![]() ![]() Remove rings, watches and restrictive clothing before the area begins to swell. Cold running water is recommended, as the burn injury will heat up still water.ĭo not immerse the area in cold water for longer than 20 minutes, as this can lead to hypothermia. This will help to dissipate heat away from body tissues (Lawrence, 1997). However, it is imperative that practitioners are aware of good practice, as they may be called on to administer first aid outside an acute setting.įor burns caused by wet heat, such as boiling water, steam or bitumen and for those caused by dry heat, such as flames or contact with a hot object, immerse the burnt area under cold running water for at least 10 minutes. First aidīy the time the patient reaches A&E it may be too late to implement first aid measures, as most of the heat will have dissipated from the burn. Thrombosed veins may be visible and the wound bed will be insensate. The colour of the wound may vary from pearly white to cherry red, brown, tan and black. The wound bed may appear dry and leathery. They may also include destruction to adipose tissue, muscle, tendon and bone. Full-thickness burn woundsįull-thickness burn wounds destroy the epidermis and all of the dermis. In view of this, the patient should be referred to a surgeon with a special interest in burns and plastics regarding excision and grafting (Parker and Copley, 1993). For example, there may be poor quality skin cover involving keloid scarring. Wound-healing may take more than three weeks and the end result may be poor. The presence or absence of pain will depend on the amount of damage sustained by pain receptors - for example, if pain receptors have been destroyed the wound will be insensate. The area may not blanch due to the extravasation of blood from damaged dermal capillaries at best, capillary return is sluggish. The burnt area appears mottled red and white. Deep dermal burn woundsĭeep dermal burn injuries destroy the epidermis and almost all of the dermis. Some epidermal cells lining the hair follicles and sweat glands may survive these will regenerate and speed the epithelialisation process. Some partial thickness wounds require skin-grafting, particularly when function is at risk due to the risk of contractures. Healing can take up to three weeks and some scarring may result. Pain in response to a pinprick with a sterile needle confirms the presence of viable dermal cells. The hyperaemic area will blanch with pressure and, again, capillary refill is brisk. The burnt area swells and will appear moist and bright pink or red in colour. Large blisters develop and there is skin loss. Superficial partial thickness burn wounds involve the epidermis and the upper layer of the dermis. Superficial partial thickness burn wounds A superficial burn wound is extremely painful due to damaged nerve endings. Superficial burn wounds usually heal without scarring in three to seven days because there is still a sufficient number of surviving epithelial cells available to allow the wound to achieve rapid epithelialisation. There may be slight swelling and the skin may blister after an interval of 12-24 hours. The area of hyperaemia will blanch when pressure is applied and capillary refill is quick following release. It will initially appear pink or red in colour. Superficial burn woundsĪ superficial burn wound - for example, sunburn - only affects the epidermis. The build-up of blister fluid may cause local pressure necrosis (Flanagan and Graham, 2001).ĭue to the damage to the micro-circulation, burn wounds are at an increased risk of infection and delayed wound-healing. The accumulation of this fluid may cause the epidermis to separate from the dermis, resulting in blister formation. The tissue in this zone should recover completely Damaged capillaries become more permeable and leak large amounts of plasma into the tissues. This becomes red due to the inflammatory process. The zone of hyperaemia - this is the outermost zone and is essentially the burn border. Although blood supply is sluggish, due to aggregation of white blood cells, this tissue has the potential to recover (Trofino, 1991) The zone of stasis - this surrounds the burn centre. If it is above the dermal layer, spontaneous healing will occur through re-epithelialisation (Jordan and Harrington, 1997) If this zone is within or deeper than the dermal layer the tissue will die and slough off. The zone of coagulation - the centre of the burn contains coagulated blood vessels. At a cellular level, three zones of tissue change may be noted: ![]()
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