Burns an avoidable illness
The ability to create fire on our own is said to be the first milsestone that differentiated humans from all the other animal kingdom. Man has learnt to use this fire to his advantage leading on to the world that we see today. But fire brings with it its own disadvantages. Each and every human has suffered some kind of burn in his lifetime, ranging from a small spark/splinter to extensive burns causing death of the individual.
Based on the sources causing burns, burns can be classified as Flame burns(due to fire flames), Thermal (contact with hot object) burns, Scalds( due to hot liquids), Electric burns, and burns due to corrosive chemicals.
Each of the burns behave differently as does their treatment. Unfortunately the most common problem is the one with most misconceptions. The number of remedies suggested for a burn is as good as the number of people u talk to. Everyone has their own formula and everyone is worried about the scar that results.
We have seen people use different remedies for burns including toothpaste, ash , lime , mud , oil , leaves.. and the list goes on.
Due to extensive health campaign by government and media we have got one thing right and that is washing with water.
I would like to elaborate on the treatment and the first aid measures that can be under taken immediately at site of the incident in a step by step fashion.
First things first. Safety is of paramount importance. The saviour and the victim both should first think of Isolation. That is moving to a safe place away from the heat so that further burns are prevented.
Second is prevention of further burns by pouring water or holding the part under running water. This reduces the local temperature and prevents further tissue damage. In case of electric burns, usage of water should be at sufficiently safe distance or it may increase the damage as water is a good conductor of electricity. In case of acid burns, some people advice it to be washed with milk till it stops turning into curd. This is dangerous, as the reaction releases heat and that can further increase the damage. Hence acid or alkali should be washed thoroughly with water or any liquid with neutral pH. Flowing tap water is ideal as it removes the chemical and cools the part as well.
Third is to look for ABC.
A -airway: look for any burns in nose or mouth, any soot particles, signs of choking, if anything is found should be removed immediately. Any tight clothing around neck, chest or abdomen should be cut immediately.
B- breathing: is the patient breathing normally or are there signs of choking if there are no signs of breathing , Cardio pulmonary resuscitation(CPR)should be started immediately. (Mouth to mouth breathing and chest compressions).
C- circulation : feel for the pulsation next to the Adam’s apple( thyroid cartilage) in the neck or feel for the heartbeat if it is not beating start CPR immediately.
In case breathing and circulation returns stop CPR and shift to the nearest medical centre. In case the breathing or circulation did not return continue CPR till u reach a medical center. CPR can be continued for upto 1 hour or till u reach the medical centre.
Four: The wound management Preferably nothing should be applied at the site of burns and the patient should be covered with Clean Clothes and transferred to the nearest medical centre. In case of minor burns the wound can be covered with a clean cloth and then transferred. Covering the patient with Clean Cotton clothes will help prevent hypothermia also reduces contact with air hence reducing pain. Nothing should be given to eat or drink including water as it may cause choking and worsen the problem. It also delays treatment if the doctor wants to plan dressing or Debridement under Anesthesia.
If any clothing(synthetic) or foreign body is sticking to the skin no attempt should be made to remove it as it may peel out the skin adherent to it. Just hold it under running water to cool it. It may fall off, if not let the Surgeon deal with it.
In case of minor household burns after cooling the part under running water one can apply Silver Sulfadiazine Cream available in the name of Burn Cool or Silvidine cream and cover it with a sterile dressing such as bandaid/ handyplast.
One should seek medical attention as early as possible. Early medical treatment can reduce the scarring. For SCALDs ‘collagen dressings’ have come as a boon and their early application can heal with nearly no scar. At Ananta Plastic Surgery Clinic, we have been using Collagen Sheet dressings in all types of burns giving excellent results. Their advantages are three fold:
1- They reduce the rate of infection by acting as an artificial skin like cover tremendously reducing the rate of infection
2- They reduce the amount of fluid loss from body hence reducing the intravenous fluid requirement and prevention of ill effects of dehydration on kidneys and heart
3- The healing is faster than healing by conventional dressings
In case the wounds do not heal by the above treatment they will have to be treated by Plastic Surgery procedures like Skin Grafting or Flap Surgery.
Deep burns require Plastic Surgery early in their treatment.