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A burn is damage to the skin or tissues caused by contact with an electrical current or a hot source. Burns can be classified as First,Second, Third and Fourth degrees. First-degree burns involve only the outer layer of skin, which is the epidermis. These burns usually appear red and swollen. There is no blistering with first-degree burns. These burns usually heal within 3-6 days without permanent scarring. Second-degree burns involve the epidermis and some or all of the dermis.
Blistering is usually noted with second-degree burns, which are red in color. However, a deep second-degree burn may appear white in color and often is not painful. Second-degree burns usually heal in 10-21 days, but may be associated with significant scarring. Third-degree burns involve the entire dermis and destroy the hair follicles and sweat glands. These burns are white in appearance and also are not painful. Third degree burns require skin grafting to heal properly. Fourth-degree burns occur when the injury extends to the bone, and are often seen with electrical burns.

Burns are a common cause of preventable injury, affecting over 1 million people in the United States, leading to the hospitalization of almost 40,000 children each year and over 1000 deaths. And half of these injuries are in children under that age of 4 years.

Although children are often burned by contact with hot liquids, household appliances, sun exposure, etc, scalding burns are the most common burn injury in younger children. These burns can occur as a toddler knocks over a coffee cup or grabs the handle and spills a pot of boiling water on the stove. Toddlers and preschool age children are also commonly burned by curling irons and other household appliances. Unfortunately, burns are also a common cause of intentional injuries or child abuse. The possibility of child abuse should always be explored, especially if the child has other injuries or if the type or pattern of the burn doesn’t fit the story of how it happened.

Most burns can be prevented. Review our burn safety guide for steps you can take to keep your children safe from burns.

Treatment of burns depend on how severe they are. Burns may be first degree and limited to the outer layer of the skin, causing it to be dry, red and painful, but without blistering. A mild or moderate sunburn is an example of a first degree burn.

A second degree, or partial thickness burn is more serious, and involves blistering of the skin. This type of burn is also painful, but unlike a first degree burn, the affected skin will likely appear to be moist.

With a full thickness or third degree burn, all of the skin layers have been penetrated and the burned area will be white, charred, firm and leathery. A third degree burn also destroys nerve endings, so your child may not feel pain in the burned area.

There are also fourth degree burns, which extend down to muscle and/or bone, but fortunately, these are rare.

After your child has been removed from the source of the burn, if he has a minor burn, you should soak it in cold water for about fifteen minutes, by placing it under running tap water or by covering the area with a cold, wet towel. You should not put ice, butter, or any ointments on the burn and do not break any blisters that have formed. If possible, remove burned clothing or cut it away. Next place a sterile dressing over the burned area and call your doctor for further instructions, especially for second or three degree burns, which should almost always be seen by a health professional.

Many burns also need to undergo cleaning and debridement, which involves removing devitalized tissue around the wound, but this should only be done by a health care professional. Your doctor might also decide to debride very large blisters, although other doctors prefer to leave them intact, or blisters that have ruptured.

After debridement, an antimicrobial ointment, usually Silvadene (silver sulfdiazine), is applied to the burned area and it is covered with a gauze dressing. Because of the very small risk of skin discoloration, some doctors prefer to use alternative oinments on the face, such as Bacitracin. Silvadene should also be avoided in children allergic to sulfa drugs.

Additional treatment will depend on the severity of the burn and may include regular visits to your doctor for continued debridement (especially after blisters burst) and dressing changes every few days initially and then once a week as the wound is beginning to heal.

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In addition, you will likely also have to change the dressings at home. This should usually be done after giving your child a pain medication, either OTC acetaminophen or ibuprofen, or acetaminophen with codeine for more painful burns. As part of the dressing changes, most minor burns should be washed with soap and water and patted dry. Next, an antimicrobial ointment is placed on the burn and a nonstick gauze is applied over the area. It is then wrapped with a gauze roll. These cleanings and dressing changes are usually repeated twice a day. Your child may also need a tetanus shot.

For more serious burns that cover a large area of the body you should activate your local medical emergency system. In these situations, you may just want to cover the burns with a clean dry sheet until emergency personal arrive.

Typically, a burn that covers more than 10% of the total body surface area (TBSA) of a child is considered to be a critical burn, except for first degree burns. A quick way to estimate the TBSA of a burn is to approximate how large the burn is as compared to the palm of a child’s hand (don’t include the fingers), which represents about 1% of TBSA.

Most serious burns, including second degree burns that cover more than 10% of the total body surface area (TBSA) of a child, third degree burns that involve more than 5% of TBSA, or burns that involve the face, genitals, hands, feet or that cross a joint or totally encircle an extremity, should be referred to a specialized burn center.

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