Chemical Burnsnot

Burns chapter © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,atat a gglancela LLCnce NearlyNOT 2 million FOR SALEburn injuries OR DISTRIBUTION occur each year in the United States,NOT FOR SALE OR DISTRIBUTION resulting in 75,000 hospitalizations and more than 3,000 deaths. Burns occur in every age group, across all socioeconomic levels, at home and 3 Burns in the workplace, and in urban, suburban, and rural settings. It has been estimated that about 80% of all burn injuries occur in the home, 3 Types of Burns © Jones &with Bartlett house firesLearning, responsible LLC for the majority of fire deaths.© Jones Most &burn Bartlett Learning, LLC NOT FORvictims SALE are OR injured DISTRIBUTION as a result of their own actions. NOT FOR SALE OR DISTRIBUTION The highest-risk age groups for burn injuries are children younger than 5 years and adults older than 55 years. Both groups may have limited ability to recognize and escape from a fire or burn incident. In addition, their relatively© Jones thinner & skin Bartlett predisposes Learning, them to LLC more seri- © Jones & Bartlett Learning, LLC ous injuries. Death andNOT complications FOR SALE increase OR DISTRIBUTION dramatically for burn NOT FOR SALE OR DISTRIBUTION victims older than 55 years owing to the likelihood of preexisting health problems and their immune systems’ decreased ability to fight infection. Skin death and injury occur as the applied heat exceeds the body’s ability to disperse the heat; that point starts at about 113° F. The amount and ©depth Jones of skin & Bartlettdamage depend Learning, on the LLCheat’s intensity, the duration© Jones & Bartlett Learning, LLC of contact,NOT FOR and the SALE skin’s OR thickness. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Types of Burns

© Jones &Burn Bartlett injuries Learning, can be classified LLC as thermal (heat), chemical,© Jones or electrical. & Bartlett Learning, LLC NOT FOR SALE Not OR all DISTRIBUTIONthermal (heat) burns are caused by flames.NOT ContactFOR SALE OR DISTRIBUTION with hot objects, flammable vapor that ignites and causes a

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEflash OR or DISTRIBUTIONan explosion, and steam and hot liq- NOT FOR SALE OR DISTRIBUTION uid are other common causes of burns. Just 3 seconds of exposure to water at 140° F can cause a full-thickness (third-degree) burn in an adult. At 156° F, the same burn occurs in 1 second. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chemical burnsNOT. A wide FOR range SALE of chemical OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION agents can cause tissue damage and death on contact with the skin. As with thermal burns, the amount of tissue damage depends on the ©duration Jones of& contact, Bartlett the Learning, skin thickness LLC in the © Jones & Bartlett Learning, LLC NOTarea ofFOR exposure, SALE and OR the DISTRIBUTION strength of the chem- NOT FOR SALE OR DISTRIBUTION ical agent. Chemicals will continue to cause tissue destruction until the chemical agent is removed. Three types of chemicals—acids, alkalis, and organic compounds—are responsi- © Jones & Bartlettble for Learning,most chemical LLC burns. Alkalis produce © Jones & Bartlett Learning, LLC NOT FOR SALEdeeper, OR moreDISTRIBUTION extensive burns than acids. NOT FOR SALE OR DISTRIBUTION Electrical burns. The injury severity from contact with electric current depends on the type of current (direct or alternating), the voltage, the area of© the Jones body exposed, & Bartlett and the Learning, LLC © Jones & Bartlett Learning, LLC duration of contact.NOT Electricity FOR SALE can induce OR DISTRIBUTION ven- NOT FOR SALE OR DISTRIBUTION tricular fibrillation (a type of cardiac arrest), cause respiratory arrest, or “freeze” the victim Figure 11-1 to the electrical contact point with powerful First-degree burn. muscle spasms that increase the length of © exposure.Jones & Victims Bartlett of low-voltage Learning, electrical LLC © Jones & Bartlett Learning, LLC NOTinjuries FOR may SALE have no OR skin DISTRIBUTION burns at all but NOT FOR SALE OR DISTRIBUTION might still have cardiac or respiratory arrest.

Thermal Burns © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOREvaluate SALE aOR thermal DISTRIBUTION burn using the following steps. NOT FOR SALE OR DISTRIBUTION These steps form the basis for treatment of thermal burns. 1. Determine the depth (degree) of the burn. Historically, burns have been described as first-degree, second-degree,© Jones & Bartlettand third-degree Learning, LLC © Jones & Bartlett Learning, LLC injuries. The termsNOT superficial,FOR SALE partial OR thick- DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ness, and full thickness are often used by burn- Figure 11-2 care professionals because they are more descriptive of the tissue damage. Second-degree burn blisters. © Jones First-degree & Bartlett (superficial) Learning, burns LLC affect the © Jones & Bartlett Learning, LLC NOTskin’s FOR outer SALE layer OR (epidermis) DISTRIBUTION Figure 11-1 . NOT FOR SALE OR DISTRIBUTION Signs and symptoms include: redness, mild Second-degree (partial-thickness) burns swelling, tenderness, and pain. Healing oc- extend through the entire outer layer and curs without scarring, usually within a into the inner skin layer Figure 11-2 . Signs week. The outer edges of deeper burns of- and symptoms include: blisters, swelling, © Jones & Bartlettten Learning, are first-degree LLC burns. © Jones & weepingBartlett of Learning,fluids, and severe LLC pain. The NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

09467_CH11_143_160.indd 144 2/15/11 3:41 PM Chapter 11 Burns 145

Back: 18 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC

NOT FOR SALE OR DISTRIBUTION NOT FOR99 SALE OR DISTRIBUTION 18

12 Back: 18 18 1 18 18 © Jones & Bartlett Learning, LLC © 9Jones & Bartlett18 Learning, LLC 9 9 NOT FOR SALE OR DISTRIBUTION 18NOT FOR 9SALE OR DISTRIBUTION Figure 11-3 1 1 16.5 16.5 13.5 13.5 Third-degree burn.

