Burns - When to seek care?
Whether you stayed too long at the beach or got a little careless at the BBQ, burns can be a painful part of anyone’s summer. Some burns you can take care of at home with some common sense and first aid; other burns can be quite serious and require medical attention.
So how do you know? Here are some general tips to help you decide when to seek care:
How big is the burn?
In general, the bigger the burn, the more serious it can be. Clinicians will describe burn size as a percent of your total Body Surface Area (BSA) –this is the standard way of estimating how much of your skin has been burned.
For most adults the surface area of your palm (not fingers or wrist) is equal to 1% of your skin surface – so you can tell at home how big the burn is by seeing how many “palms” it takes to cover the whole burn. So, four palms = 4% BSA burned. In general, any burn that is more than 3% of your BSA in adults and > 2% in children, will need medical attention right away.
How deep is the burn?
Burns are also classified by how “deep” they have penetrated tissue. The higher the number, the deeper and potentially more serious the burn.
- First-degree (superficial) burns. First-degree burns affect only the outer layer of skin (the epidermis). The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example.
- Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful.
- Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.
- Fourth-degree burns. Fourth-degree burns go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.
Any burn that is second degree or greater will need medical attention right away!
Where is the burn?
This is another important factor to consider when evaluating a burn. Certain locations on the body are more susceptible to infection, are harder to care for, or have other anatomical considerations that make treatment challenging. These include: Face, hands, feet, genitals, any burns that are "circumferential" -meaning that they go all the way around the limb or digit. Finally, burns that cross over a joint (wrist, elbow, knee, spine etc.) can require additional care to prevent complications down the road.
Any complicated burn should be seen by medical provider right away.
Who was burned?
This is also an important factor in burn injury outcomes. Older patients, infants or toddlers, diabetics, and those with other chronic medical conditions may have prolonged healing and/or poorer outcomes, so would more likely need to be seen by a healthcare provider early on.
Higher risk patients should seek medical attention right away.
Home vs urgent care vs emergency room for burns?
As discussed above, any large burns or burns that are 2nd degree or more, will need medical care right away. If you have any doubt about whether the burn is large or deep, it is best to see a health care provider. Third- and fourth-degree burns are best suited for the emergency room, while second-degree burns may be cared for at an Urgent Care center. Burn patients will also need pain control, possibly a tetanus booster and sometimes even a referral to a burn center. First-degree burns are usually treated with home care. Healing time may be quicker the sooner you treat the burn. Treatments for a first-degree burn include:
- Soaking the wound in cool water for five minutes or longer
- Taking acetaminophen or ibuprofen for pain relief
- Applying aloe vera gel or cream to soothe the skin
- Using an antibiotic ointment and loose gauze to protect the affected area
Make sure you don’t use ice, as this may make the damage worse. Also, avoid home remedies like butter, mayonnaise, or eggs as these are not proven to be effective. Most UCCs can provide initial care for first- and second-degree burns.
Any large or serious burns (> 10 % BSA or 3rd degree or higher) will typically need to be seen in an Emergency Department and may require referral to a burn center. In general, the major issues when treating burns are pain control, preventing infection, and achieving a good cosmetic outcome. If there are signs of skin infection, such as increasing redness, pain, pus-like discharge, or temperature greater than 100.4ºF or 38ºC, you should seek medical attention right away.
Treating burns with blisters
For burns with closed blisters:
- Flush the burn with cool running water or put cold moist cloths on the burn until there is less pain. Don’t use ice or ice water, which can cause more damage to the skin.
- Remove jewelry or tight clothing from the burned area right away before the skin begins to swell. If you cannot do this, most Urgent Care centers and emergency departments have special tools for removing jewelry or clothing.
- Try not to break the blisters. If the blisters break, it’s easier for the burn to get infected.
For burns with open blisters:
- Don’t remove clothing if it is stuck to the burn.
- Run cool water over the burn unless the burn is several inches in size. Running water over a large burn might increase the risk of shock
Special burn cases
Chemical Burns: follow these first-aid steps while making sure to avoid more contact with the chemical:
- Immediately remove any clothing and jewelry on which the chemical has spilled.
- Flush liquid chemicals from the skin thoroughly with running water for at least 15 minutes. Be sure to avoid splashing the chemical in your eyes. After flushing, call the local Poison Control Center for advice about the specific chemical that burned you, or have someone else call while you are rinsing off the chemical. It helps to have the chemical container with you when you make the call to make sure you give the correct name for the chemical.
- Brush dry chemicals off the skin if large amounts of water are not available. Small amounts of water will activate some chemicals, such as lime, and cause more damage, so keep dry chemicals dry unless very large amounts of water are available. Be careful not to get any chemicals in the eyes.
- Don’t try to neutralize a chemical. For example, putting an alkali chemical onto skin that has been exposed to an acid will often produce a large amount of heat and may increase the burning.
- Once all of the chemical has been removed, cover the burn with a sterile or clean, loose, dry bandage and get medical care immediately.
For electrical burns:
- All electrical burns must be examined promptly by a healthcare provider. An electrical burn may seem to have caused just minor damage, but it can go deep into tissues under the skin. The damage may not be obvious for several hours or even until the next day. Delayed treatment can cause more damage.
- Cover the area of the burn with a clean (sterile, if possible), dry bandage, such as a gauze pad. Wrap it loosely. Don’t put any ointments or other substances on the burned area.
Sources:
https://www.uptodate.com/contents/skin-burns-beyond-the-basics