whether heat or cold, causes injury to skin, tissues, blood vessels, vital organs, and, in some cases, the whole body. In addition, contact with the sun’s rays, electrical current, or certain chemicals cause injuries similar in character to burns.
Figure 4-72.—Rule of Nines.
THERMAL BURNS
True burns are generated by exposure to extreme heat that overwhelms the body’s defensive mechanisms. Burns and scalds are essentially the same injury, burns being caused by dry heat, and scalds by moist heat. The seriousness of the injury can be estimated by the depth, extent, and location of the burn, the age and health of the victim, and other medical complications.
Burns can be classified according to their depth as first-, second-, and third-degree burns, as shown in figure 4-71. With a first-degree burn, the epidermal layer is irritated, reddened, and tingling. The skin is sensitive to touch and blanches with pressure. Pain is mild to severe. Edema is minimal. Healing usually occurs naturally within a week.
A second-degree burn is characterized by epidermal blisters, mottled appearance, and a red base. Damage extends into, but not through, the dermis. Recovery usually takes 2 to 3 weeks, with some scarring and depigmentation. This condition is painful. Body fluids may be drawn into the injured tissue, causing edema and possible a “weeping” fluid (plasma) loss at the surface.
Third-degree burns are full-thickness injuries penetrating into muscle and fatty connective tissues or even down to the bone. Tissues and nerves are destroyed. Shock with blood in the urine is likely to be present. Pain will be absent at the burn site if all the area nerve endings are destroyed and the surrounding tissue, which is less damaged, will be painful. Tissue color will range from white (scalds) to black (charring burns). Although the wound is usually dry, body fluids will collect in the underlying tissue and if the area has not been completely cauterized, significant amounts of fluids will be lost by plasma “weeping” or by hemorrhage, thus reducing circulation volume. There is considerable scarring and possible loss of function. Skin grafts may be necessary.
Of greater importance than the depth of the burn in evaluating the seriousness of the condition is the extent of the burned area. A first-degree burn over 50 percent of the body surface area (BSA) may be more serious than a third-degree burn over 3 percent. The “Rule of Nines” is used to give a rough estimate of the surface area affected. Figure 4-72 shows how the rule is applied to adults.
A third factor in burn evaluation is the location of the burn. Serious burns of the head, hands, feet, or genitals will require hospitalization.
The fourth factor is the presence of any other complications, especially respiratory tract injuries or other major injuries or factors.
The corpsman must take all these factors into consideration when evaluating the condition of the burn victim, especially in a triage situation.
First Aid
After the victim has been removed from the source of the thermal injury, first aid should be kept to a minimum.
Maintain an open airway.
Control hemorrhage, and treat for shock.
Remove constricting jewelry and articles of clothing.
Protect the burn area from contamination by covering it with clean sheets or dry dressings. DO NOT remove clothing adhering to a wound.