© Jones & Bartlett Learning,signs occur becauseLLC the capillary blood ves-© Jones & Bartlett Learning, LLC NOT FOR SALE OR selsDISTRIBUTION in the dermis are damaged and give upNOT FOR FigureSALE 11-4 OR DISTRIBUTION fluid into surrounding tissues. Intact blisters provide a sterile, waterproof covering. Once Rule of nines. a blister breaks, a weeping wound results, and the© risk Jones of infection & Bartlett increases. Learning, LLC © Jones & Bartlett Learning, LLC Third-degreeNOT FOR (full-thickness) SALE OR burns DISTRIBUTION are NOT FOR SALE OR DISTRIBUTION severe burns that penetrate all the skin layers into the underlying fat and muscle Figure 11-3 . Signs and symptoms include: leathery, waxy, or pearly gray skin that is © Jonessometimes & Bartlett charred. Learning, It has a dryLLC appearance © Jones & Bartlett Learning, LLC NOT FORbecause SALE capillary OR DISTRIBUTION blood vessels have been NOT FOR SALE OR DISTRIBUTION destroyed and no more fluid is brought to the area. The skin does not blanch after being pressed because the area is dead. The © Jones & Bartlett Learning,victim feels LLCno pain from a third-degree © Jones & Bartlett Learning, LLC NOT FOR SALE OR burnDISTRIBUTION because the nerve endings have beenNOT FOR SALE OR DISTRIBUTION damaged or destroyed. Any pain felt is from surrounding burns of lesser degrees.

A third-degree burn requires medical care Figure 11-5 and the removal of dead tissue and often a skin graft© Jonesto heal properly. & Bartlett Learning, LLCRule of the hand. © Jones & Bartlett Learning, LLC 2. DetermineNOT the extent FOR ofSALE the burn. OR Skin DISTRIBUTION will NOT FOR SALE OR DISTRIBUTION not ignite unless heated to thousands of degrees. However, if clothing ignites or skin is 9%, one complete arm is 9%, the front torso is kept in contact with a heat source, such as 18%, the complete back is 18%, and each leg is © Jonesscalding & Bartlett water, large Learning, areas of the LLC skin will be 18%.© Jones The rule & of Bartlett nines must Learning, be modified LLC to NOT FORinjured. SALE Determining OR DISTRIBUTION the extent of a burn takeNOT into FOR account SALE the different OR DISTRIBUTION proportions of a means estimating how much body surface area small child. In small children and infants, the the burn covers. A rough guide known as the head accounts for 18% and each leg is 14%. For rule of nines assigns a percentage value of total small or scattered burns, use the rule of the hand body surface area (BSA) to each part of an Figure 11-5 . The victim’s hand, including the © Jones & Bartlettadult’s Learning, body Figure LLC 11-4 . The entire head is © Jones & Bartlettfingers and Learning, the thumb heldLLC together, represents NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORmedical SALE problems. OR DISTRIBUTION Concurrent injuries such as fractures, internal injuries, and open wounds What is the rule of the palm? increase the severity of a burn. 6. Determine the burn’s severity Table 11-1 . The rule of the palm says that a person’s palm This forms the basis for how to treat the surface represents 1%© ofJones the BSA, & but Bartlett in actuality, Learning, LLC © Jones & Bartlett Learning, LLC burned victim. Most burns are minor, occur it represents about 0.4%.NOT The FOR entire SALE hand includ-OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ing the closed fingers and thumb represents about at home, and can be managed outside a med- 0.8%. This textbook suggests using the rule of the ical setting. Seek medical care for all moder- hand—using the entire hand, including the closed ate and severe burns, as classified by the fingers and thumb—as an easy method to estimate the extent of a burned area. The extent of a burn is American Burn Association, or if any of the calculated© Jones only &on Bartlett people with Learning, partial-thickness LLC or following© Jones conditions & Bartlett applies: Learning, LLC full-thicknessNOT FOR burns. SALE OR DISTRIBUTION TheNOT victim FOR has difficultySALE OR breathing. DISTRIBUTION Other injuries exist.

about 1% of his or her total body surface. For a very large burn, estimate the unburned area in © Jones & Bartlettnumber Learning, of hands and LLC subtract from 100%. © Jones & Bartlett Learning, LLC NOT FOR SALE3. Determine OR DISTRIBUTION which parts of the body are NOT FORTable SALE 11-1 Burn OR DISTRIBUTION Severity burned. Burns on the face, hands, feet, and genitals are more severe than those on other Minor Burns body parts. A circumferential burn (one that • First-degree burn covering less than 50% BSA in adults (face, hands, feet, and genitals not goes around a© finger, Jones toe, & arm, Bartlett leg, neck, Learning, or LLCburned)* © Jones & Bartlett Learning, LLC chest) is considered more severe than a non- NOT FOR SALE OR DISTRIBUTION• Second-degree burn coveringNOT less FOR than 10%SALE BSA OR DISTRIBUTION circumferential one because of the possible in adults constriction and tourniquet effect on circula- • Second-degree burn covering less than 10% BSA tion and, in some cases, breathing. All of in children and elderly persons these burns require medical care. Moderate Burns ©4. JonesDetermine & Bartlettrespiratory Learning, involvement. LLC Respi- • First-degree© Jones burn covering & Bartlett more than Learning, 50% BSA LLC NOTratory FOR tract SALE damage OR caused DISTRIBUTION by heat associated in adultsNOT FOR SALE OR DISTRIBUTION with a burn can cause death after a victim is • Second-degree burn covering 15% to 30% BSA in hospitalized. Respira tory damage may result adults* from breathing heat or the products of com- • Second-degree burn covering 10% to 20% BSA in children and elderly persons bustion, from being burned by a flame while © Jones & Bartlett Learning, LLC © Jones• Third-degree & Bartlett burn Learning, covering up toLLC 10% BSA in in a closed space, or from being in an explo- NOT FOR SALE OR DISTRIBUTION NOT FORadults SALE (face, hands,OR DISTRIBUTION and feet not burned) sion. In these cases, even with no skin burn Critical Burns injury, there may be respiratory damage. • Second-degree burn covering more than 30% Super heated air is absorbed by the upper BSA in adults respiratory tract (the area from the nose to the • Second-degree burn covering more than 20% trachea), resulting© Jones in inflammation. & Bartlett Swelling Learning, LLCBSA in children and elderly© persons Jones & Bartlett Learning, LLC occurs in 2 to NOT24 hours, FOR restricting SALE orOR com- DISTRIBUTION• Third-degree burn coveringNOT more FORthan 10% SALE BSA OR DISTRIBUTION pletely shutting off the airway so that air can- in adults not reach the lungs. All respiratory injuries • Third-degree burn covering more than 2% BSA in children and elderly persons must receive medical care. • Third-degree burn of hands, face, eyes, feet, or 5. Determine whether other injuries or preex- © Jones & Bartlett Learning, LLC genitalia;© also Jones most inhalation& Bartlett injuries, Learning, electrical LLC isting medical problems exist or if the victim NOT FOR SALE OR DISTRIBUTION injuries, NOTand burns FOR accompanied SALE OR by majorDISTRIBUTION trauma is elderly (older than 55 years) or very young or significant preexisting conditions (younger than 5 years). A medical problem or Source: Adapted from the American Burn Association. being in one of the sensitive age groups *Criteria for children have not been established. If in doubt, consult increases a burn’s severity. Burns can aggravate a medical professional. © Jones & Bartlettexisting Learning, medical conditions LLC such as diabetes, © Jones & Bartlett Learning, LLC NOT FOR SALEheart OR disease, DISTRIBUTION and lung disease, as well as other NOT FOR SALE OR DISTRIBUTION

