burns Archives - Student Nurse Life

First Aid for Wounds and Burns

Wounds are skin breakages caused by injury. Complications in relation to wounds include bleeding and infection.

Types of Wounds

incision – a cut, such as one made with a knife
laceration – pulled off skin
abrasion – wound caused by friction
contusion – a.k.a. bruising
puncture wound – wound caused by a pointy object eg. nail

Retrieved from https://emedicodiary.com/que/437/wound on 20th September 2022

First Aid for Traumatic Wounds

There are 3 concepts required in providing immediate care for traumatic wounds:

control the bleeding
clean the wound
protect the wound

1. Control the Bleeding

Step 1: wear gloves to protect self from casualty’s blood
Step 2: control the bleeding
Step 3: assess for shock & if suspected, provide first aid for shock
Step 4: call 112 for assistance

2. Clean The Wound

Step 5: once the bleeding is under control, irrigate the wound with running water
Step 6: remove gross debris

3. Protect The Wound

Step 7: cover wound with a clean cloth or sterile dressing if available
Step 8: seek medical advice as required

NOTE: DO NOT remove any foreign objects embedded in wounds! Such objects need to be removed in a hospital setting, with adequate pain relief. If foreign object is embedded, apply bandaging to hold it in place until casualty arrives at the hospital.

First Aid for Particular Types of Wounds

Fracture site wounds

If there is a visible fracture at the injury site, or a fracture is suspected, do not apply a lot of pressure to stop the bleeding since this would cause a lot of pain, as well as create further problems with the fracture. In such case you can still irrigate the wound by running water.

Thoracic Wounds

When dealing with thoracic wounds, do not apply too much pressure to stop the bleeding. Additionally, leave the chest wound uncovered. You may clean the area surrounding the wound, but there is no need to irrigate the wound with running water.

Abdominal Wounds

If an injury to the abdomen causes the intestines to be pushed out of the abdomen, do not attempt to push them back inside the casualty, as this may cause serious damage. Instead, use a moist sterile cloth and cover the intestines, or else leave the intestines uncovered and wait for the ambulance to arrive.

Burns

Burns occur when the body is exposed to thermal, chemical, or electrical energy which leads to skin loss and damage to the underlying tissue. Complications arising from burns include tissue damage, fluid loss, heat loss, and infection.

Types of Burns

thermal burns – flames, hot objects, flash burns, radiation, hot liquids, and steam burns
chemical/corrosive burns
electrical burns – caused by electric conduction which usually causes 2 wounds: a small entry wound and a larger wound at the earthing area; electrical burns can easily cause a cardiac arrest!

The severity of an injury caused by a burn depends on factors such as the site of injury, the depth and extent of injury, the cause, as well as the casualty’s age, prior health status and additional injuries.

Burn Depth

1. Superficial Burn

In a superficial burn, the burn affects only the epidermis of the skin. Signs of a superficial burn include:

pain
redness
blanches with pressure
absent oedema

2. Partial Burn

In a partial burn, the burn affects both the epidermis and the dermis. In such burns, blisters may appear, which are fluid-filled located between the epidermis and the dermis. NEVER burst a blister unless in a hospital setting! Signs of a partial burn include:

pain
blisters
moisture

3. Full Burn

In a full burn, the burn uncovers the structure of the affected area – structures such as muscles and bones. Nerves are usually burned in these types of burns, which causes the casualty to experience no pain sensation. Signs of a full burn include:

uncovered structures
discolouration
dryness
absent pain

Retrieved from https://suprathelu.com/row/ on 20th September 2022

Measuring the Extent of a Burn

Method #1: The Palmar Method
Method #2: The Rule of 9’s

Retrieved from https://twitter.com/hp_ems/status/1421585002073149445 on 20th September 2022

Managing Burn Injuries

In burn injuries the main aims are to:

reduce pain
reduce the burning process
protect the injury

cool burn down with running water
remove ALL burnt clothing
cover burned area with a moist dressing and keep it wet so it doesn’t stick to the burnt area
if a moist dressing is not available, cover the area with plastic film
seek medical attention

DO NOT use any creams to treat burns.
DO NOT use ice to calm down the burning sensation as ice can cause a burn too.
DO NOT remove any clothing that is seemingly stuck to the burnt area.

First Aid for Other Types of Burns

Electrocution burn

Whilst an electrocuted casualty may not experience a cardiac arrest immediately, it is still possible after some time. Thus, if the casualty complains of chest pain and dyspnoea, get ready to resuscitate as a cardiac arrest may become quite possible.

Liquid chemical burn

If a casualty experiences a liquid chemical burn, flood burned area with water.

Dry Powder Chemical Burn

In the case of dry powder chemical burns, brush dry powder off, making sure it is still safe for you, and then flood with water.

NOTE: Inhaling hot or chemical fumes causes burns within the airway and the lungs. Thus, a casualty experiencing inhalation in such cases should go to the hospital for treatment as soon as possible.

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Skin Lesions

Skin lesions can be defined as a part of the skin that has an abnormal growth or appearance when compared to intact skin. Skin lesions can be classified into 4 types:

Infections
Allergies
Burns
Skin Cancer

1. Skin Lesions – Infections

Athlete’s Foot

Athlete’s foot presents as itchy red peeling in the skin between the toes as a result of infection by the fungus tinea pedis. Athlete’s foot is common due to the said areas being prone to sweat or when left wet/ not thoroughly dried.

