Burns

About 2 million Americans are burned seriously enough each year to require medical attention, almost half of them children. Although in most people's minds burns are associated with fire or flames, they can also be caused by chemicals, steam, and electricity.

The resulting injuries range from mild to fatal. Minor burns simply make the outer layer of skin red and painful, but severe burns penetrate more deeply and can damage nerves, blood vessels, glands, and even muscle and bone. They can also cause life-threatening metabolic abnormalities and disrupt the immune system.

Diagnostic Studies and Procedures

A physical examination is the only means of diagnosis that is necessary for simple burns. Severe, extensive burns require blood and urine analyses, as well as studies of kidney and liver function. In addition, any assessment of a burn patient requires classifying the injury by degree and extent of body involvement. This task can be difficult, because the depth of a burn is often hard to measure. In general, burns are classified as follows:

First-degree, which causes both pain and redness but no blisters, and the damage is confined to the epidermis, the skins tough outer layer.

Second-degree, which produces blisters and damages both the epidermis and the dermis, the inner layer of the skin. These can be quite painful but usually are not serious unless they cover a large part of the body or the blisters become infected.

Third-degree, which looks charred, white, or blackened, and extends to the tissue below the skin. Such burns usually are not painful at first, because the nerve endings are damaged. But all third-degree bums are considered a medical emergency; they can be fatal if they cover more than 30 percent of the body's surface, or if they impair any of the vital functions.

Medical Treatments

First-degree burns generally do not requite a doctors care. Any second-degree bum with blisters more than one inch across or that affects the hands, face, feet, or genitals, should be seen by a doctor. In the past, blisters were often opened, but now, most bum specialists advocate letting them drain naturally to reduce the risk of infection. If a blister is opened, it must be done under sterile conditions to avoid infection. The doctor may prescribe antibiotics to prevent infection and recommend immunization against tetanus.

If the burn involves a joint, manipulation and perhaps splinting will be needed to prevent a permanent shortening of the skin, which may develop when scar tissue formation takes place. Depending on the severity of the burn, the doctor may arrange for physical or occupational therapy.

Third-degree burns need immediate attention by medical professionals, preferably in a bum center or hospital critical care unit. Shock often follows serious bums, and blood or plasma transfusions may be given to combat it. Oxygen is usually administered, and if the lungs or airways have been damaged, a breathing tube may be inserted. Antibiotics will be prescribed to prevent an infection.

Fluid replacement to make up for what is lost through the damaged skin is also critical. For extensive bums, the fluids are given intravenously.

Deep burn wounds also demand special care. The damaged tissue must be excised and the remaining tissue covered with a sterile dressing or artificial skin. Skin regenerates itself after first and second-degree burns, but not third-degree. The margins may heal but the destroyed skin will be replaced by thick scar tissue. Skin grafting is often necessary in the treatment of these deep burns. The development of artificial skin has made the procedure simpler and less painful than it once was.

Alternative Therapies

Alternative therapies can be helpful in treating first- and second-degree bums, particularly if they are not extensive. Alternative approaches used for any third-degree burn should supplement conventional medical care.

Herbal Medicine. Aloe vera is recommended to treat minor bums because of its anesthetic and healing properties. The natural way to use it is from the plant, which can be grown in a pot indoors. When needed, break off a leaf and squeeze it out over the burned area. Or make a poultice by wrapping a freshly cut leaf in gauze. If you don't have a plant, use aloe vera gel or cream, available in pharmacies and health food stores. The higher the percentage of aloe vera, the more effective it will be. However, aloe should not be applied to open blisters or third-degree burns.

Other herbs that may be used also to treat minor burns include comfrey, calendula, and witch hazel. Typically, they are applied as compresses that have been soaked in decoctions.

Hypnosis and Meditation. These and other relaxation techniques may help burn victims cope with the pain of wound care, which involves removal of dressings and dead tissue. The methods may also be used as part of rehabilitation following a severe burn.

Nutrition Therapy. A diet that is high in both calories for energy and protein for tissue repair is important for recovery from burns, particularly if they are extensive. Fluid intake should be kept high, and the diet supplemented with vitamin C for wound healing, B vitamins to meet the body's increased metabolic demands, and vitamin A and potassium to promote skin health. When applied to the skin, vitamin E may speed healing.

Self-Treatment

For first- and second-degree burns, immerse the burned part in cool water if possible. Apply cold packs to reduce the pain and swelling, but do not apply ice directly to the skin. Leave a cold pack on for 20 minutes, remove it for 10 minutes, and then reapply it.

Take aspirin or ibuprofen for pain and inflammation. If you are pregnant or have a history of ulcers, be sure to ask your doctor if these medications are safe for you to take.

Should blisters develop, do not puncture them -- this increases the risk of infection. If a blister opens on its own, wash the area gently with soap and water, apply an antibiotic ointment, and cover with a sterile bandage. Change the dressings at least once a day, and call your doctor if you see any signs of infection or inflammation.

If a bum was caused by a corrosive chemical, as in a product for unclogging household drains, remove all contaminated clothing and jewelry and immediately flush the burned area with cool water for 15 to 30 minutes. Be sure to read the first aid instructions on the product's label.

If your eye has been burned by chemicals, flush it with water at once, being careful not to get the chemical into the other eye. Cover your eye with a cool compress and go directly to the nearest hospital emergency room.

If you receive an electrical burn, call 1 your doctor right away. These burns are often more severe than they look, sometimes causing greater damage within the body than on its surface.

If you have been seriously burned, don't try to remove burned clothing or attempt any self-treatment. Instead, call an ambulance or have someone take you to the nearest emergency room as fast as possible.

Other Causes of Burns

Excessive sun exposure can result in an extensive first- or second-degree bum that requires medical attention.