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Type of Burn Do . . . Don’t . . . First-degree burn (redness, Apply cold water and, after cooled, apply Apply butter, oleomargarine, or similar mild swelling,© and Jones pain) & Bartlettaloe vera Learning,gel or a body lotion.LLC substances.© Jones & Bartlett Learning, LLC

Second-degree NOTburn FOR SALEApply cold OR water. DISTRIBUTION Break blisters.NOT FOR SALE OR DISTRIBUTION (deeper injury; blisters After cooled, apply antibiotic ointment. Remove shreds of tissue. develop) Treat for shock. Use a home remedy.

Third-degree burn Cover the burn with a sterile cloth to Remove charred clothing that is stuck to © Jones(deeper &destruction; Bartlett Learning,protect LLC it. © Jonesthe burn. & Bartlett Learning, LLC NOTskin FOR layers SALE destroyed) OR DISTRIBUTIONTreat the victim for shock. NOTApply FOR ice. SALE OR DISTRIBUTION Watch for breathing difficulty. Use a home medication. Obtain medical attention quickly.

Chemical burn Remove chemical by flushing with Apply water under high pressure. © Jones & Bartlett Learning, LLC large quantities of ©water Jones for at &least Bartlett Try toLearning, neutralize with LLC other chemicals. NOT FOR SALE OR DISTRIBUTION 20 minutes. NOT FOR SALE OR DISTRIBUTION Remove surrounding clothing. Quickly obtain medical care.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION An electrical injury exists. The face, hands, feet, or genitals are burned. Child abuse is suspected. DO NOT remove clothing stuck to the skin. Cut © Jones The & surfaceBartlett area Learning, of a second-degree LLC burn is around© the Jones areas where & Bartlett clothing sticksLearning, to the skin. LLC NOT FORgreater SALE than OR 10% DISTRIBUTION of the body surface area. DO NOTNOT pull on FOR stuck SALE clothing; OR pulling DISTRIBUTION will further The burn is third degree. damage the skin.

