Need a certification?
We want you to feel confident that you're receiving the best training, so ProFirstAid is fully available for preview below. If you're in need of a certificate of completion for work, create your account today to track your progress.
Oh, I hope these cookies are done. Ow! Roy: Now let's talk about burns. Generally speaking, there are three degrees most prevalent: first, second, and third-degree burns, third-degree being the most severe and life-threatening. First-degree burns are characterized by a superficial burn that's normally red and painful. The second-degree burn then develops into a blister, while the third-degree burn is a full-thickness burn, sometimes noted even with charring all the way down to the bone. The way we treat the burns is exactly the same. Remove them from the source of the burn, A. B, cool the burn with water. And C, cover the burn with dry sterile dressing whenever possible and get the patient or the victim to the hospital. The bigger the burn, obviously, the more the complication. This is a fairly large-size burn and we can see blisters, some popped and some not popped. The way we treat a second-degree burn in this case is by actually cooling the burn, which we're going to show in just a moment. The third-degree burn will be the same exact way, but we really need to expedite getting this person to the hospital. If they had a burning agent that caused that severe of a burn, we have to be thinking about what else might be going on. Was it involved in a house fire? Did they get scared and inhale an enormous amount of heat? The singeing of the nose, the mouth, there's soot on the tongue, means that they could have possible inhaled that heat blast, and now we're going to be dealing with some swelling of the airways in a short amount of time. So will they actually be in respiratory distress within the next few minutes? These are all considerations we need to think about as we're looking at the overall management of a burn patient. We also need to be thinking about the fact that the larger the burn-- in fact, when it starts to cover percentages of the body-- this person is losing a lot of fluid, and they're also losing their heating and cooling system. So the fact that we've already cooled them down with water, and the fact that they are already wet, probably, if we had to put their clothing out with water, means that they're also going to be running into hypothermic events, and that's something we need to be mindful of the whole time while we're treating the patient, as well as looking for signs of shock-- pale, cool, sweaty, and they might be losing consciousness. Now let's cover the treatment of this specific burn, which is first and second degree. As we said before, we want to make sure that we check the patient for any life-threatening complications: breathing problems, decreased level of consciousness. If that happens, we're going to call 911 right away. In this case, she's fine. She touched her hand to a hot item, and so it's isolated just to the top of her hand. First and second degree, big blisters but not super-duper big blisters, not the full arm, so though she's going to have some things to think about here, it's not something that I'm going to be thinking life-threatening. In fact, in most cases, even severe burns, as long as they weren't effected through respiratory, they're not life-threatening in the first six, eight, ten, twelve hours of the actual injury. It's all the later complications that start to occur like hypothermia, loss of fluids, and so on. So in this case we're dealing with pain management, really. The cold water's going to help anesthetize the skin. It's going to help bring some soothing to that area, but as soon as we take it out from the water it's going to start to hurt again. So we need to expedite getting this person to the med center, or even better yet, probably to the emergency room where they might have a burn center available to treat it appropriately, to reduce the chances of infection, and to help the patient with pain management. I'm going to cool this underwater regardless of the degree of the burn until the tissues are fully cooled and the burning has stopped. Now contrary to what might have been taught in the past, we're really simplifying this down to one treatment: cover after we've cooled it with a dry sterile dressing whenever possible and transport the patient to definitive care. I'm still going to be watching this patient for signs of decreased level of consciousness, signs of shock, and signs of complications with their breathing, but for the most part, this is what we're talking about, and keeping this clean, keeping it minimally agitated, not popping the blisters, and getting them to definitive care, is the idea when it comes to burns.
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.
There are basically three degrees of burn – 1st, 2nd, and 3rd. 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
Pro Tip #1: There are many things to consider beyond the burn itself, especially the larger or more severe the burn is. Severe burns include more severe complications, like respiratory arrest if the victim inhaled some heat. While larger burns increase the chances for hypothermia, fluid loss, and the innate ability of the body to heat and cool itself.
The Cliff's Notes version of treatment is threefold:
- Remove the victim from the burn source.
- Cool the burn with water.
- Cover the burn (preferably with a dry, sterile pad) and transport the victim to the hospital.
The burn source can be many things, like burning clothing, burning embers, or a chemical agent. Remember, don't become a victim yourself. And in the absence of a dry, sterile pad, use something that's clean, as infection is perhaps the biggest risk in most burn cases.
Pro Tip #2: Most 1st and 2nd degree burns won't warrant a 911 call. (They'll still warrant a visit with a doctor, though.) However, a 3rd degree burn is an automatic 911 call, as the complications can turn life-threatening quickly.
How to Provide Care
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 going to help you."
- Check for life-threatening complications – airway or breathing troubles, a decreased level of consciousness, etc.
- 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. With 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 #3: Observe the victim for signs of shock or dizziness. If they begin 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.
- Get the victim to a hospital where a medical professional can help with infection control and pain management. If it's a 3rd degree burn and you activated EMS, wait for them to arrive. Minimal agitation is the goal, as is not popping any burn blisters.
Pro Tip #4: The biggest threats or complications when it comes to burns, even severe burns, usually don't kick in for several hours – hypothermia, fluid loss, infection, etc. That should help alleviate some concern when treating a burn and also impart how important it is to get follow-up care, even when the burn doesn't appear bad.
A Few Common Questions About Burns
How will I know if the victim inhaled some heat, which may lead to respiratory distress?
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.
Why do we run cold water over a burn for so long?
When we cook foods with heat, even though we remove the food from the source of the heat, it will continue to cook on the inside for some time. The same is true with burns.
Don't think of it as trying to cool the surface. The reason you're pouring water over the burn for so long are all those layers beneath the surface that you can't see. Layers that may still be burning, especially with more severe and deeper burns. You need to cool those tissues until all burning has stopped.
Keep in mind that the cold water has an anesthetizing effect on burns. But as soon as you remove the burn from the cold water, the pain will come rushing back.
What if the victim suffered from a chemical burn?
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.
Remember, 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.