The burn that should never have happened

 In 60 per cent of the cases, the accident happens at home and is most usually caused by scalding from boiling liquid, with as many as half of those affected being young children. While many burns can of course be treated with first aid, it is vital to recognise the seriousness of the burn as it may require professional emergency treatment. 

The skin has three layers: the superficial layer or epidermis is 0.1 to 0.5mm thick and has no vessels. The middle layer or dermis is 0.5 to a few millimetres in thickness and contains sweat glands, hair, nerves and small vessels. The deeper one, the hypodermis, is made of fat tissue, collagen and larger vessels and enables the skin to bind to underlying tissue. 

The gravity of a burn is based on the depth of the skin lesion (damage degree), its size (the percentage of burnt surface over the total body surface area or TBSA), its localisation (head, face, hands, groin and major joints are at higher risk) and pre-existing illnesses (diabetes, heart or lung disease and weakened immunity are aggravating factors). 

There are four degrees of skin damage. First-degree involves only the epidermis and causes redness of the skin and short-lived minor discomfort. Moderate sunburn is an example of typical first-degree burn. The second-degree reaches the dermis layer, causing intense pain, swelling and blisters or bubbles on the skin filled with fluid, which leave the skin surface wet. Scarring may occur with second-degree burns. The third-degree burn goes through the underneath fat tissue and leaves yellow-brown and leathery skin changes. Importantly, a third-degree lesion does not cause pain as the nerve endings have been damaged. The fourth-degree goes beyond the entire depth of skin and affects muscles or bones. 

As well as degree, it’s vital to quickly assess the size of the burnt surface. One of the most practical approaches to calculate the size of the burn is to use the palm of the hand, which roughly corresponds to one per cent of the TBSA. 

Three types of complications may arise from burns: massive loss of fluid within the first hours, infections after a few days and aesthetic complications due to scarring in the long term.

In severe burns affecting more than 15 per cent of the TBSA (10 per cent for infants or the elderly), the fluid leakage around the injury may lead to acute life-threatening cardiovascular shock within the first hour after the accident. Any serious burn above 5 to 10 per cent of the TBSA area is considered a medical emergency and requires immediate transfer to a specialised burns unit in intensive care.

First aid consists of cooling the burn as soon as possible with running water that’s lukewarm for 15 to 20 minutes. Contrary to what our grandmothers taught us, iced water or greasy products should never be applied. The water may help reduce the severity of the burn while partly relieving the burning sensation. The burnt clothing needs to be removed unless it is stuck to the skin. Jewellery should be removed as swelling is possible. 

First-degree or minor second-degree burns of limited size can be treated at home using regular wound cleaning measures and antiseptic cream. In all other cases, it is wise to seek a medical opinion to avoid delayed healing, infection and to minimise scarring. 

In addition to large and severe injuries, any third-degree, electrical or chemical burns, burns occurring during explosion or through gas inhalation, or affecting the head, neck, eyes, hands and genitals need immediate specialised care. Serious third-degree burns require initial intensive care treatment followed by prolonged reconstruction and rehabilitation with multiple skin grafts. 

Prevention though is key. The vast majority of household or occupational burns can be avoided though common sense, anticipation, watchful supervision and simple safety measures.

 

DR GERARD LALANDE is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical |check-ups in Thailand. He can be contacted at |[email protected]