Care for Thermal Burns Burn care aims to reduce pain, to provide physical Care for First-Degree Burns © Jones & Bartlettprotection, Learning, and to provide LLC a favorable environment© Jones &1. Bartlett Run cold tapLearning, water (60º LLC to 77ºF [15º to 25ºC]) NOT FOR SALEfor healing OR DISTRIBUTION that minimizes the chances of scarringNOT FOR SALEover the OR area DISTRIBUTION as soon as possible Figure 11-6 or and infection Table 11-2 . Because burns can con- apply a wet, cold cloth to reduce pain. Apply tinue to injure tissue for a surprisingly long time, it cold until the part is pain free while in and out is critical to stop the burning. If clothing is burning, of the water (usually in 10 minutes, but it may have the victim roll© Jones on the ground& Bartlett using Learning, the “stop, LLC take up to 45 minutes).© Jones Cold stops & Bartlett the progres- Learning, LLC drop, and roll” method. Smother the flames with a sion of the burn into deeper tissue. If cold water NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION blanket or douse the victim with water. Stop a per- is unavailable, use any cold, drinkable liquid to son whose clothes are on fire from running, which reduce the temperature of the burned skin. only fans the flames. The victim should not remain 2. Give ibuprofen to relieve pain and standing, because he or she is more apt to inhale inflammation. flames.© Jones Once & theBartlett fire is extinguished, Learning, LLC remove all hot 3. Have© Jones the victim & Bartlett drink as Learning,much water asLLC pos- orNOT smoldering FOR SALE clothing OR becauseDISTRIBUTION the burning may sibleNOT without FOR becomingSALE OR nauseous. DISTRIBUTION continue if the clothing is left on. If possible, remove 4. After the burn has been cooled, apply an aloe jewelry because heat may be held near the skin and vera gel or an inexpensive skin moisturizer cause more damage. Swelling could make jewelry lotion to keep the skin moistened and to reduce difficult to remove later. Monitor the victim’s © Jones & Bartlett Learning, LLC © Jones & Bartlettitching and Learning, peeling. Use LLC a lotion that does not breathing. have alcohols or strong fragrances. Lotions with NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Cool burn with cold water until pain is relieved. When cooling a burn, how cold should the water be and how long should cooling last? © Jones & Bartlett Learning, LLCImmediately cool the burn with© cold—butJones not& Bartlettice- Learning, LLC NOT FOR SALE OR DISTRIBUTIONcold—water. Cooling of burns NOThas many FOR beneficial SALE OR DISTRIBUTION effects, including pain relief, reduced swelling, reduced depth of the burn, and more rapid healing. Although cooling should begin as soon as possible, delayed cooling may still be beneficial. Studies rec- ommend various temperatures and durations. Opti- © Jones & Bartlett Learning, LLC mal healing© involves Jones temperatures & Bartlett of 60°FLearning, to 77°F LLC NOT FOR SALE OR DISTRIBUTION (20°C to 25°C).NOT Other FOR studies SALE have OR water DISTRIBUTION temperature ranging from 50°F to 59°F (10°C to 15°C). Typi- cal cold water available in North American homes ranges from 50°F to 59°F (10°C to 15°C). Cooling usually takes 10–45 The duration of cooling is controversial, but cooling © Jones & Bartlettminutes. Learning, LLC © Jonesshould & continue Bartlett at least Learning, until the pain LLC is relieved and probably for a total duration of 15 to 30 minutes. NOT FOR SALEFigure OR 11-6 DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Whenever using any cold water for a burn, monitor for hypothermia (ie, shivering and cold skin on Immerse the burn. Cool burn with cold water until unburned areas). Although brief exposure to ice or pain is relieved. Cooling usually takes 10–45 minutes. ice water may be beneficial, prolonged cooling may cause additional injury. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC glycerin and mineralNOT FORoil are best.SALE Aloe OR vera DISTRIBUTION has NOT FOR SALE OR DISTRIBUTION antimicrobial and anti-inflammatory properties and is a mild analgesic. cold water is unavailable, use any cold, 5. Keep a burned arm or leg raised to reduce drinkable liquid to reduce the temperature of swelling and pain. the burned skin. © Jones & Bartlett Learning, LLC 2. Give ibuprofen© Jones to & relieve Bartlett pain Learning, and LLC NOT FOR SALE OR DISTRIBUTION inflammation.NOT FOR SALE OR DISTRIBUTION 3. Have the victim drink as much water as possible without becoming nauseated. DO NOT apply cold over a large burn for a prolonged 4. After a burn has been cooled, apply a thin layer of an antibiotic ointment. Topical anti- © Jones & timeBartlett because Learning, it can produce LLC hypothermia. © Jones & Bartlett Learning, LLC DO NOT use an ice pack or ice water unless it is the only biotic therapy does not sterilize a wound, but NOT FOR SALEsource ofOR cold DISTRIBUTION available. If you must use it, apply it for NOT FORit decreasesSALE OR the DISTRIBUTION number of bacteria to a level only 10 to 15 minutes. that can be controlled by the body’s defense DO NOT apply grease, butter, cream, or a home mechanisms and prevents the entrance of remedy. Such coatings are unsterile and can lead to infection. They also can seal in heat, causing further bacteria. Physicians may prescribe a silver- damage. © Jones & Bartlett Learning, LLC based antibiotic, which© isJones the agent & ofBartlett choice Learning, LLC DO NOT cover a first-degreeNOT FOR burn. SALE OR DISTRIBUTIONfor burn wounds. NOT FOR SALE OR DISTRIBUTION 5. Cover the burn with a dry, nonsticking, sterile dressing or a clean cloth. Covering the burn reduces the amount of pain by keeping air from < Care for Small Second-Degree Burns ( 10% BSA) the exposed nerve endings. The main purpose © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. Run cold tap water (60º to 77ºF [15º to of a dressing over a burn is to keep the burn NOT25ºC]) FOR over SALE the area OR as DISTRIBUTIONsoon as possible or clean,NOT prevent FOR evaporative SALE moistureOR DISTRIBUTION loss, and apply a wet, cold cloth to reduce pain. Apply reduce pain. If fingers or toes have been cold until the part is pain free while in and burned, place dry dressings between them and out of the water (usually in 10 minutes, but it seek medical care. © Jones & Bartlettmay takeLearning, up to 45 LLCminutes). Cold stops the © Jones6. Seek& Bartlett medical Learning,care for second-degree LLC burns NOT FOR SALEprogression OR DISTRIBUTION of the burn into deeper tissue. If NOT FORcovering SALE more OR DISTRIBUTIONthan 10% of the BSA.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORLater SALE Thermal OR Burn DISTRIBUTION Care For after-thermal burn care, follow a physician’s rec- ommendations, if a physician has been consulted Burned Tongue (many burns are never seen by a doctor). The follow- A few grains of sugar sprinkled on the tongue can ing suggestions may apply: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC relieve the misery of a tongue burned by hot food Wash hands thoroughly before changing any or drink. RepeatNOT as often FOR as needed. SALE Sucking OR DISTRIBUTION on ice NOT FOR SALE OR DISTRIBUTION chips or a popsicle can cool the burn. dressing. Leave unbroken blisters intact. Change dressings once or twice a day unless a physician instructs otherwise. © Jones & Bartlett Learning, LLC To change© Jones a dressing: & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 1. RemoveNOT FOR the old SALE dressing. OR If DISTRIBUTION a dressing sticks, soak it off with cool, clean water. DO NOT cool more than 20% of an adult’s body surface area (10% for a child) except to extinguish 2. Cleanse the area gently with mild soap and flames. water. 3. Pat the area dry with a clean cloth. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 4. Apply a thin layer of antibiotic ointment to NOT FOR SALE OR DISTRIBUTION NOT FOR SALEthe burn. OR DISTRIBUTION 5. Apply a nonsticking sterile dressing. Watch for signs of infection. Call a physician if Care for Large Second-Degree Burns (>10% BSA) any of these appear: 1. Cold can be© Jonesapplied if& you Bartlett monitor Learning, the vic- LLC Increased redness,© pain, Jones tenderness, & Bartlett swelling, Learning, LLC tim for hypothermiaNOT FOR (eg, SALE shivering, OR DISTRIBUTIONcold skin or red streaks nearNOT the burn FOR SALE OR DISTRIBUTION on unburned areas). Pus 2. Follow steps 2 and 3 for first-degree and Elevated temperature (fever) small second-degree burn care. Keep the area and dressing as clean and dry as 3. Cover the burn with a dry, nonstick, sterile, possible. Elevate the burned area, if possible, for the © Jonesor clean & Bartlett dressing. Learning, LLC first 24 hours.© Jones Give pain& Bartlett medication, Learning, if necessary. LLC NOT4. FORTreat forSALE shock. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 5. Seek medical care. Care for Third-Degree Burns 1. Cover the burn with a dry, nonsticking, ster- Why does it take several days for a physician to © Jones & Bartlettile Learning, dressing or LLCa clean cloth. © Jonesdetermine & Bartlett how Learning,deep a severe LLC burn injury goes? 2. Treat the victim for shock and keep the vic- NOT FOR SALE OR DISTRIBUTION NOT FORBecause SALE of blisters,OR DISTRIBUTION having clothing melted into the tim warm with a clean sheet or blanket. skin, or being covered with dirt, it can take several 3. Seek medical care. days of wound cleaning before proper assessment can be done by a physician. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONScald Burns NOT FOR SALE OR DISTRIBUTION Scald burns are the result of contact with hot liquids. Scald burns can be divided into two types: immersion burns and spill burns. An immersion burn results when an area of the body is fully immersed in a hot © DOJones NOT break & Bartlett any blisters. Learning, Intact blisters LLC serve as © Jones & Bartlett Learning, LLC excellent burn dressings. Cover a ruptured blister liquid. It generally has definite demarcations between NOTwith FORan antibiotic SALE ointment OR DISTRIBUTION and a dry, sterile healthy andNOT injured FOR tissue. SALE This OR type DISTRIBUTION of burn tends to dressing. be deep and is often full thickness. This type of injury DO NOT use plastic as a dressing because it will trap is generally caused by abuse and is seen most often in moisture and provide a good place for bacteria to grow (its only advantage is that it will not stick to the children. © Jones & Bartlettburn). Learning, LLC © Jones &A spillBartlett burn occurs Learning, when a liquidLLC spills, drops, or is NOT FOR SALE OR DISTRIBUTION NOT FORthrown SALE on a person.OR DISTRIBUTION The pattern of this type of burn

