Burns are a complex injury, as there are varying degrees of burns, different sizes, and different locations that can present unique challenges. And there are also different types of burns – thermal, chemical, and electrical.
In this lesson, when we talk about treating a burn, assume we're referring to treating thermal burns. Near the end we'll present some information on chemical and electrical burns.
How to Assess and Treat a Burn Injury
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
The first thing you want to do is assess how bad the burn is. To determine the degree of burn, look for the following signs:
- 1st degree – usually presents itself as a pink outer ring; characterized by redness and pain
- 2nd degree – will present itself with blistering skin and is usually very painful
- 3rd degree – dark, charred areas; can include life-threatening complications
Warning: A 3rd degree burn, no matter the size, is an immediate 911 call. Activate EMS and then perform the sequence of treatment that's outlined below.
Sequence of Treatment for Burn Victims
- Remove the body from the burn. This can mean a few different things – like the presence of smoldering clothing or a victim who's laying in burning embers.
- Cool the burn. Pour cool to cold potable, clean water over the burn for five to 10 minutes. Your goal is to cool the full thickness of the tissue that's been burned and to stop the burning process.
- Apply loose, dry, sterile dressing over the wound. Begin wrapping above the burn and wrap particularly lightly over the burn. During 3rd degree burns, the nerve endings become damaged, so there is less pain. However, 1st and 2nd degree burns can be quite painful.
Pro Tip #1: Observe the patient for signs of shock or dizziness. If they are losing their balance, help them into a seated or lying position, whichever is more comfortable. At the first sign of shock, call 911 and activate EMS immediately.
- Look for inhalation burns. Is the victim wheezing? Is there some swelling or burns around the face? Have the eyebrows been burned? Is there soot on the inside of the victim's mouth? All of these could signal possible future complications in the form of respiratory issues.
Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.
Remember, if you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call.
Chemical Burns
You're likely going to encounter two types of chemical burns – those from dry chemicals and those from wet.
When you're dealing with dry chemicals, you first want to brush off as much of the loose, dry chemical as you safely can. Safety is key. You don't want to become the next victim. After brushing off the loose chemical, rinse the burn for a minimum of 15 minutes, again using cool to cold potable, clean water.
When dealing with wet chemicals, go right into rinsing them off using cool, clean water.
Pro Tip #2: Dilution is the solution to pollution. When dealing with chemical burns, rinsing them off with cool, clean water will have a weakening effect, as the chemicals are diluted again and again with every dousing of clean water.
Electrical Burns
Electrical burn situations require an extra level of safety. Before anything, make sure the energy source has been removed before coming into contact with the patient. This could mean removing the patient from the energy source, cutting the power, or something else.
You cannot risk becoming another patient at the scene.
Pro Tip #3: There is a significant difference between electrical entry burn wounds and electrical exit burn wounds. Entry wounds look like typical thermal burns. But exit wounds look more like shotgun exit wounds – huge, explosive, and damaging.
Manage the entry wound the same as you would a thermal burn. Manage the exit wound as the situation requires, which will likely include treatment options for tissue damage and excessive bleeding.
Warning: As electricity travels through the body it can affect the conductivity of the heart, which could potentially damage the conduction points in the heart and contribute to secondary cardiac issues.
With electrical burns, it's important to monitor for heart dysrhythmias for 24 to 72 hours.
A Word About Burn Victim Pediatric Considerations
It's important to note that children have greater surface areas relative to their weights than adults. This can become a major factor when it comes to staying hydrated.
Burn victims tend to lose a lot of water through evaporation, and children are even more prone. This can lead to hypothermia. The solutions, however, are quite simple, and begin by administering more fluids and keeping room temperatures a little higher than normal.