Candidiasis

Candidiasis is a fungal infection caused by Candida (a yeast). Candida usually presents on the skin and/or within the body, in areas such as the mouth, throat, gut, vagina, as well as areas prone to sweat (eg. under the breasts) and wetness (eg. nappy rash following prolonged humid environment).

When presenting in the mouth, Candidiasis (also known as Thrush) is characterized by white discolorations in the tongue, around the mouth, and the throat. Sometimes, irritation that causes discomfort when swallowing may occur. Oral Candidiasis can at times be caused in prolonged use of oral steroid medication eg. in asthmatic patients.

When presenting within the skin, Candidiasis causes itching, irritation, chafing or broken skin.

Ringworm

Ringworm, a fungal infection of the skin, can affect both humans and animals. Typically, humans acquire ringworm from strays or pets. Ringworm usually presents in areas on the skin such as on the scalp, feet, groin and beard.

Mild ringworm is usually treated successfully by antifungal topical medication (cream). However, more severe ringworm infection usually requires antifungal oral medication to be successfully treated.

Boils and Carbuncles

Boils and Carbuncles are classified as bacterial infections. They happen as a result of inflammation of the hair follicles and sebaceous glands, and quite commonly present on the dorsal neck. Usually, local antibacterial topical medications (eg. Fucidin) don’t work on boils and carbuncles – they are usually treated through oral antibiotics.

Impetigo

Impetigo is a bacterial (staphylococcus) infection of the skin, commonly found in young children. It is highly contagious – in fact, children with Impetigo are required to be kept home so as to avoid spreading of the infection. Impetigo is commonly found around the mouth and nose, and presents as pink water-filled raised lesions which turn into a yellowish crust, which eventually ruptures.

Cold Sores

Cold sores are small fluid-filled blisters presenting around the lips and in the oral mucosa, that cause itching and a stinging sensation. They are caused by Herpes Simplex infection. Herpes Simplex is a lifelong virus that once acquired remains dormant for long periods of time until it causes an outbreak following a trigger.

Chickenpox

Chickenpox is caused by the Varicella Zoster virus. It presents as a very itchy skin rash with blisters. The Varicella Zoster virus is a lifelong virus that once acquired stays in the body, specifically in the sensory nerve ganglia, as a dormant infection.

Shingles

Shingles is the reactivation of the Varicella Zoster virus (which initially causes Chickenpox). Typically, Shingles causes pain in a particular area in the body, which is later on followed by a rash, which initially appears as red spots before turning into blisters that eventually dry up and form scabs.

Warts

Warts are a type of skin infection resulting from the Human Papillomavirus (HPV). Warts present as rough, skin-coloured bumps on the skin which are highly contageous and can be easily spread through skin-to-skin contact. There is currently a vaccine which is offered to girls aged 12 years (ideally administered prior to 1st sexual encounter) to prevent development of the HPV.

2. Skin Lesions – Allergies

Contact Dermatitis

Contact Dermatitis is caused by the irritation or inflammation of the skin following direct contact with a substance or material that triggers an allergic reaction. It causes itching, redness as well as swelling of the skin which eventually progresses to blistering.

Psoriasis

Psoriasis is a chronic condition whereby overproduction of skin cells occurs. It presents as reddened epidermal lesions covered by dry silvery scales, and is commonly triggered by trauma, infection, hormonal changes and stress.

3. Skin Lesions – Burns

Burns are tissue damage and cell death that result from heat, UV radiation, chemicals or electricity. Burns can be minor medical problems or life-threatening emergencies, and treatment depends on their location and severity.

Life-threatening problems happen since in burns:

the body loses fluids, causing dehydration and electrolyte imbalance, which may lead to circulatory shock;
the burned skin is only sterile for 24 hours, after which the resulting wound becomes prone to infection.

degrees of burns — Retrieved from https://pt.slideshare.net/winreyes/burn-injury-13545329/3 on 16th October 2021

Estimating the extent of burns in percentages using the rule of nines…

Following calculation of the extent of burns in a patient, a patient is considered critical if:

>25% of the body has 2nd degree burns
>10% of the body has 3rd degree burns
3rd degree burns are present on the face, hands or feet

estimating burns rule of nines — Retrieved from https://www.chegg.com/homework-help/human-anatomy-8th-edition-chapter-5-problem-6cr-solution-9780134243818 on 16th October 2021

4. Skin Lesions – Skin Cancer

There are 3 major types of skin cancer:

Basal Cell Carcinoma
Squamous Cell Carcinoma
Malignant Melanoma

Basal Cell Carcinoma

Basal Cell Carcinoma is the least malignant but most common type of skin cancer that most often develops on areas of skin exposed to the sun. This type of cancer arises from cells within the stratum basale and presents itself as shiny dome-shaped nodules which eventually develop a central ulcer.

Squamous Cell Carcinoma

Squamous Cell Carcinoma is the second most common form of skin cancer which is characterised by abnormal accelerated growth of squamous cells. Squamous Cell Carcinoma arises from cells within the stratum spinosum and presents itself as a scaly, reddened papule that gradually forms a shallow ulcer with a firm raised border.

Malignant Melanoma

Malignant Melanoma, the most deadly form of skin cancer, develops from the pigment-producing cells known as melanocytes. It may develop spontaneously or from existing moles that suddenly start exhibiting changes, indicating cancer growth.

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