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORgenerally SALE isOR irregular DISTRIBUTION and may be scattered across large NOTrare. FOR The rednessSALE ofOR a sunburn DISTRIBUTION is caused by the dilation body areas. A spill burn usually is not as deep as an of the small blood vessels. Blister formation comes from immersion burn. plasma leakage. Neglect and lack of supervision of children in the Human skin displays marked differences in its response to UV radiation exposure. Some people kitchen and the bathtub© Jones are frequent & Bartlett causes Learning,of spill LLC © Jones & Bartlett Learning, LLC burns. Scalds in adults occur more often in the elderly always burn and never tan, while others rarely expe- population, who generallyNOT have FOR decreased SALE sensation. OR DISTRIBUTION As rience a painful sunburn. TheNOT variability FOR SALE is largely OR DISTRIBUTION a result, many elderly victims are scalded in the bath. attributed to the degree of pigmentation (melanin) that the skin contains. Darker-hued people generally are more resistant to the sun’s rays than are those with Sunburn light complexions, but all human beings eventually In the© UnitedJones States, & Bartlett about oneLearning, third of adultsLLC and © Jones & Bartlett Learning, LLC will burn if exposed to enough UVB. Other variables aboutNOT two thirds FOR of SALE children OR have DISTRIBUTION a sunburn each sum- NOT FOR SALE OR DISTRIBUTION that contribute to individual sensitivity include the mer. Sunburn is the skin’s response to the trauma of area of the body exposed, the underlying condition of ultraviolet (UV) radiation that results mainly from the skin, the degree of tanning, and the role of various exposure to UVB radiation or, rarely, to UVA radiation. photosensitizing medicines. Sunburn may be the most common burn sustained by © Jones & Bartlett Learning, LLC © JonesVarious & Bartlett skin types Learning, respond differently LLC to UV light: humans, and probably all persons have had one at some NOT FOR SALE OR DISTRIBUTION NOT FOR Type SALE I skin OR always DISTRIBUTION burns easily and never time Figure 11-7 . True sunburn reaction begins 2 to tans. A type I person normally has blue eyes, 8 hours after UV radiation exposure. The amount of red hair, and freckles. UV light the skin has received is difficult to gauge Type II skin burns easily, tans slightly. accurately. Not until after exposure (4 to 12 hours Type III skin sometimes burns, but always later) does the redness,© tenderness,Jones & Bartlettand discomfort Learning, of LLC © Jones & Bartlett Learning, LLC tans gradually and moderately. sunburned skin confirmNOT the FOR overexposure. SALE OR Painful DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Type IV skin minimally burns and always blistering and swelling peak about 24 hours later. tans well. Examples of people with type IV Sunburn results in first- or second-degree burns. A skin are people of Hispanic or Asian descent. third-degree burn can occur from a sunburn, but it is Type V skin rarely burns and tans deeply. © Jones & Bartlett Learning, LLC Examples© Jones of people & with Bartlett type V Learning, skin are Middle LLC NOT FOR SALE OR DISTRIBUTION EasternersNOT and FOR Indians SALE (heavily OR pigmented). DISTRIBUTION Type VI skin does not burn (although it can burn or peel with significant exposure). An example of people with type VI skin is people © Jones & Bartlett Learning, LLC © Jonesof & African Bartlett descent Learning, (deeply pigmented).LLC NOT FOR SALE OR DISTRIBUTION NOTCare FOR for SunburnsSALE OR DISTRIBUTION 1. Cool compresses for up to 45 minutes are quite soothing to sunburned skin. Frequent cool showers or soaking in a tub may provide © Jones & Bartlett Learning, LLC remarkable relief. Some© expertsJones advise & Bartlett against Learning, LLC the use of topical analgesics, sprays, or lo- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tions, especially those containing benzocaine. Benzocaine may sensitize the skin, resulting in contact dermatitis that compounds the origi- nal problem. Topical anesthetic sprays or lo- © Jones & Bartlett Learning, LLC tions ©may Jones provide & Bartletttemporary Learning, relief, but they LLC NOT FOR SALE OR DISTRIBUTION are expensiveNOT FOR and SALEgenerally OR ineffective. DISTRIBUTION Over- the-counter (OTC) analgesics such as ibuprofen should suffice in most cases because they

Figure 11-7 reduce pain and inflammation. Drinking lots © Jones & Bartlett Learning, LLC © Jones of& waterBartlett is also Learning, suggested. LLC 2. First- and second-degree sunburns can be quite NOT FOR SALESunburn. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION painful. When a large area of skin is involved,

09467_CH11_143_160.indd 150 2/15/11 3:42 PM Chapter 11 Burns 151

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Partial-thickness (second-degree) or full-thickness Superficial (first-degree) What is the degree of burn? (third-degree) © Jones & Bartlett Learning, LLC (Choose the more serious© Jones when & Bartlett Learning, LLC in doubt.) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Apply cold until pain © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,Third-degree LLC burn? stops (10 to NOT FOR SALE OR45 minutes).DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones &Monitor Bartlett breathing Learning, and treat LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALEaccordingly. OR DISTRIBUTION Treat for shock. Remove clothing and jewelry from the burned area. If stuck, cut; don’t Remove clothing and jewelry from pull off. Apply sterile dressing or burned area. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,clean LLC cloth. Apply cold until pain stops Elevate burned arms and legs. NOT FOR SALE OR DISTRIBUTION (10 to 45 minutes).NOT FOR SALE OR DISTRIBUTION Apply antibiotic ointment. Cover with nonstick, sterile dressing.

