First Aid 101 - You Got Burned

I've done it. You've done it. You've splashed boiling water, you've touched the brownie pan straight out of the oven, you fallen asleep in the lounge chair by the pool. We've all gotten burned. However, what now? Aloe isn't a fix-all, so what do you do? Since I don't want to go down the path of heat stroke and sun poisoning, I'm going to mostly leave sunburns out of this. We'll talk about that another time.
There are a lot of myths out there about burns (e.g. Don't you slather a burn with butter?) so here's the rundown.

Immediately....Stop the burning. Are you outside in the sun? Get in the shade or inside. Are you touching something hot? Stop touching it. Is there something hot on you (e.g. wax, spaghetti sauce, tar, etc.)? Cool it. Run a burn under cool water for 10 minutes minimum. When wax cools, it hardens and will easily come off. After it's cool and you can pick off the wax and then run the affected skin under cool water. (note: This does not mean ice water. cool water.) If you have tar on yourself, a) what are you doing with tar on yourself? and b) mayonnaise. Just like peanut butter is the key to getting gum out of your hair, mayo is the answer for taking tar off skin. It's true. Apparently we (we being Vanderbilt, not my family) used to keep a big tub of mayo in the trauma bays for precisely that reason. Fun fact.

While you're running your burn under cool water for 10 minutes minimum, assess the burn. There are four degrees of burns. A first degree burn involves only the epidermis - the top layers of skin. A first degree burn appears reddened and is tender. A mild to moderate sunburn is usually a first degree burn. Aloe should suffice.

A second degree burn involves the middle layer of skin called the dermis. Second degree burns usually manifest themselves as painful, superficial blisters. Ouch. Aloe should also do the trick here, although there are some really sweet "after burn" topical treatments with lidocaine in them that will cause some superficial numbing. You may want to try that as well.

Third degree burns involve the subcutaneous tissue. Nerves and muscle are damaged by the burn and usually appears charred (i.e. brown or black) in appearance. Yiggity. Go to the ER. The good news? Due to the damaged nerves, third degree burns can be predominantly painless. The bad news? Hair follicles are destroyed and wherever you got burned will now forever be bald. Mrr. Fourth degree burns are really bad news. Shocker, I know. Fourth degree burns, or full-thickness burns, are the deepest burns and involve not only skin and muscle tissue, but tendons and ligaments as well. Fourth degree burns are generally white and waxy in appearance. See the picture below - the middle of that burn is a fourth degree. The outer, brown edges are third degree. And the I'm not sure what the pink dotties are on the other leg - my best guess is that they're skin graft sites.

The biggest and baddest sequlae of a fourth degree burn is when the burn is completely circumferential and goes all the way around, say, a leg or arm. The stricture and consequent loss of blood supply to the extremity is called compartment syndrome and threatens the life of the limb and possibly of the person. The treatment involves something called a fasciotomy and you don't want that. You also don't want to see a picture of it either, so I didn't include it. If you're curious, Google Images will more than quench your thirst.Let's talk for a brief second about chemical burns. If they are minor, the treatment is dilution of the area with massive amounts of water. Best bet is to hop in the shower for a good 30 minutes or more. Don't try to "neutralize" an acid with a base or vice versa because you'll probably end up causing a not-so-awesome chemistry 101 experiment and your skin is not the place for that. That being said, any chemical burn is a legit reason to seek the professionals so you can feel justified in coming to the ER (or at least going to the doctor) if you've had any kind of chemical burn.

Whatever you do, don't....use ice. Cool water is not the same as cold water, ice water, or straight up ice. If you place ice straight on burnt skin it will cause further tissue damage.

Butter your bread, not your burns. Butter and oils actually retain heat and can prolong the burning. If you want to stick with old school remedies, use milk. Soaking a (first degree) burn in milk will soothe it. Slathering yourself in butter will only result in you more burned...and covered in butter. Insult to injury.

Don't pop your blisters. Burns love to get infected so don't mess with your blisters. This goes for blisters of all origin. Let them heal on their own.

Seek the professionals if....You've received an electrical burn. Even the smallest electrical burn is considered a third degree burn. Both entry and exit wounds are possible and can have deadly consequences.

If you've received a chemical burn and you are having trouble seeing, breathing, if you're dizzy or having chest pain. Come see us.

If your burn covers a portion of your body larger than a quarter (for a child) or a silver dollar (for an adult). If you were sunbathing naked for a little too long and now every inch of you is red and angry, sorry, but you're just going to be miserable for a few days and probably want to make best friends with a big bottle of aloe. If you have big festering blisters all over your back or beyond, come see us.

There's a way to measure the total surface area (TSA) of body burned called the Rule of Nines. Here's a picture:

So, if you've burned your entire right leg (front and back) you've burned 18% of your body. If the TSA number scares you, seek medical attention.

You can never be too careful when it comes to dealing with your burns. As mentioned previously, most any burns are a totally legitimate reason to seek medical attention. Always err on the side of caution with these puppies. And please please please wear sunscreen. Anything SPF 15 or greater will do.

Next time: Epistaxis: The fancy word for "nosebleed."

xoxo