Burns and Scalds

In fact a burn of extensive degree presents a most complex medico-surgical problem that can best be handled by a trained burn team in a modern hospital with up-to-date laboratory and other facilities.

There are three great dangers in burns or scalds. The first is shock, which is often grave because the psychological trauma of the experience is added to the actual physical injury. The second is serum loss, enormous quantities of fluid being poured out from the burned surface, thus depleting the body of vital proteins, salts and water. This result in interference with normal functions and increases shock: The third danger is that of sepsis, which is a later hazard and has caused many fatalities after apparent initial recovery.

Shock is inseparable from this type of injury. It is of vital import• ance in the first place not to increase shock by unwise activities and, in the second place, to counteract shock by relieving pain and pre- venting chilling. A dose of Arnica 200 should be given at once, or of Aconitum 200 if the patient is suffering from fright. This should be followed in a few minutes by Cantharis 30 to allay pain, a dose
every 10 minutes or so till relief is obtained.

No burned clothing should be disturbed, but a dressing should be applied to cover any exposed burned area. Pieces of clean linen should be used for this purpose, either dry or wrung almost dry out of Hypercom lotion (ten drops of mother tincture to the half pint of water). The patient should be kept warmly covered ש a well ventilated room. Overheating must be avoided as this would cause sweating and increase the danger of fluid loss.

IMPORTANT NOTE:—In the event of scalding with boiling liquid the saturated clothes must be removed as rapidly as possible and as gently as possible. The longer they are allowed to remain in contact with the skin the more serious the injury.

An immediate measure before the application of a protective dressing in the case of a scorch or a scald is to place the affected area or skin under the cold tap or in cold water. This helps to allay pain and also to diminish swelling.

An alternative to Hypercom is Urtika urns, the remedy pre- pared from the small stinging nettle. The lotion (ten drops of mother tincture to the half pint of water) is an excellent dressing for small burns or scalds or the ointment may be used. Urtica urens 30 may be taken internally as an alternative to Cantiaris for relief of pain. The dressing, of course, should not be disturbed once it has been applied, as explained above.

Numberless external medicaments have been recommended in the past for burns, including cod liver oil, tannic acid, various dyes, plain sterile ague moistened with saline. A modern method of treating burns in hospital is to leave the cleansed burn area exposed to the air at a temperature of 65 to 70 deg. F. in order to encourage the formation by natural processes of a protective crust.

Picric acid was popular at one period but was found to carry the risk of toxic absorption with resulting damage to the kidneys. One u9eful emergency measure is to apply white of egg to the burned area. This is cooling and, if sufficient is applied, forms quite a good protective covering. But Hypercom or Urtica urens have proved their worth and can be used with confidence.

Electric burns call for the same treatment as outlined above. Anti-shock measures are especially important.

Burns by chemicals present a special problem. The immediate need is to thoroughly sluice the contaminated skin with water.

Writer- Dr Ricardo Kidron