Check burn severity table as a guide about seeking medical care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEthe OR person DISTRIBUTION may feel ill and have chills and fe- NOT FORlotion SALE can ORkeep DISTRIBUTION the skin moist. Do not use but- ver. After the pain of a first-degree sunburn has ter or petroleum jelly. subsided, the use of aloe vera or another body Sunburn Aftercare For aftercare of a second-degree sunburn, apply anti- © Jones & Bartlett Learning,biotic LLC (available as an OTC medication)© Jones &ointment Bartlett in Learning, LLC NOT FOR SALE OR DISTRIBUTIONa thin layer. It is inexpensive,NOT antimicrobial, FOR SALE widely OR DISTRIBUTION available, easily applied, and adheres even to exposed Windburn resembles a first-degree sunburn. A greasy areas such as the face. If blisters break, gently wash the sunscreen can be used to prevent and treat it. area twice daily with soap and water and then cover with an antibiotic ointment and sterile gauze to prevent © Jones & Bartlett Learning, LLC infection. If the© Jonesburn becomes & Bartlett infected, Learning, seek medical LLC NOT FOR SALE OR DISTRIBUTION care. If the eyesNOT are FORaffected, SALE seek medicalOR DISTRIBUTION care.

Chemical Burns DO NOT use topical OTC burn ointments or sprays or © Jones & anestheticBartlett spraysLearning, because: LLC © JonesA chemical & Bartlett burn is the Learning, result of an LLC acid or an alkali NOT FOR SALE• Some ORproducts DISTRIBUTION may cause allergic reactions. NOTsubstance FOR SALE touching OR the DISTRIBUTION skin Figure 11-8 . Because • Most do not contain enough benzocaine or lidocaine to chemicals continue to “burn” as long as they are in suppress pain. contact with the skin, they should be removed from • The duration of any possible relief is relatively short (30 the victim as rapidly as possible. to 40 minutes). More than three or four applications per First aid is the same for all chemical burns. Alka- day of products containing© Jones local anesthetics & Bartlett is discour- Learning, LLC © Jones & Bartlett Learning, LLC aged because toxic effects can occur if the agents are lis such as drain cleaners cause more serious burns used too frequently.NOT FOR SALE OR DISTRIBUTIONthan acids such as battery acidNOT because FOR theySALE pene- OR DISTRIBUTION • They seal in the heat. trate deeper and remain active longer. Organic com- • They are expensive. pounds such as petroleum products are also capable of burning. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & SunburnBartlett Prevention Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEThe best OR protection DISTRIBUTION against the damaging effects of UV radiationNOT FOR is to limitSALE exposure OR DISTRIBUTIONto sunlight. That is done most easily with protective clothing, such as hats, long-sleeved shirts, and long pants. Wet, white cotton will transmit UV radiation, so people can be sunburned while wearing such clothing. People should avoid prolonged exposure during times of the day when radiation is most intense (usually between 10 AM and 2 PM) and apply effective sunscreens. Sunscreens are readily available and offer the best protection against sunburn, skin cancers, and other long-term skin injury. The proper© useJones of sunscreens & Bartlett will protect Learning, a person LLC from the harmful effects of the© sun. Jones Sunscreens & Bartlett must Learning, LLC be applied correctly, which generally means applying the sunscreen at least 20 minutes before sun exposure, so it will “bond” to your skin,NOT and FOR reapplying SALE it every OR few DISTRIBUTION hours. Use waterproof sunscreen if you sweatNOT a FOR lot or ifSALE you will OR DISTRIBUTION be in and out of the water. It is important to note that sunscreens do not promote tanning; they do, however, allow the user to tan gradually without serious burning. To help consumers select an effective sunscreen, the system of rating products by the skin protection factor (SPF) has been developed. The higher the SPF number, the greater the protection against sunburn. However, a sunscreen that© hasJones an SPF & of Bartlett 30 is not twice Learning, as good as LLC one with an SPF of 15. An SPF© of Jones 15 blocks & out Bartlett 95% of the Learning, most harm- LLC fulNOT rays; a FOR sunscreen SALE with OR an SPF DISTRIBUTION of 30 gives you only another 3% of protection.NOT BecauseFOR SALE most people OR DISTRIBUTIONusually use only half the amount of sunscreen that is effective, using a sunscreen with an SPF of 15 probably affords protection equivalent to a sunscreen with an SPF of 7.5. If they use a sunscreen with a 30 SPF, they are probably getting the protection of a 15 SPF sunscreen. Many “suntan lotions” have no sunscreen effect and serve only to keep the skin moist. Products such as baby oil and © Jones & cocoaBartlett butter Learning, offer no protection LLC against serious sunburn© and Jones may actually & Bartlett enhance Learning, burning. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Figure 11-8 Figure 11-9 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chemical burn from sulfuric acid. NOT FOR SALE OR DISTRIBUTION FlushingNOT a chemical FOR burn. SALE OR DISTRIBUTION

flushing. Water may activate a dry chemical © Jones & Bartlett Learning, LLC © Jones & Bartlettand cause Learning, more damage LLC to the skin. Take stan- How can you determine how deep a burn is? dard precautions to protect yourself from NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION There are two layers of skin: the epidermis and the exposure to the chemical. dermis. The epidermis, the outer layer of skin, serves 2. Remove the victim’s contaminated cloth- primarily as a barrier between the body and the envi- ing and jewelry while flushing with water. ronment. The dermis has blood vessels and contains Clothing can hold chemicals, allowing nerves, sweat glands,© Jones sebaceous & Bartlett glands, and Learning, hair LLC them to continue© to Jones burn as & long Bartlett as they Learning, LLC roots. NOT FOR SALE OR DISTRIBUTION are in contact withNOT the FOR skin. SALE OR DISTRIBUTION The individual layers of skin are not visible to the 3. Flush for 20 minutes or longer. Let the victim naked eye, so when determining depth of a burn, it is helpful to remember that the dermis is the layer that wash with a mild soap before a final rinse. will bleed. Full-thickness burns do not bleed because Washing with large amounts of water dilutes the blood vessels have been destroyed. © Jones & Bartlett Learning, LLC the© chemicalJones &concentration Bartlett Learning, and washes itLLC away. 4. Cover the burned area with a dry, sterile NOT FOR SALE OR DISTRIBUTION dressingNOT FOR or, for SALE large areas, OR DISTRIBUTIONa clean lint-free Care for Chemical Burns cloth, such as a pillowcase. 1. Immediately remove the chemical by flushing 5. If the chemical is in an eye, flood it for at least the body portion with water Figure 11-9 . If 20 minutes, using a gentle stream of water. © Jones & Bartlettavailable, Learning, use a LLC hose or a shower. Brush dry © Jones &6. Bartlett Seek medical Learning, care immediately LLC for all chemi- NOT FOR SALE ORpowder DISTRIBUTION chemicals from the skin before NOT FOR SALEcal burns. OR DISTRIBUTION

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Is it a dry chemical?

