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Introduction

Burn injuries are one of the most debilitating and life threatening injuries seen. Most of us (99% of us including health professionals) are not aware of first aid when burn happens. The reason I am writing this blog is because of my patient Ram (name changed). Ram visited my clinic sometime back with burn injury to his hand with hot oil. Ram had deep burns on his hand which led to huge blisters. He tried home treatment for sometime before the blisters increased significantly in size. This is when he decided to visit my clinic. Though his burn injury is deep and he is recovering quite fast, He told me all the strange first aids told by the neighbours for first aid of his hand burns. This prompted me to write about what to do and what not to do in burn injuries.

I am Dr Deepak Rathore. I am a Plastic surgeon trained specially in dealing with burn injuries (both acute and chronic). This blog will give you a broad overview of burn injuries and what to do when you encounter one.

Classifying Burn Injuries

• Burn injuries can be divided broadly into 5 major types.
  1. Thermal burns: due to flame burns like gas leakages cylinder blasts and bonfires.
  2. Scald burns: due to hot water, liquids, oils etc. (Like our patient Ram)
  3. Electrical burns: due to high voltage transmission electrical lines, lightening etc.
  4. Chemical burns: Acid or alkali burns and various industrial burns.
  5. Radiation burns: after nuclear accidents or nuclear bomb explosions.

Of the above list type 1 and 2 (thermal and scald burns) lead to most of the injuries. Burns may be extensive or minor depending on the areas involved. Irrespective of the amount of area involved we can provide some assistance/first aid for burns at the spot of injury to the patient that might be life saving.

Onsite management (What to do)

• First rule of First aid is that rescuer should be safe while attempting a rescue.
• Get yourself and patient away from smoke.
• If the individual is in flames try to douse it with water/sand or ask patient to stop-drop-roll.
• Stop-drop-roll is classically taught to douse fires. But unless someone is previously known to the idea it is difficult to do when needed. So do read Stop-drop-roll and learn it.
• In case of electrical burn switch off the mains, Do not try to remove the patient with your bare hands directly.
• Cool the burn with running water or bucket of water till burn sensation/pain disappears.
• Cover the burn area if possible with a clean cloth/dressing to reduce pain.
• If patient is conscious give ORS solution to drink till patient reaches hospital.
• Remove acids or chemicals by washing it with large amounts of water to prevent further burn. (Note: Do not wash certain chemicals like dry lime, phenols, concentrated sulfuric acid, sodium metal )
• Remove clothes and jewellery in case of chemical burns.
• In case eyes are involved with chemicals wash them thoroughly with water and rush to nearest hospital.

Most important what not to do?

People tend to advice all sorts of Dadi and Nani k nuskhe as First aid for burns. Some of these suggestions can be very harmful to you. Inspite of being the burn capital of the world the general knowledge of first aid for burn injuries is very low in our country. Let me list some very common things which should NEVER be done. I see these very frequently being done in my clinical practice but I always discourage my patients from doing these.

• Never apply toothpaste or colgate on the wounds. This advice is so common that even some hospitals ask people to do this. This is the worst thing that you can do to the burn injury. Don’t ever apply toothpastes on burn injuries.
• Do not apply potato juice or other vegetable juices on wounds.
• Never apply cow dung on wounds.
• Avoid applying Ratanjot and Kapoor on wounds.
• Never apply Ink/turmeric on wounds. This hampers depth assessment by plastic surgeons later.
• Do not use blankets as they trap heat and cause further burns.
• Avoid use of ice for cooling burn area. This may lead to further injury to skin.
• Do not try to remove clothes adherent to wounds in case of thermal burns.
• Blister management: Let a trained doctor break blisters to prevent infections.

When to seek help

Any burn involving more than 10-15% body surface area in adults and more than 5 % in children can cause serious repercussions. Once first aid for burns has been given, patients should be immediately transferred to a centre equipped to handle such injuries. A Plastic surgeons trained in burn surgeries should evaluate these injuries.

We at essence follow very strict guidelines for burns treatments. We use latest available special dressings (like collagen, nano silver dressings and skin substitutes) in large surface area burns. With a dedicated team of four plastic surgeons you will have the best care anyone can offer.

Dr Deepak Rathore (MBBS, MS, Mch Burns, plastic, maxillofacial and microvascular surgeon)

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