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ADMINISTERING IMMEDIATE FIRST AID to a burn victim helps limit the extent of injury and prevent complications such as hypothermia and infection. Knowing what and what not to do in the first critical minutes after a burn can significantly affect the victim's outcome. Keep in mind that responding inappropriately could harm you both.
In the following text and photos, I'll detail quick steps you can take to protect a burn victim.
The primary step in first aid for a burn victim is to put out the fire or remove the victim from the fire. Follow these general guidelines.
* Victim on fire. Have him stop, drop, and roll; cover him with a blanket to smother the flames or apply water to douse them. Immediately cool burned skin with cool water-not ice. Once the area is cool, however, stop applying water because it can induce hypothermia. If the victim has inhaled smoke or encountered fire in a closed space, quickly get him to where he can breathe fresh air.
* Chemical burn. Immediately remove all contaminated clothing. Brush off dry chemicals from the victim's skin, then continuously wash the area with plenty of water to remove all the chemical.
* Electrical burn. Make sure that the victim is no longer touching the electric source or you could become a victim too. The safest action is to turn off the main power switch or breaker. When you're sure he's no longer in contact with electricity, call 911-the current might have triggered a serious but hidden injury. (You may see entrance and exit burn wounds.) Protect the victim's cervical spine if the jolt caused him to fall or be thrown.
Your basic response should be the same for any type of burn. Be prepared to report your assessment findings and interventions to Emergency Medical Service (EMS) providers.
* Assess the victim's level of consciousness, airway, breathing, and circulation. If necessary, start cardiopulmonary resuscitation.
* Put on gloves, if available, and inspect the burned areas to determine the extent and severity of injury.
* Remove all the victim's jewelry-even items not near the burn because fluid shifts and swelling are inevitable.
* Remove any clothing from the burned area. If fabric adheres to the wound (synthetic cloth can melt into the skin), gently cut away as much as possible with scissors. Any remaining fabric will be removed later by staff at the emergency department or burn center.
* Cover all burned areas with dry, sterile dressings, if available, or a clean, dry sheet. This prevents airflow over the burn site, reducing pain.
* If the victim's fingers or toes are burned, place dressings between them to prevent the skin from sticking together.
* Try to keep him warm. Hypothermia develops quickly when skin has been destroyed, and it can worsen shock related to the burn.
Use the following measures to prepare the victim for transport to the hospital:
* Warn him not to smoke or to drink alcohol after an acute burn injury, even if he wants something to calm himself. If his burns are serious, keep him from taking anything by mouth.
* Look for evidence of airway involvement (carbon in the sputum, singed nasal hair, facial or mucosal burns, change in voice quality). Tell him to alert you immediately if he has trouble breathing or swallowing. Anticipate the possible need for advanced cardiac life support interventions, including intubation, and report the problem when you transfer care.
* Provide calm reassurance. Try to learn as much as possible about the incident and any pertinent medical history, including the victim's tetanus immunization status.
Report to the EMS providers how the victim was burned, including information about the burn source (such as the type of chemical or the voltage of electric current, if known); how long he was in contact with the source; emergency actions taken; your assessment findings and treatment rendered; and any significant medical history. If you removed the victim's jewelry or other valuables, record what you did with them or who's holding them for safekeeping.
* water to douse flames and wash off contaminants
* a blanket or large cloth (preferably made of natural material)
* a clean, dry sheet or dressing material
* scissors to cut away clothing
* gloves and eye protection
Do [horizontal ellipsis] treat a minor burn (resembling a sunburn without blistering) with cool compresses, aloe vera gel, or oral nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen to relieve pain and inflammation.
* Irrigate chemical burns with water-nothing else-first and ask questions later.
* In the case of an electrical burn, find out where the building's main breaker switch is located so power can be turned off without delay.
Don't [horizontal ellipsis] use any type of salve, lotion, cream, or greasy substance on a serious (partial-thickness or full-thickness) burn wound. Staff at the burn center will have to remove it, causing more pain.
* Don't let bystanders apply home remedies (butter, shortening, herbal treatments) or ice to significant burn wounds.
* Don't wet burn dressings; keeping them dry helps prevent hypothermia.
* Don't disrupt blisters, which act as a sterile, physiologic dressing.
* Don't try to neutralize an offending chemical with another chemical; the process could generate heat and worsen the burn.
Linda Laskowski-Jones is the director of trauma, emergency, and aeromedical services at Christiana Care Health System, Christiana Hospital, in Newark, Del. Meet Ms. Laskowski-Jones, who's speaking at the Nursing2006 Symposium in Las Vegas, Nev., April 19 to 22, 2006.
Advanced Burn Life Support Course Provider Manual. Chicago, Ill., American Burn Association, 2005.
Auerbach PS, et al. Field Guide to Wilderness Medicine, 2nd edition. St. Louis, Mo., Mosby, 2003.
Newberry L. Sheehy's Emergency Nursing Principles and Practice, 5th edition. St. Louis, Mo., Mosby, 2003.
Rapid Response to Everyday Emergencies: A Nurse's Guide. Philadelphia, Pa., Lippincott Williams & Wilkins, 2006.
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