Caustic or corrosive Brush off before (acid, alkali, or organic flushing with water. compound)? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Do not try to Do not try to neutralize. neutralize. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Seek medical care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORwith SALEthis type OR of DISTRIBUTIONinjury is that the surface injury may be just the tip of the iceberg. High-voltage electric currents passing through the body may disrupt DO NOT waste time! A chemical burn is an emergency! the normal heart rhythm and cause cardiac arrest, internal burns, and other injuries. DO NOT apply water© Jones under high& Bartlett pressure; itLearning, will drive LLC © Jones & Bartlett Learning, LLC the chemical deeper into the tissue. During an electrical shock, electricity enters the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION DO NOT try to neutralize a chemical even if you body at the point of contact and travels along the path know which chemical is involved; heat may be pro- of least resistance (nerves and blood vessels). The duced, resulting in more damage. Some product major damage occurs inside the body—the entrance labels for neutralizing may be wrong. Save the con- tainer or the label for the chemical’s name. burn may appear small. Usually, the electricity exits © Jones & Bartlett Learning, LLC where the© body Jones is touching & Bartlett a surface Learning, or is in contactLLC NOT FOR SALE OR DISTRIBUTION with a groundNOT (forFOR example, SALE a OR metal DISTRIBUTION object). The exit wound can be extensive. Sometimes, a victim has more Electrical Burns than one exit site. Care for Electrical Burns © Jones & BartlettEven a mild Learning, electrical shockLLC can cause serious internal© Jones & Bartlett Learning, LLC injuries Figure 11-10 . A current of 1,000 volts or more 1. Make sure the area is safe. Unplug, discon- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION is considered high voltage, but even the 110 volts nect, or turn off the power. If that is impossi- found in ordinary household current can be deadly. ble, call 9-1-1 for help. Never touch an There are three types of electrical injuries: thermal energized wire, object, or victim yourself. burn (flame), arc burn (flash), and true electrical 2. Check breathing and, if absent, begin CPR. injury (contact). A© thermalJones burn & Bartlett (flame) results Learning, when LLC 3. If the victim fell, check© Jones for a spinal& Bartlett injury. Learning, LLC clothing or objectsNOT in direct FOR contact SALE with OR the DISTRIBUTION skin are 4. Treat the victim forNOT shock. FOR SALE OR DISTRIBUTION ignited by an electric current. These injuries are 5. Place dry, sterile dressings on all burn wounds. caused by the flames produced by the electric current 6. Place blankets under and over the victim. and not by the passage of the electric current or arc. 7. Seek medical care immediately. Electrical injuries may require treatment in a burn center. © JonesAn arc burn & Bartlett (flash) occurs Learning, when electricity LLC jumps, © Jones & Bartlett Learning, LLC or arcs, from one spot to another and not from the pas- sageNOT of anFOR electric SALE current OR through DISTRIBUTION the body. Although ContactNOT With FOR an Outdoor SALE ORPower DISTRIBUTION Line the duration of the flash may be brief, it usually causes If the electrical shock is from contact with a downed extensive superficial injuries. power line, the power must be turned off before a res- A true electrical injury (contact) happens when cuer approaches anyone who may be in contact with the wire. If a power line falls across a car containing © Jones & Bartlettan electric Learning, current passes LLC directly through the body.© Jones & Bartlett Learning, LLC a person, tell the person to stay in the car until the NOT FOR SALEThis typeOR DISTRIBUTIONof injury is characterized by an entranceNOT FOR SALE OR DISTRIBUTION wound and an exit wound. The important factor power can be shut off. The only exception is if fire threatens the car. In that case, tell the victim to jump out of the car without making contact with the car or the wire. © Jones & Bartlett Learning, LLC If you feel a tingling ©sensation Jones in& yourBartlett legs andLearning, LLC NOT FOR SALE OR DISTRIBUTIONlower body as you approachNOT a victim, FOR stop. SALE The OR sensa- DISTRIBUTION tion signals that you are on energized ground and that an electric current is entering through one foot, passing through your lower body, and leaving through the other foot. Raise one foot off the ground, turn around, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and hop to a safe place. NOT FOR SALE OR DISTRIBUTION If youNOT can safelyFOR reachSALE the OR victim, DISTRIBUTION do not attempt to move any wires, even with wooden poles, tools Figure 11-10 with wood handles, or tree branches. Wood can con- Electrical burns. A. Exit wound on a foot. B. Electrical duct electricity and the rescuer will be electrocuted. © Jones & Bartlettburn caused Learning, by chewing LLC through an electrical cord. © JonesDo not& Bartlettattempt to Learning, move downed LLC wires unless you are NOT FOR SALE OR DISTRIBUTION NOT FORtrained SALE and equippedOR DISTRIBUTION with tools able to handle the

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Is the victim still in contact with © Jones & Bartlettelectricity? Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Is the victim inside a building? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Turn off the electricity at the fuse box (inside or outside) or circuit Call 9-1-1. breaker or unplug the © Jones & Bartlett Learning, LLC ©appliance. Jones & Bartlett Learning, LLC DoNOT not FOR touch SALE or move OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION power lines or the victim. Keep people away from the scene. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

When danger to rescuers passes: © Jones & Bartlett Learning, LLC • ©Monitor Jones breathing & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT and, FOR if absent, SALE OR DISTRIBUTION begin CPR. • Treat for shock. • Treat burns as you would treat thermal © Jones & Bartlett Learning, burns LLC (two or more © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONwounds may be present). NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORhigh voltage.SALE ORWait DISTRIBUTION until trained personnel with the proper equipment can cut the wires or disconnect them. Prevent bystanders from entering the danger

Entrance wound area. Skin © Jones & Bartlett Learning, LLCContact Inside Buildings© Jones & Bartlett Learning, LLC Muscle NOT FOR SALE OR DISTRIBUTIONMost electrical burns thatNOT occur FORindoors SALE are caused OR byDISTRIBUTION faulty electrical equipment or careless use of electrical appliances. Turn off the electricity at the circuit Tissue damage breaker, fuse box, or outside switch box, or unplug the appliance if the plug is undamaged. Do not touch the © Jones & Bartlett Learning, LLC appliance© or Jones the victim & Bartlett until the currentLearning, is off. LLC NOTSkin FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Exit wound Once there is no danger to rescuers, first aid can begin. Electric current flows quickly into the body’s Figure 11-11 tissues and then exits. The surface injuries of the skin The external signs of an electrical burn may be de- involve small surface areas (entrance and exit points); © Jones & Bartlettceiving. Learning, The entrance LLCwound may be a small burn, © Jonesthe &major Bartlett damage Learning, occurs LLCdeep under the skin NOT FOR SALEwhile OR the DISTRIBUTION damage to deeper tissue may be massive. NOT FORFigure SALE 11-11 . ORSee Chapter DISTRIBUTION 24, Wilderness First Aid, for lightning burns and their care.

