BURNS

Burns are skin or mucosa lesions caused by heat, cold, electricity, or corrosive chemical agents.

To deal with a burnt crewmember, first of all the severity of the burn must be assessed, taking into account:

1. Area
   
   To estimate the affected body surface the "nine rule" is used, which consists on dividing the body in regions that represent multiples of 9% of the total:
   
   
   • Head and neck: 9%.
   • Torso: Anterior half (thorax and abdomen), 9 x 2 (18%).
     posterior half (back), 9 x 2 (18%).
   • Arms (including the hand): 9% each.
   • Legs (including foot and buttock): 9 x 2 each (18%, 9% Anterior and 9% posterior)
   • Genitalia and perianal area: 1%
     
   
   As a simpler alternative, and sometimes more efficient, the palm of the patient's hand represents 1% of the body surface.
   
   
   
   
   Picture 7-38: 1% of body surface.



2. Depth
   
   Depending on the depth of the lesion, burns are divided into three categories:
   
   
   • First degree: only the surface layer is affected. It causes red skin and pain.
   • Second degree: the deep layer is affected. Blisters containing clear liquid and severe pain appear; they usually leave a scar.
   • Third degree: there is destruction of all skin layers. It causes a dark lesion that is not painful.
   
   There are usually different degree burns in a same injury.
   



3. Affected area
   
   There are areas of greater severity: face and neck, hands and feet, genitalia and, as a whole, all skin folds, as well as natural orifices.
   
   
   
   
   Picture 7-39.



4. Age, fitness and Anterior conditions (diabetes, heart disease, etc.)
   
   The overall effects such as hypovolemic shock (due to large fluid loss) (refer to Chapter 2.1, SHOCK) infections and respiratory system injuries represent greater life threats than those due to local effects.
   
   IMMEDIATE CARE (refer to Chapter 2.3, BURNS)
   
   The burn victim's immediate care requires: assessment of airway damage, and if required, maintenance of ventilation and oxygenation; stopping the burning process (keep the patient away from the burning agent and wash the burn with plenty of water); relieving the pain; replace lost fluids (plasma); diagnosis and treatment of any added life threatening lesion, and protection against bacterial contamination.
   
   TREATMENT CRITERIA
   
   If there are no inhalatory lesions (in the respiratory tract), burns that can be treated on board the ship must fulfil the following general criteria:
   
   
   • First degree burns with an extension less than 20% of body surface.
   • Second degree burns affecting less than 10% of body surface.
   • Third degree deep burns affecting less than 1% of body surface.
   
   The rest must be evacuated to a hospital for treatment, as well as all those affecting areas of greater severity or people with chronic conditions.
   
   TREATMENT
   
   
   • Undress the affected area: wet the clothes with clean water or serum and remove carefully to avoid tearing.
     
     
     
     
     Picture 7-40: Material for treating burns.
   
   
   
   • Clean the wound: If possible, the small wound must be cooled immediately with cold water, especially those caused by a chemical agent (unless counter indicated). After that it must be treated as any other wound (refer to required material). In these cases do not put anything on the wound, unless the doctor says so.
     
     The blisters around the wound should be carefully trimmed only if they have already burst. Dead or torn tissue should be carefully removed from the wound, using tweezers and scissors (DRAWER 12, first aid kits A and B). All these techniques will be performed under aseptic measures as shown in the WOUNDS section.
     
     Once clean, it must be covered with fatty gauzes (DRAWER 14, first aid kits A, B and C) and a non compressive bandage, checking afterwards to make sure it does not compress.
   
   
   
   • Replace fluids, as the body loses them in great quantity due to the burn. If the patient is conscious offer oral serum (DRAWER 13, first aid kits A and B) in small sips to prevent vomiting, or if not available, mix a litre of mineral water (or cold boiled water), half a teaspoon of salt, half a teaspoon of bicarbonate, the juice of one or two lemons or oranges and three to four spoons of sugar. If the person is unconscious and the burn is severe, intravenous serum must be given as indicated by MEDICAL ADVICE VIA RADIO (refer to Chapter 6.4, MEDICATION ADMINISTRATION).
   
   
   
   The urine output must be monitored in the following hours to assess whether the fluid replacement is enough.
   
   
   • Calm the pain with an analgesic: paracetamol (DRAWER 3, first aid kits A, B and C) or metamizole (DRAWER 3, first aid kits A, B, C and RAFTS).
   • Give protection against tetanus, as shown in the section WOUNDS.
   • If the wound affects a joint and is at least of second degree, the area must be immobilised.
   
   The hand is immobilised individually wrapping each finger (DRAWER 14, first aid kits A, B, C and RAFTS) (see picture 7-41). Place padding in the palm to keep the joints in mildly bent (see picture 7-75).
   
   
   
   
   Picture 7-41: Individual wrapping of each finger.
   
   The limb joint immobilisation should be done avoiding contact between surfaces so that they do not stick together in the healing process; the same occurs in the rest of folds, such as armpits and groins.
   
   It is important to lift the limb in burns involving arms or legs, to reduce swelling.
   
   
   • Prevent infection. In burns of second degree and higher, an antibiotic is required to prevent infection. Ask for MEDICAL ADVICE VIA RADIO .
   
   
   
   • Periodical bandage. Daily bandages should be placed taking care not to tear the tissues that are starting to heal when removing the Anterior bandage. They should be damped in normal saline solution or plenty of clean water before removing them, and after all debris should be washed away from the wound. Finally, fatty gauzes and a bandage should be used.