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01 November 2007

First aid for burns

If you know what to do if someone is burnt, you may be able to limit injuries. Better still, learn how to prevent a tragedy from happening in the first place.

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Burns are the greatest cause of unnatural death among South African children under the age of five. Burns commonly result from the sun, scalding by hot liquids, fire, electricity or chemicals. Very young children have especially sensitive skin and even a burn from a cup of coffee can prove fatal.

If you know what to do if someone is burnt, you may be able to limit injuries. Better still, learn how to prevent a tragedy from happening in the first place.

Signs
Pain is not an indicator of the severity of a burn. Burns are classified into first, second and third degree according to the depth and size of the burn.

First-degree burns only involve the outer layer of the skin. Sunburn is an example of a first degree burn. There is mild swelling, redness and pain, but no blisters. The pain gets better in 48 to 72 hours and there is usually no scarring.

Second-degree burns involve injury to both layers of the skin, the epidermis and dermis. These burns are often caused by hot liquids. They are very painful because they affect a large number of nerve endings. The burnt area is tender, blotchy and swollen. Blisters generally form which may weep fluid. If this type of burn is not infected, it will heal in seven to 21 days, unfortunately with some scarring.

Third-degree burns or full-thickness burns involve destruction of all layers of skin and may damage muscles, fat cells and bones. These burns appear white or charred black, and are bloodless. They are not painful because the nerves have been destroyed. The area of the burn also feels dry, leathery and hard. This type of burn can only heal with skin grafting to cover the damaged area. It leaves deep scars. There may also be painful second-degree burns on the edges of the burn.

The size of the burnt area is also important in assessing how serious the burn is. As a rule of thumb: the open hand of the burnt person represents 1% of the body surface area.

Home treatment

First- and second-degree burns

  • Submerge the burnt area in cool, running water until the pain subsides, between 10 and 30 minutes. Cool water reduces the heat and prevents further tissue damage. Alternatively, cover it with a wet, clean cloth, or a burn shield, particularly if the burn is on the face. Don’t use ice as it can cause frostbite.
  • Never use butter, grease or oil on a burn.
  • Once the pain subsides, wash the area gently with soap and water and pat dry.
  • If the burn rubs against clothing, cover it with an antiseptic cream and a dry gauze bandage changed twice a day.
  • Don’t burst blisters. They help the skin to heal. If blisters break, clean them with water, apply antiseptic ointment and cover with a gauze bandage. Change the bandage twice a day.
  • Remove clothing and jewellery from the burnt area as swelling could make it difficult to remove it later. Don’t remove clothing that sticks to the skin.
  • If a secondary burn is on the arm or leg, keep the limb elevated above the heart.
  • Take paracetamol for pain.

Third-degree burns

  • Get to the hospital immediately. While you wait for a lift or an ambulance:
  • If the person is not breathing, perform rescue breathing. If there is no pulse, perform CPR.
  • Check that the person isn’t in shock.
  • Don’t remove any clothing near or at the site of the burn.
  • If the burn is on the arm or leg, keep the limb elevated above the heart.
  • Run cool water over burnt areas for 10 to 30 minutes.
  • Place clean, dry, non-fluffy cloths over the damaged area to help reduce loss of body heat.

Get help immediately if:

  • A child or elderly person is burnt, even if you think that the burn is minor.
  • It is a third-degree, chemical or electrical burn.
  • It is a second-degree burn which covers an area greater than your palm.
  • The face, hands, feet, genitals or creases of the joints are burnt, or if the burn encircles a limb or body.
  • You are uncertain of the severity of the burn.
  • The person is in shock.
  • The burn is caused by chemicals or electricity.

Call your doctor if:

  • A burn, even a minor one, becomes infected. Signs of infection include increased pain, redness, swelling, oozing or fever of 37.8 degrees Celsius or higher.
  • A first or secondary wound shows no signs of improvement after two days.
  • Pain lasts longer than 48 hours.
  • It is a second-degree burn and the person has not had a tetanus injection in the past five years.

Prevention

  • Never leave your child alone in the kitchen with pots on the stove. Keep kettles, toasters and similar appliances out of reach of children. Turn pot handles towards the wall.
  • Supervise children in a room with a fireplace or paraffin stove.
  • All electrical appliances should be safely earthed and wall plugs secured with child-proof covers.
  • Store erosive chemicals out of reach of children.
  • Always use flame-proof materials for bedding and clothing.
  • Set your geyser at 50 degrees Celsius or lower.
 

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