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Condition What to Look For What to Do © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Thermal (Heat) Burns NOTFirst-degree FOR SALE burn (superficial) OR DISTRIBUTION1. Cool the burn with cold water.NOT FOR SALE OR DISTRIBUTION • Redness 2. Apply aloe vera gel or a skin moisturizer. • Mild swelling 3. If available, give an OTC medication to reduce pain and • Pain swelling. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Second-degree burn (partial 1. Cool burn with cold water and monitor victims with NOT FOR SALEthickness) OR DISTRIBUTION large, second-degreeNOT FOR burns SALE for hypothermia. OR DISTRIBUTION • Blisters 2. Apply antibiotic ointment. • Swelling 3. Cover with a dry, nonstick sterile dressing. • Pain 4. If available, give an OTC medication to reduce pain and © Jones & Bartlett Learning,• Weeping LLC of fluid © Jonesswelling. & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT5. FOR Seek medicalSALE care.OR DISTRIBUTION

Third-degree burn (full 1. Monitor breathing and provide care as needed. thickness) 2. Cover burn with a dry, nonstick sterile, or clean • Dry, leathery skin dressing. ©• JonesGray or charred& Bartlett skin Learning, LLC3. Treat for shock. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION4. Seek medical care. NOT FOR SALE OR DISTRIBUTION

Chemical Burns • Stinging pain 1. Brush dry chemicals off skin. 2. Flush with a large amount of water for 20 minutes (gentle water flow). © Jones & Bartlett Learning, LLC 3. Remove the© Jonesvictim’s contaminated & Bartlett clothingLearning, and jewelry LLC NOT FOR SALE OR DISTRIBUTION while flushing.NOT FOR SALE OR DISTRIBUTION 4. Cover the area with a dry, sterile, or clean dressing. 5. Seek medical care.

Electrical Burns • Possible third-degree burn with 1. Safety first! Unplug, disconnect, or turn off the © Jones & Bartlett Learning,entrance LLC and exit wounds © Joneselectricity. & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT2. FOR Open SALEthe airway, OR check DISTRIBUTION breathing, and provide care as needed. 3. Care for burns as you would a third-degree burn. 4. Seek medical care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEReady OR DISTRIBUTION for Review NOT FOR SALE OR DISTRIBUTION Burns occur in every age group; across all socioeconomic levels; at home and in the prep workplace; and in urban, suburban, and rural settings. © Jones & Bartlett Learning, LLC © Jones & Bartlett kit Learning, LLC Burn injuriesNOT can FOR be classified SALE asOR thermal, DISTRIBUTION NOT FOR SALE OR DISTRIBUTION chemical, or electrical. Treatment depends on the depth of burns. first-degree (superficial) burns Burns affecting only A chemical burn is the result of a caustic or the epidermis. Characterized by skin that is red but © Jonescorrosive & Bartlett substance Learning, touching the LLC skin. not blistered© Jones or burned & Bartlett through. Learning, LLC There are three types of electrical injuries: NOT FOR SALE OR DISTRIBUTION second-degreeNOT FOR (partial-thickness) SALE OR DISTRIBUTION burns Burns thermal burn (flame), arc burn (flash), and affecting the epidermis and some portion of the der- true electrical injury (contact). mis but not the subcutaneous tissue. Characterized by blisters and skin that is white to red and moist. © Jones & BartlettVital Learning, Vocabulary LLC © Jonesthermal & Bartlett (heat) burnsLearning, Damage LLC to the skin caused by NOT FOR SALEburns OR Injuries DISTRIBUTION in which soft tissue receives more energyNOT FORcontact SALE with OR hot DISTRIBUTION objects, flammable vapor, steam, than it can absorb from thermal heat, chemicals, or hot liquid, or flames. electricity. third-degree (full-thickness) burns Burns that affect chemical burns Damage caused to the skin by all skin layers and may affect the subcutaneous lay- chemicals. © Jones & Bartlett Learning, LLCers, muscle, bone, and ©internal Jones organs, & Bartlett leaving Learning,the LLC electrical burns InjuryNOT causedFOR SALEfrom contact OR DISTRIBUTION with elec- area dry, leathery, and white,NOT dark FOR brown, SALE or charred. OR DISTRIBUTION tric current.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORCheck SALE Your OR DISTRIBUTION Knowledge Directions: Circle Yes if you agree with the statement; prep circle No if you disagree. Yes No 1. Victims of a burn should immediately kit © Jones & Bartlett Learning, LLC drink water. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONYes No 2. Petroleum jellyNOT can FORbe applied SALE over OR a DISTRIBUTION burn. Assessment in Action Yes No 3. The rule of the hand can help determine the size of a burned area. After© a Joneslong, hot & day Bartlett at the waterLearning, park, your LLC friend Yes No 4.© NeutralizeJones & an Bartlett acid on theLearning, skin by using LLC complainsNOT ofFOR severe SALE sunburn OR on DISTRIBUTION his back and shoul- NOTbaking FOR soda. SALE OR DISTRIBUTION ders. He failed to apply sunscreen while at the water Yes No 5. Use a large amount of water to flush park. Blisters have formed, and your friend refuses to chemicals off the body. sit up in a chair and complains of severe pain. Yes No 6. Brush a dry chemical off the skin before Directions: Circle Yes if you agree with the statement; © Jones & Bartlett Learning, LLC © Jones & Bartlettflushing Learning, with water. LLC circle No if you disagree. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE7. OR DISTRIBUTION Yes No 1. The blisters and pain are signs that this Yes No When someone gets electrocuted, there is a first-degree burn. can be two burn wounds: entrance and exit. Yes No 2. You should break the blisters to relieve pressure and clean the burn. Yes No 8. When a victim is in contact with a power line, use a tree branch to remove Yes No 3. Cool compresses© Jones can& Bartlett be used to Learning, relieve LLC © Jones & Bartlett Learning, LLC the wires. pain. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Yes No 9. Ibuprofen helps relieve pain and Yes No 4. You can apply antibiotic ointment and swelling. aloe vera to keep the skin moist. Yes No 10. Cold water can be used, in moderation, Yes No 5. This person does not need medical on any burn of any size. © Jones care.& Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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