Scald

Scald refers to a burn from a hot liquid or steam. The injury that occurs by scalding is usually regional. Severe scalding occurs when hot liquids enter an orifice. Scald burns can range from reddened skin to blisters. There could be oozing of fluid when severe scalding occurs. Scalding does not cause death. However, death has occurred in unusual cases, say when the victim had accidentally broken a steam pipe.

Scald and children

It is estimated that each year at least 4000 children under age 14 are scalded by hot water in the US. Scalding usually occurs while they are in the bath tub. It takes just three seconds for a child to sustain a third degree burn from water at 140 degree F or higher. Bath and shower water and sink faucets can cause common threats to children. Scalding is the second common cause of serious burn injuries in children. Scalding usually occurs in children less than five years of age. This is because an infant's reflexes do not quickly respond to hot temperature threats. The child's skin is thinner than an adult's skin and therefore more prone to scalding.

Measures to prevent scald in the bathroom

• Test how hot the hot water is before using it.
  
• To ensure that bathing is safe, the water heater's thermostat should be set at low or warm.
  
• Anti scald devices are available. They could be installed in the shower and bathtub fixtures so that it will stop water flow if the temperature exceeds 120 degrees F.
  
• There is a tendency for young children to turn on the hot water on by themselves. Therefore, kids in the tub should always be under supervision.
  
• Children should be taught to turn on cold water faucets first before the hot water faucets.

Measures to prevent scald in the kitchen

• Hot foods and drinks should be kept away from the edge of tables and counters.
  
• Never hold a child when hot liquids or food is being held.
  
• Never drink hot liquids when small children are around.
  
• Never pour hot liquids when a child in underfoot.
  
• Check the food that has been warmed in a microwave before feeding the child.
  
• Cool mist humidifier should be used. It is advised not to use hot mist humidifiers.

When severe scalding occurs, always check for airway, breathing and circulation. Difficulty in breathing could be a significant clue to inhalation injury. Serious scald burns that cover a large area of the body of the child could be life threatening. Seek medical help without any delay.

First aid for scald burns

• The burnt area should be immersed in cool water. Cool compresses should be applied to burns on the trunk or face. This should continue for at least thirty minutes until the child is out of pain.
  
• Never break blisters that occur by scalding.
  
• Ice, butter or oil should not be applied on the injury.
  
• The scald area could be covered by a non stick bandage after immersing the extremity in cool water.
  

Second Degree Burns

When the epidermis and part of the dermis of the skin are involved in any burn injury, it is known as a second-degree burn. Depending on the level of nerve involvement, the severity of the pain varies in second-degree burns. In the case of second-degree burns, in addition to superficial blistering, there is accumulation of clear liquid in the area. Involving superficial or papillary dermis, second-degree burns sometimes involve the reticular or deep layer of the dermis.

When the skin experiences any burn or surface damage, the surrounding layer of the skin expands resulting in a blister. The Plasma or serum is released as the result of the damaged Keratinocytes - outermost layer of the skin. The released plasma /serum helps to prevent further damage and also to help in the healing process. This is the reason why blisters should not be punctured as it would invite infection to the affected skin. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

According to the severity of these burns, they are further classified as deep or superficial. When only the outermost part of the dermis is involved, it is called superficial. Extreme pain and hypersensitivity to touch are characteristics of superficial burns. Appearing moist and red or mottled pink in color, the skin at the area of the burn blanches on pressure. Usually blisters appear after some time. Normally, this kind of superficial second - degree or partial thickness burns heal by themselves.

Blood Blister : This ensues when a part of the skin is pinched or crushed with force. The capillaries affected by the force rupture leaking blood into the skin.

Tissue destruction to the deeper layers of the dermis is involved in deep second - degree and deep partial thickness burns. In contrast to the superficial type, these deep second -degree burns are usually dry and whitish in appearance, but they may appear like superficial burns. Normally pain is associated with this type of burns, though the skin does not blanch. It may take three to four weeks for the burn to heal. Thick or hypertrophic scars may remain even after the injury heals.

Causes of a second-degree burn include scald injuries, flames and a brief contact of the skin with a hot object. Sometimes deep sunburn, contact with hot liquids or chemicals and burning gasoline or kerosene also may cause second-degree burns. With second degree burns, the skin color turns to deep red and you will notice blisters. The burnt area appears shiny and moist. Second-degree burns that are only superficial normally heal in about three weeks. Care should be taken to keep the wound clean and protected. For effective treatment of second degree burns, the following conditions are considered:

• The medical history, overall health and the age of the patient
  
• To what extent the burn has damaged the skin
  
• Site of the burn
  
• Incident that caused the burn
  

Person affected by burns of this type may go into shock, since they lose lots of fluid from the burned site, if the injury involves more than 10% of skin. If a second-degree burn is greater than 2 or 3 inches in diameter, only a medical professional should treat it. It is safe to treat a burn like this at home only when it is a smaller. According to the severity of the burn, treatment may vary from antibiotic ointments to systemic antibiotics. Every day cleaning of the wound is necessary to remove dead skin. Depending on the severity of the burn, the dressing should be changed at least once or twice a day. It may be painful for the patient when the dressing is changed. A pain reliever or analgesic will help to reduce the pain. Care should be taken not to burst any blisters that have formed.

First Aid for second-degree burns

• Before the area begins to swell, tight clothing and jewelry should be removed.
  
• Cold-water compresses like a wet towel can be applied or flushing the burn with cool running water may also help to lessen the pain. Using ice or ice water can do more harm to the burned area and should be avoided.
  
• Do not try to burst the blisters. Breaking blisters will expose the skin which will lead to infection.
  
• Covering the burn with a sterile, non-fluffy and dry bandage can be done, but tapes should not be used on top of it.
  
• Ointments, grease, petroleum jelly, butter or any home remedies are better avoided.
  
• By keeping the burned arms or legs raised, you can reduce swelling.
  
• Getting medical help is the best for second-degree burns greater than 2 to 3 inches in diameter or for those on hands, buttocks, penis or vaginal region.

When there are open blisters following second-degree burns:

• If the clothing is stuck to the burn, better not remove them.
  
• Running water over the burn or using water on the bandage will increase the risk of shock and so do not do it.
  
• You can cover the burn with a clean, dry, non-fluffy bandage like gauze pad, but do not use tapes on the bandage.
  Get the help of a doctor if the burn is very extensive and more than 2 to 3 inches in diameter.