Trauma and Burn

Burns are a type of injury caused by heat. The heat can be thermal, electrical, chemical, or electromagnetic energy. Most burn accidents occur at home. About 75 percent of all burn injuries in children are preventable.

Smoking and open flame are the leading causes of burn injury for older adults, while scalding is the leading cause of burn injury for children. Both infants and the elderly are at the greatest risk for burn injury.

A burn injury usually results from an energy transfer to the body. There are many types of burns caused by thermal, radiation, chemical, or electrical contact:

• Thermal burns. Burns due to external heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring. Hot metals, scalding liquids, steam, and flames, when coming in contact with the skin, can cause thermal burns.
• Radiation burns. Burns caused by prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as X-ray.
• Chemical burns. Burns caused by strong acids, alkalies, detergents, or solvents coming into contact with the skin and/or eyes.
• Electrical burns. Burns from electrical current, either alternating current (AC) or direct current (DC).

During the last 20 years, fatalities and injuries from burns and fires have decreased significantly. This decrease can be attributed to heightened public awareness of fire prevention, as well as safer manufacturing of many consumer products.

The following tips can increase burn awareness and promote fire safety:

• Periodically, check electrical plugs and cords for dirt or fraying.
• Keep appliances unplugged when not in use.
• When working with a hot liquid, keep your child safely away from the source.
• If you have a toddler or small child at home, avoid using a tablecloth. The child may pull on the corner of the tablecloth, causing potentially hot objects to fall on them.
• Teach your child what to do in case of a house fire. Practice your exit strategy and teach them how to put out a fire.
• When cooking with hot oil or a deep fryer, keep your child a safe distance from the source.
• When cooking, keep pot handles turned inward on the stove top and away from the edge of the stove.
• If you use a microwave to heat your child's food, test the temperature before giving it to your child.
• Heating formula or milk in a microwave can be dangerous, as the liquid does not heat uniformly. Some portions may be hotter than others. Use a bottle warmer as a safer means to warm infant formula and milk.
• If you are cooking on the stove or in the microwave, do not hold your child as you remove items from these appliances.
• Teach your child to stay away from lighters and matches. Keep these items out of a child's reach.
• Before placing a child or infant in a bathtub, check the water temperature with your hand.
• Train your children to identify exits in public places, theaters, concert halls, and hotels.
• Turn down your water heater to 120° F.
• Check alternative heating devices for safe operation (electric space heaters or kerosene heaters).
• Check smoke detector batteries and clean your smoke detector often.
• Smoke detector batteries should be changed twice a year. Choose two dates that are easy to remember such as when you change your clocks, or on a summer or winter holiday.
• Before using barbecues or grills, clean them of grease buildup and use lighter fluid sparingly.
• Make sure your child uses a sunblock whenever he/she is in the sun.
• Supervise children near fireworks.
• Encourage children to wear shoes in the summer and avoid walking on hot asphalt or hot sand.
• When traveling, know where hotel and motel exits are in case of a fire.
• Store harmful chemicals and cleaners in an area where children will not be able to access them.
• Before using a chimney or fireplace during the winter months, have them cleaned.
• Always discard smoking materials in a deep or wet receptacle.
• Do not overload electrical outlets.
• During a power outage, use flashlights instead of candles.
• During Halloween, assure that your child is wearing a flame-retardant costume.
• Use the following tips for Christmas tree safety:
  • Check tree lights and decorations.
  • Keep trees well-watered.
  • Unplug all lights when leaving home for any length of time.
  • Do not block an exit with Christmas decorations.

What are the classifications of burns?

Burns are classified as first-, second-, or third-degree, depending on how deep and severe they penetrate the skin's surface.

• First-Degree (superficial) burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color.
• Second-Degree (partial thickness) burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.
• Third-Degree (full thickness) burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred. There is no sensation in the area since the nerve endings are destroyed.

Second and third-degree burns require the immediate attention of a physician or other healthcare provider. Listed below you will find additional information relating to first-, second-, or third-degree burns.

Get medical help if:

• Burn is second-degree
• Burn covers more than 5% of your body (even if it is only a first-degree burn)
• Stop the heat immediately. The faster you cool the burn, the less severe the injury. Flushing with cool water is best, but if necessary, use a cold non-alcoholic beverage. Don't use ice, and don't use salt water.
• Remove clothing, rings, belts, shoes, before swelling occurs.
• For chemical burns, flush the area for 20 minutes with cool water.
• Cover the burn with a sterile dressing or band aid.
• Elevate the burned limb to relieve swelling and soreness.
• Loss of body heat is a concern with burns covering a large area. Cover the injured person with a dry sheet for warmth.

Here's what NOT to do:

• Do not apply butter, grease, or ointment.
• Do not break blisters.
• Do not remove clothing that sticks to burn. Cut clothing away if necessary.

According to the latest data available from the National SAFE KIDS Campaign and the Centers for Disease Control and Prevention (CDC), consider the following statistics:

Accidental, or unintentional, injury is a leading cause of death among children ages 14 and younger.

Leading causes of accidental injury at home are burns, drowning, suffocation, choking, poisonings, falls, and fire arms.

Burns and fires are the fifth most common cause of accidental death in children and adults, and account for estimated 4,000 adult and child deaths per year.

Nearly 75 percent of all scalding burns in children are preventable.

Toddlers and children are more often burned by a scalding or flames.

Nutritional needs for a child who has been burned:

A child who has been burned needs a diet higher in calories and proteins to help him/her heal and grow. Your child may have an intravenous (IV) for extra fluids when he/she first comes to the hospital. When your child is more alert and is feeling better, he/she can start to eat.

Most children do not eat as well when they are feeling sick or when they are in the hospital. There are many ways parents can help encourage their to children eat, including the following:

• Bring your child's favorite foods from home.
• Serve your child small frequent meals.
• Praise your child after eating, even if it was only a small amount eaten.
• Offer your child high-calorie shakes and snacks (ice creams, puddings, and custards). Avoid candy and soda, as they do not contain any nutritional value. The dietitian will help you to set up snacks for your child.
• Let older children help choose their own meals by filling out their own menus. Also let them help set up their tray.
• Serve drinks with fun straws in fun cups.

What foods should I give my child?

Give your child a variety of foods that have good nutrients to help the skin heal. Vitamins A and C are important vitamins for the skin. Some foods that have Vitamin A and C are oranges, grapefruits, tomatoes, strawberries, broccoli, and carrots. Many enriched cereals also contain vitamins. Foods that contain protein such as meat, fish, eggs, peanut butter, chicken, and milk are also important to skin healing.

Consult the child's dietitian for diet and nutritional information.