The extent of a burn is the percentage of total body surface
area (TBSA) it covers. A person’s palm, including the fingers,
is usually equal to about 1 percent of his TBSA; this can help a
caregiver estimate a burn’s extent.
In addition to the depth and extent of a burn, the
particular location on the body should be noted as well.
Certain special-function areas warrant particular attention.
These include the face, neck, hands, feet, groin and armpits.
The face and neck are important due to concerns about the
airway; hand, foot and groin injuries can significantly affect
quality of life. The armpits merit concern because burns
there can result in dangerous fluid loss. Any burn that goes
all the way around a limb can potentially impair circulation,
so it also deserves special attention.
Subsequent Treatment
Once a burn has been thoroughly cooled and assessed, wash
it gently with clean, soapy water, rinse thoroughly and pat
dry. Do not break intact blisters, but bits of clothing or small
areas of obviously dead skin may be trimmed away. Dress
and bandage the wound with a nonadherent dressing such
as Telfa, Adaptic or 2nd Skin Moist Burn pads. It is also
appropriate to use double-antibiotic ointment and a gauze
pad, but it’s important to ensure a burn is thoroughly cooled
before covering it with any dressing. Change dressings daily
to check for infection.
Superficial and small partial-thickness burns can usually
be managed in the field, but injured people may wish to
discontinue a trip due to discomfort. Aloe gel, ibuprofen
or topical over-the-counter creams may help relieve
symptoms. Sunburn should be covered to ensure it does
not burn any further.
Any partial-thickness burn that covers more than 15
percent of a person’s body must be evaluated promptly by
a physician. The pain from such a burn would be difficult
to manage in the field, and the risk of significant fluid
loss would be high. Any full-thickness burn also warrants
immediate evacuation. The risk of infection, fluid loss and
other complications precludes field management.
As with any injury, a burn is easier to prevent than
treat. Take care around flames, hot objects, boiling water,
electricity and caustic chemicals. Take cover during
thunderstorms, and protect yourself from the sun. If you’re
faced with caring for someone who has been burned, stay
calm, ensure the scene is safe, assess CAB, and cool the burn
by pouring on water. When in doubt, add more water.
AD
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