Burns of any size, shape or degree are very painful. They can be potentially life-threatening due to excess fluid loss and the potential for infection. Our skin acts as a barrier which keeps out organisms and disease. When this barrier is damaged, especially a large area, the potential for more problems increases. Specific burn treatment depends on the type and extent of the burn. Thermal burns are classified according to the depth of tissue injury they produce.

First degree burns are also known as superficial burns. These affect the outermost layers of the skin. The most common type of first degree burn is a sunburn, presenting as red, hot, painful skin. The management of superficial burns is mostly supportive in nature. If the tissue is still hot, apply cool, moist dressings. Do not use creams or ointments, especially those with an oil base because they seal in the heat. Some first aid sprays have anesthetics in them which help relieve pain. Superficial burns usually resolve themselves within a week, often ending up with the burnt layers of skin peeling off. Children or the elderly with large superficial burns should be seen by EMS and evaluated at a hospital.

Second degree burns are referred to as partial thickness burns. These penetrate the skin deeper than superficial burns and cause more severe pain. You may also note evidence of blistering. These fluid-filled blisters help protect against infection. Do not pop the blisters under any circumstances. If they break on their own, wash the area with soap and water, then apply clean dressings.

Any pressure will cause extreme pain because of irritation to the nerve endings. If the burned area is still warm to the touch, cool, wet dressings are the treatment of choice. Once the tissue has cooled, remove the moist dressings and replace them with dry, sterile dressings. The patient with a second degree burn needs to be seen by EMS and possibly transported to the hospital for continued treatment. These patients are at risk of infection as well as dehydration.

Third degree burns are sometimes referred to as full thickness burns. These are by far the most serious thermal burn and involve damage to the full thickness of the tissue. Third degree burns leave the tissue looking charred and leathery. The hallmark of this type of burn is that the patient feels no pain except around the edges of the burn. This is due to the nerve endings being destroyed in the burned area.

Treatment for third degree burns centers on infection control. Place sterile dressings over the burned area. If pain is an issue, cold, dry compresses may be used on top. Initially, the most critical aspect of full thickness burns is fluid loss and the possibility of the patient going into shock. EMS should be requested immediately with any third degree burn.

A common type of burn you may see is called a `bulls-eye' burn.

This burn appears much like concentric rings with 3rd degree burning in the center, 2nd degree farther out and 1st degree burns on the outside of the circle. As with any burn, never use ointments or creams because they will have to be cleaned off once the patient arrives at the hospital.

Emergency departments use many methods to treat burns. Surgery, tissue debridement, skin grafts, hydrotherapy, pain medications and antibiotics, to name a few. In the first aid setting, cold compresses and sterile dressings are your first mode of treatment. The newest innovation in the treatment of burns is a substance called Water Jel or Burn Free. These sterile, moist, cool dressings are available in first aid kits and provide sanitary relief for burns. They are designed to be one time use, but are extremely effective for pain control.

Chemical burns occur when a strong acid or base comes into contact with the skin. The immediate management of a chemical burn involves removing the chemical from the patient's skin. This is an ideal time to practice scene safety so you don't become burned as well. Dry chemicals should be brushed off completely using a towel, brush or clothing and then flushed with copious amounts of water. Wet chemicals need to be flushed immediately, again, with copious amounts of water. If chemicals get into the patient's eyes, flush them with water. The most effective way of doing this is to allow water to run from the bridge of the nose, across the eye and off the side of the face.

Acids usually dilute quickly to relatively harmless levels with water. That is not always true with alkalies, which may be oil or alcohol based. Whenever possible, check the chemical container as it may have specific emergency care instructions. Flushing with water should last at least 15 minutes. Avoid using antidotes unless you are very familiar with them. This is a time when Poison Control should be used. They will advise you of the most effective method of treatment.

Electrical burns can be very deceiving, as they may produce devastating internal injuries with little external evidence. The degree of tissue damage from an electrical burn is related both to the intensity of the current and the duration of the exposure. As electrical current passes from the contact point into the body, it is converted into heat. This heat continues to develop along the path of the current. In the case of low voltage (less than 1,000 volts) the current follows a path along the blood vessels and nerves, causing extensive damage to these tissues. When the voltage is high, the current takes the shortest path through the body to ground. Unfortunately, on the way through, it can cause violent muscle contractions and possibly broken bones.

Household current or what would more accurately be called alternating current (AC), can be more dangerous than direct current (DC) due to the pulsing nature of the current. This pulsing may cause muscle spasms in the body which can "freeze" the person until the source of the electricity is shut off. The direction of the current flow is also significant. When the flow is from one hand to another, the danger is particularly acute since it passes over and through the heart. As we know, the heart is very sensitive to exposure to any electrical current.

By far the most important step in managing a patient exposed to electrical current is to protect yourself. Either turn off the power or make certain that someone else has turned it off. Once this is done, you can gain access to the patient. Look for entrance and exit wounds as well as any broken bones. Treat any visibly burned areas with dry, sterile dressings. Monitor the patient closely because they may go into respiratory or cardiac arrest. With any type of burn, remove any tight or smoldering clothing unless you feel resistance.