, so avoid that if possible. For first degree burns, once most of the heat has dissipated from the area, pat the area gently with a dry towel to absorb excess water; do not rub the area, as that can damage the skin. Aloe vera gel can be applied to the area in small amounts. Do not use butter or other ointments, as they will not help and may make things worse. The cat may remain calmer in a dimly lit room with a box padded with soft cloth to hide while the shock subsides.
First degree burns can normally be treated successfully at home but contact your vet if you are unsure or unable to administer treatment. In the case of electrical burns always get the vet to examine the animal as there may be muscle or nerve damage.
For second degree burns, your cat or dog will need to be seen by your vet, so leave the wet cloth in place as you travel to the surgery. Cats and dogs with second and third degree burns are seriously at risk of shock, infection and dehydration. If the burns were from chemicals and the cat or dog licks at the burn it may show signs of ingesting the chemical as well. If the burns are from a fire, there may be respiratory problems from smoke and fume inhalation.
For third degree burns, the cat or dog is likely to start going into shock. Cover the worst burned areas with a wet cloth, then wrap your cat or dog in a dry towel or blanket to restrain them and get them to your vet as soon as possible. If the dog cannot walk also cover the burned area with a wet cloth and carry it to the vet ensuring there is no pressure on the burn.
Further general information.
Most alternative natural remedies do not work very well in promoting wound healing with the exception of honey. Do not use cheap Chinese honey as it is derived from bees fed with sugar syrup, if you can afford it use Manuka honey which has a very good record, albeit making a sticky dressing. You ideally need a dressing that won't stick to the skin, so avoid cotton wool, foam and other fluffy materials. Paraffin gauze dressings are often used by doctors and nurses, because they are simple and seem to work well. There are a whole range of dressings available, for most eventualities, such as hydrocolloid, silicon nylon, polyurethane ﬁlm and biosynthetic dressings as well as antimicrobial dressings that contain silver, but you should consult your pharmacist or doctor as to their use as some are primarily for infected wounds and may make things worse. If your doctor suspects that your skin is infected, you will be given antibiotics and suitable dressings.
HOSPITAL Once you have taken the above steps, you will need to decide whether further medical treatment is necessary. Irrespective of whether the patient protests they should be taken to a hospital accident and emergency (A&E) department if they have suffered any of the following:
Chemical and electrical burns.
Large or deep burns – any burn bigger than the affected person’s hand
Full thickness burns of all sizes – these burns cause white or charred skin
Partial thickness burns on the face, hands, arms, feet, legs or genitals – these are burns that cause blisters
Some patients with other ailments may also require medical help straight away these would include:
Has other injuries that need treating or is going into shock (signs include cold, clammy skin, sweating, rapid, shallow breathing and weakness or dizziness)
Is over 60 years of age
Is less than five years of age
Has a medical condition such as heart, lung or liver disease, or diabetes.
Has a weakened immune system, for example because of HIV or AIDS or because they're having chemotherapy for cancer
** If someone has inhaled smoke or fumes, they should also seek medical attention. Some symptoms may be delayed and can include coughing, a sore throat, difficulty breathing, singed nasal hair or facial burns. This can cause rapid swelling and inflammation of the air passages. The swelling may rapidly block the airway, giving rise to a serious risk of suffocation. Immediate and highly specialised medical assistance is required.
Calculating the area of the burn. The medical profession use a formula known as “the rule of nine” which they use to determine the extent of the burn and in consequence the level of medical treatment required. If we use a partial thickness burn as an example then a 1% (about hand size) must be treated by a doctor. If the burn is greater than 9% then shock is likely and the patient must go immediately to hospital.
Your consultant may refer you to a specialist burns unit. Full-thickness burns tend to result in scars that can be disfiguring and you may require skin grafts to minimise their appearance. Skin grafts are performed by plastic surgeons normally using skin from an unaffected part of your body and will be used to repair any of your burned skin that can't heal itself.
Once healed the damage to the skin can be improved dramatically by using either Argan Oil or Rosehip Oil applied to the area twice each day. Both of these oils are quite expensive but you only need small amounts. Be careful applying the oil to the damaged area as the new skin will be fragile. This will also help to prevent scarring and improve the skins condition.
Burns - radiation therapy
- Radiation Therapy Burns - Relieve any pain and allow the skin to heal naturally and without scars.
Radiation Therapy can cause quite severe and painful burns. There are a variety of treatments and this hub explores some of them including various oils and essential oils.
© 2012 Peter Geekie