Burns and blisters

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Facilitator:
Time: 20 mins; 1735-1755
Actual time:
Learning Objectives:
Materials: To pass around: Ching Wan Hung burn cream, non-adherent sterial dressing, moleskin.

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Principles of burn care

• Remove whatever is causing the burn and cool the burned flesh

• Assess for red flags and refer on to further care

• Limit pain, infection, and swelling, and promote healing

Types of burns

• Thermal Burns: can be caused by solids, liquids and fire, touch something hot, including tear gas containers, steam

• Chemical Burns: from chemical weapons and other chemicals; folks with asthma are especially vulnerable

• Radiation Burns: sunburn. Wear oil-based sunscreen, cover all exposed skin with light cotton or other clothing, wear a hat with a wide brim

• Electric Burns: taser injuries, lightning strike, electrocution (more on tasers tomorrow morning)

• Friction Burn: blisters, high pressure water. Wear 2 pairs of socks with well broken-in shoes, as soon as you get a "hot spot" cover it with moleskin or duct tape

Classification of burns

Superficial Burns ("first-degree" burns): affect the top layer of skin only; skin is red and painful.

Partial-Thickness Burns ("second-degree" burns): affect the top 2 layers of skin; most notable by blisters (which may develop quickly but may take 24 hours to form), but also red, mottled, wet and painful

Full-Thickness Burns ("third-degree" burn): all 3 layers of skin affected and may have burns of muscles, bones and other deep tissues; leathery, dry, charred, gray, may not be painful b/c nerve endings have been destroyed BUT may be very painful b/c surrounded by partial-thickness and superficial burns.

Red Flags

• Beware of airway or breathing problems: any facial burns or singing of facial hair, think AIRWAY problem (back to Initial Assessment)

• Any circumferential burn (all the way around an arm, leg, or neck) should be sent on fast because burn could constrict and cut off circulation to the limb or compromise airway

• Anyone with large burn, or smaller burn and other injuries, especially fractures, should be sent on fast

• If it doesn't hurt, it may be really bad

• For anything but the most minor burns, think shock

• Anyone with a superficial burn larger than their palm should be sent on for more care

• Anyone with a partial thickness burn larger than a quarter, or any full thickness burn, should be sent on for more treatment

• Anyone with burns in sensitive places: face, hands, feet, genitals should be sent on

First aid: thermal burns

Burn care principles:

1. Cool with water ¹

2. Pat dry

3. Apply honey (optional)

4. Apply dressing

Be sure to evaluate for other injuries as well

• Stop the burning ASAP (goal: within 3 min.): extinguish any active burning; blow away powdered chemicals; pour water on burning clothing or skin

• Remove clothing that comes off easily (but if cloth sticks, leave it there)

• Remove any jewelry or other objects that could get stuck with swelling

• Run the burn under cool tap water for 10 minutes (to cool down superficial AND deeper skin). If there's no running water and there is no open skin on the burn you can use a cloth or gauze wet with cool or room temperature water. To cool a cloth, get it wet and wave it around a bit, causing evaporation, cooling the cloth. Don't use ice, as it can freeze tissue. In cold weather beware of hypothermia

• Pat the area dry

• If you put any ointment, salve or oil on a burn that is not thoroughly cooled, it will trap the heat and increase the damage, so stop burning completely before applying any of the following:

• Antibiotic ointment may help a little, but the effect is pretty small according to medical research. Biggest effect seems to come from providing a barrier to germs and keeping the dressing from sticking to the bur

• Silvadene cream is good topically for burns

• Honey does pretty much the same things antibiotic ointment does, and can improve healing time (grab honey packets from restaurants and coffee shops)

• Aloe -- Aloe vera gel applied directly to superficial burns. Eases pain, fights infection and promotes healing. Gel squeezed fresh from the plant is best. You can also buy the prepared gel.

• Chinese medicine burn remedy, applied topically, Jin Wan Hong (also known as Ching Wan Hung)

• Put sterile dressing on (non-adherent if possible), separate skin folds (between fingers, toes, under breasts and any over-hanging skin, such as abdomen skin)

• Remember to recommend tetanus precautions if none within 5 years

Blisters: do not break them unless you think they will inevitably break on their own. Dress with a blister pad, or "donut" made of moleskin, relieving pressure on the blister.

If you must break the blister:

• Prep a needle or pin by holding over an open flame until it glows red

• Remove carbon deposits on needle with alcohol pad

• Break along base of blister by inserting sterilized needle, alongside the undamaged skin. Leave top of blister on.

• Gently press on top of blister to push out liquid inside

• Dress like an open wound

• Pad pad pad with moleskin

Aftercare

Burn aftercare principles (1-2x/day):

1. Soak off dressing

2. Gently wash or soak burn wound

3. Apply honey (optional)

4. Apply new dressing

Notes:

• Honey or ching wan hung placed on the skin decreases pain, promotes healing and prevents infection, aloe also an option for superficial burns only

• A poultice of grated carrot, tofu, comfrey, or raw potato can decrease inflammation and promote healing: make a poultice by covering the burn area with the food listed above, then covering with a bandage. Leave on for 15 to 30 minutes. Repeat as needed

• Move affected area gently through range of motion to prevent scar forming that limits motion

• Nutrition is very important: for wound healing the body needs a good supply of vitamin C and zinc. vitamins A, E, the entire B vitamin family, calcium and magnesium also may help with healing from wounds and burns -- so eat well

• Give "care for burn injuries" care sheet