Physical Education

Treatment of burns and scalds

Burns are caused by dry heat, and scalds are caused by moist heat. Treatment is the same for both. Contact with an electric current also causes burns, especially if the skin is dry. The seriousness of the burn can be determined by its depth, extent, and location and by the age and the health of the casualty. You must take all these factors into consideration when evaluating burns. Burns are classified (Fig. 7-1) according to their depth as first-degree, second-degree, and third-degree.

First-degree Burns

First-degree burns involve only the first (epidermal) layer of the skin. The skin is red, dry, warm, sensitive to touch, and turns (blanches) white with pressure. Pain is mild to severe, swelling (edema) may occur. Healing occurs naturally within a week.

Second-degree Burns

Second-degree burns involve the first and part of the second (dermis) layer of the skin. The skin is red, blistered, weeping, and looks (spotted) mottled. Pain is moderate to severe, swelling often occurs. Healing takes 2 - 3 weeks, with some scarring and depigmentation.

Third-degree Burns

Third-degree burns involve all layers (full thickness) of the skin, penetrating into muscle, connective tissue, and bone. The skin may vary from white and lifeless to black and charred. Pain will be absent at the burn site if all the nerve endings are destroyed and the surrounding tissue will be painful. There is considerable scarring, and skin grafting may be necessary. Third-degree burns are life threatening.

Figure 7-1, First-, Second-, and Third-degree Burns

It is important to remember that the extent (size) of the burned area (Fig. 7-2) is more important than the depth of the burn. A first-degree burn that covers a large area of the body is usually more serious than a small third-degree burn. The "rule of nines" is used to give a rough estimate of the surface area burned and aids in deciding the correct treatment. Shock can be expected in adults with burns over 15 percent or in small children with burns over 10 percent of the body surface area (BSA). In adults, burns involving more than 20 percent of the body surface area endanger life and 30 percent burns are usually fatal if adequate medical treatment is not received. The third factor in burn evaluation is the location: burns of the head, hands, feet, or genitals may require hospitalization. The causes of burns are classified as thermal (heat), chemical, electrical, or radiation.

Figure 7-2-Rule of Nines