Burns

Reviewed by Dr Stephen Collins, GP

What are burns?

Burns are skin damage caused by contact with fire, heat, electricity, radiation, or caustic chemicals.

Burns are classified according to the depth and extent of the skin damage, in the following way.

First-degree burns: the skin is red, painful and very sensitive to touch. The damaged skin may be slightly moist from leakage of the fluid in the deeper layers of the skin.

Second-degree burns: the damage is deeper and blisters usually appear on the skin. The skin is still painful and sensitive.

Third-degree burns: the tissues in all layers of the skin are dead. Usually there are no blisters. The burned surface can appear normal, white, black (charred), or bright red from blood in the bottom of the wound. Damage to skin nerves can mean it is quite painless. The burned skin lacks sensation to touch. A skin graft is usually necessary for significant areas.

First aid for burns

The first thing to do is to limit the extent of the damage, and prevent the burn from becoming worse.

The burnt area must be cooled by being placed under cold running water. The water must not be unpleasantly cold.

The damaged area must stay under running water for at least one hour, or longer if the pain has not stopped. Up to four hours of this treatment can be beneficial.

First-degree burns, eg mild sunburn, do not require this treatment.

Which burns need treatment by health professionals?

Burns that are bigger than the palm of the hand.

Burns on the face, neck, hands, and in the groin.

All third-degree burns.

Most second-degree burns.

Remember that it can be difficult to distinguish between second- and third-degree burns, so always have a nurse or doctor check all but the most minor burns.

If possible, keep pouring water over the burn on the way to the doctor, or use clean, soaking wet towels.

Do not lance the blisters yourself.

Never apply an ointment to burns or try other folk remedies - water is the only thing that should be used. Do not use butter or lard on burns!

Do not forget to have a tetanus injection if you have not had a booster within the last 10 years.

What complications can occur?

When skin is burned, it loses its ability to protect, which increases the risk of infection. So it is important that the damaged area be thoroughly cleansed within the first six hours, and that the area is kept clean while it is healing.

If, after a few days, there are signs of an infection - ie the skin is becoming increasingly red, hot, and swollen, and the victim experiences a throbbing pain - contact a doctor or your practice nurse.

Severe burns can cause scarring.

In cases of extensive severe burns, the body may lose large quantities of fluid. This can disturb the blood circulation and cause problems with the body's salt balance. Such injuries should be assessed at your local Accident and Emergency department.

What can be done to prevent burns?

The kitchen is the most dangerous room in the house, and the most likely place for burns and scalds to occur.

When cooking, keep small children away from hot drinks, pans and kettles, barbecues and other open flames. Remember that barbecues can suddenly 'spit' flames when inflammable liquids are poured over them. Barbecues are a major cause of serious burns.

When there are small children in the house, fill baths by running the cold tap first.

Never throw water over oil fires, such as in a chip pan, because this will cause a fire explosion that can have severe consequences. Instead the fire should be smothered by covering the pan with a damp cloth.

Buy a proper fire-smothering blanket and keep it somewhere in the kitchen where it is easily accessible.

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