First Aid of Burn Trauma

First Aid of Burn Trauma    

By : dr. Gede Wara Samsarga

Plastic, Reconstructive, and Aesthetic Surgery Department  FK UNUD

                Burns are injuries that are often found in the community. Burns are caused by contact with heat sources such as fire, hot water, chemicals, electricity and others. Most burns are caused by unforeseen actions or due to accidents, so it is important to recognize the type and how to properly handle burns early.

                Understanding the degree of burns is important before giving treatment to burns. Burns according to degree of depth are divided into three degrees. First degree burns if it affects the epidermal layer which is characterized by complaints of redness of the skin accompanied by pain. Second-degree burns occur if the wound occurs in the epidermis and dermis, which is usually characterized by blisters with more severe pain than the first degree. Third-degree burns if it affects all layers of the epidermis, dermis and the lower layers of the dermis such as fat and bone tissue. The pain is often not felt because the nerve endings and blood vessels have been destroyed. Although the definitive treatment differs according to the degree of the burn, proper initial treatment of the burn can prevent the severity of the burn and is useful for reducing the pain caused by the burn.

               The first treatment that can be given to a burn is to stop contact with a heat source by moving away from the heat source. If the heat is caused by the embers can be done by extinguishing the fire with water, and if the body is burning, the thing that can be done is to roll on the ground to help put out the fire. Remove clothing that is scalded or exposed to fire as soon as possible to avoid contact with heat sources and close the wound using a clean cloth. If burns occur to the hand, accessories such as bracelets, watches or rings are removed immediately because of the potential to reduce blood supply to the tissues because burns often result in swelling.

               After the heat source has been avoided, cool the burn. Cooling can be done by wetting the wound with running water, for about 20 minutes at 8-25ºC (ideal temperature is 15ºC). Effective cooling is done in the first 3 hours after a burn. Cooling the burn can reduce the release of inflammatory mediators so that it can reduce the severity of the burn and is also useful in reducing pain. Proper cooling of burns can also increase tissue re-epithelialization after 2 weeks of burns and reduce scarring 6 weeks after burns. Cooling by heating or soaking burns with ice or ice water is not recommended because it will cause shrinking of the skin's capillaries which will subsequently cause oxygen supply to the skin to be reduced thereby worsening the burn. Simple ingredients such as toothpaste, soy sauce, butter etc. are not recommended because they have not been proven to be beneficial and increase the risk of infection.

               In first-degree burns, wound care can be done alone without the need for doctor treatment. Wound care can be done by giving lotions or olive oil to maintain skin moisture so that the skin does not dry out. Avoid exposure to sunlight on the wound area because it aggravates burns. First-degree burns can generally heal within 3 to 5 days after home treatment.

            In burns of two or more degrees, you should need an evaluation and treatment by a doctor. If blisters occur on the skin due to burns, avoid attempts to break them down by themselves because of the risk of making the wound infected. After cooling and wound care, a blister wound can be given an ointment or cream containing antibiotics such as silver sulfadiazine to prevent infection and maintain wound moisture. To reduce swelling in burns that occur in extremities, the position of the feet and hands can be elevated during sleep. Provision of NSAID analgesics such as ibuprofen is also useful given to reduce swelling and pain caused by burns.

               There are several injuries that must be directly treated by the emergency room at the hospital, namely burns caused by chemicals, electricity, and burns that are broad and deep. Likewise with burns on some layers of facial skin, hands, arms, legs, or genitals. Patients who have difficulty breathing with a history of exposure to fire also require immediate medical attention.