First Aid

Depends on how bad the burn is, so let's identify that first. -- First-degree burns are like a sunburn. The epidermis isn't broken. They're typically pretty harmless, although painful. As the skin isn't broken, problems with infection, sterility, etc. aren't part of the equation. These are typically only dangerous -- and require medical attention -- if sensitive areas, e.g., eyes, are burned. You can use an analgesic (painkilling) cream on them and that's about all you need. -- Second-degree burns are blisters or what's left behind after the blister breaks. Because these do interrupt the epidermis, they have a lot more potential for harm. Typically, I say you can treat second-degree burns at home if they're less than about 4 square inches in surface area, and they aren't in a particularly critical area. -- Third-degree burns go through the thickness of the skin. This means the skin is there but detached, or the skin is completely gone and you're down to underlying tissue. These always require an ER. First degree -- make sure it really IS first-degree. Make sure delicate areas aren't hurt (if they are, see below). Otherwise, applying cream and cool, wet compresses can help. As the blood flows to the capillaries with this, your patient can get chilly pretty quickly. Treat as if for shock and maintain body temperature. As always, give fluids and electrolytes, and keep an eye out to make sure nothing else happens. Sun "Allergy" -- in extreme cases of sunburn, a histaminic reaction may occur, and the sunburn itches wildly. This can be easily remedied with an antihistamine. Get Diphenhydramine and take the dosage recommended on the box. As this is actually a pretty uncomfortable injury, consider the maximum dosage that is recommended. Painkillers too -- Ibuprofin or other NSAID's (Non-steroidal Anti-Inflammatory Drugs) help some. Second Degree -- if it's a blister, don't pop it -- leave it be. It's your body's way of protecting a damaged area. Just protect the area with a loose, clean bandage. If the burn is small, you can keep the patient at home and observe.

But large second-degree burns DO need to be seen by the ER. If the blister has popped, just gently bandage the area with sterile bandages and wrap loosely -- you want the dressing to come off easily at the ER. If you're going to keep the patient at home (or even in the field), the answer is different. At home, with a small, open burn, you can flush the wound with sterile saline or sterile water to clean it. You can apply some Betadyne as a disinfectant if the wound is small. Burn creams like Silvadene (Silver sulfide) are great, but require a prescription. I tend to avoid other creams, as they tend to act as adhesives for dirt, bacteria, etc. But under a bandage, they can help. Treating in the field is a little different. Cut away any dead skin from the blister if any remains. Flush the wound, and cover with sterile dressings, but wrap more tightly so as to protect the area. Burns infect easily, so it's a good idea to get out of the field for any but the most minor burns. For large second-degree burns in the field (the ones that should be in an ER but can't be), note that the body dumps a lot of moisture through open burns. So you'll need to cover the wounds with sterile dressings, as usual, to prevent further contamination and to protect. But you'll need to keep an eye on hydrating the patient. A burn the size of your palm can become a dehydration problem in the field. Larger is more problematic, so keep them drinking (fruit juices or sports drink are good, as they replace electrolytes). In the field, consider painkillers. Once you've stabilized, your goal is to get out of the field. Note: Do NOT cover burns with butter or grease -- it has to be cleaned off at the ER, which is harmful and painful. Don't use alcohol as an antiseptic -- it's super painful and acts as a surface desiccant, which will exacerbate dehydration problems. Flushing a burn with sterile saline or water is always pretty safe, and is the method of choice with larger burns away from help, but if you're close to an ER, don't disinfect at all -- just get the patient there. Long-term treatment is mostly checking the wound and watching for infection. Third-degree burns are clear through the skin. Firefighters, who know this wound all too well, say to look for a "burned meat" or "fried chicken" look, which is an indication that the damage has passed though the skin. These always require professional help. Bandage loosely to keep the burn clean, remembering always that someone will have to remove that bandage. Treat for shock and get the patient to the ER. If you're in the field, bandage well to protect the wound. If you have antibiotics and are far from help, consider using them, as this wound often infects. If you're an hour or two away, don't bother -- just make haste. Keeping the patient hydrated is now a much more critical factor, and boats and such -- which can't always expect help for a day or sometimes a week -- will stock enough normal saline to start a subcutaneous line to rehydrate the patient. DO NOT do this if you don't know how, or if you expect help in hours. The only good news is that early in the process, third-degree burns often don't hurt, as the nerve tissue has been burned away. This of course doesn't last, so your long-term picture should include pain control. In summary: The overall treatment is to flush (usually); bandage to protect; see to the patient's comfort; make the decision to find an ER or not; and act on it.

The Buckle or torus fracture is an extremely common injury in children. The previous response stated "Get them sent to an A&E/ER immediately, unless you want the risk of a deformed forearm occurring as the bone heals".

A search of the literature shows that in most cases this type of fracture can be effectively managed by either acute hospital-based professionals or outside the hospital eg a local GP with additional training.

How to treat it?

For example the J Pediatr Orthop 25: 322-325, 2005 states that t he current treatment regimen recommends some type of immobilization with either a cast or splint. The study showed that buckle fractures in the radius may be safely treated in a soft bandage without long-term adverse effects to the child. Numerous other studies confirm the effective use of splints.