Burning questions

When you think that every day most of us deal regularly with boiling water and other piping hot foods, liquids and utensils, it is almost surprising that here in the UK burn incidents are relatively low. However, every year around 175,000 people still attend hospital accident and emergency departments because of burns, and over 15,000 are admitted to hospital because of the seriousness of their injuries.

Most burn injuries are to the skin, but each year there are also burn injuries from inhaling hot fumes and gases which can damage the airways and lungs.

The cause is usually heat, but this can come from dry heat such as wood burning fires, electrical heat from hobs or other equipment, or wet heat from very hot fluids and of course steam which can be very dangerous. Burns can also be caused by the sun, from picking up objects already heated and also, in more unusual situations, from chemicals or extreme cold.

Burn injuries are of course not hard to recognize – usually they hurt! Our bodies’ defense system quickly recognizes when we touch something too hot and sends an instant signal to our brain to withdraw. Often, thanks to this quick response, the damage is only superficial, perhaps just a patch of red skin which is sore and tender to the touch.

Burns can be categorized as category one for minor to category three for severe, or through the categories of superficial, partial-thickness and full-thickness, the latter being equivalent to category three.

Partial-thickness or second degree burns will have gone deep enough to damage the epidermis and possibly the deeper dermis layers in your skin. The skin will colour up and may form blisters or become blotchy and deep red. The skin can ooze or swell.

More damaging of course are the third degree or “full-thickness” burns which can be especially dangerous because they can destroy the nerve endings in your skin so you may not feel pain or realize the seriousness of the injury. The skin will change colour, possibly to white, brown or black, and become waxy and possibly leathery.

Treatment depends on the severity of the burn, and to help identify just how bad it is, look at the centre of the damaged area. This is where the burn is usually the deepest and from here you can ascertain the depth of damage.

If you suffer a minor burn, or a partial-thickness burn that isn’t too severe, then you should be able to treat the problem at home. Treatments have changed over years but the recognised current advice is to flood the burn area with cool to tepid (some advice still says cold) water for up to half an hour.

This should reduce the pain and then you can pat the area dry and possibly apply a commercial burn medication – it is a good idea to keep something in the home first aid box for this eventuality. There are also over the counter painkillers such as paracetamol and ibuprofen which can help cover the worst of the pain. The skin should to heal within two to three weeks.

If blisters have formed then it is probably best to seek help from your doctor who will be able to advise you on treatment and also the risk of infection, always a worry with burns.

With partial and full thickness burns, you need to act quickly to prevent shock, ease pain and reduce the risk of infection. For partial thickness burns, again submerge or dose the burned area with cool or cold water. While pain can be reduced by preventing air reaching the exposed nerve endings and tissues, covering burns can add to the problem because the covering can adhere to the burned area or introduce infection. Some suggest wrapping a dressing in clean plastic (cling film) to cover the burned area. Never pierce blisters as that can introduce infection.

For serious burns, you need to urgently seek professional medical help. Deep burns can cause serious loss of body fluids and there can be a real risk of infection. Cool water treatment is still recommended as initial treatment. Shock is also often present in serious burn cases and if the patient is showing any signs of shock, then this must be treated as a matter of real urgency. Mouth to mouth resuscitation may be necessary.

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