FEATURED WORKSHOP

BREEMA: The Art of Being Present

Laura Ike, Certified Instructor

The most popular and highly rated workshop at our last two annual meetings returns as our featured workshop in 2003.

Learn several BREEMA treatment sequences.

Learn to use BREEMA techniques in your massage practice.

Practice and deepen your awareness of The Nine Principles of Harmony.

Enrich your skills as you practice the art of being present, for your personal benefit and the benefit of your clients.

SOFT TISSUE BURN INJURIES

By Robin Ann Schafer, LMT

You can describe burns by their cause: chemical, electrical, radiation and thermal – or by their depth. The deeper the burn, the more severe it is. Burns caused by heat (flame, hot liquid, or contact with hot surface) are the most common. Certain chemicals, however, can also cause burns. Electrical current can the body internally as well as externally. Radiation from the sun can cause sunburn.

A superficial burn first destroys only the top layer of skin. This is called a first-degree burn. The skin may appear pink in color, no blisters present, dry and the burn is usually painful (minor to moderate). The area may swell. Most sunburns are superficial burns. These superficial burns usually heal in 4 to 6 days without permanent scarring.

If it continues to burn, it injures or destroys the second layer of skin. This is called a partial thickness burn or a second degree burn. When burns break the protective layer of skin, they can cause infection and loss of fluid from the body. This can damage the body’s ability to control its temperature. Please note that the skin is bright pink to red and has blisters that may open and seep clear fluid. Consequently, this makes the skin appear wet. The burned skin may appear mottled or may appear blotchy (blanches with capillary refill present). These burns are usually painful and the area often swells. These partial thickness burns usually heal in 3 to 4 weeks. Scarring may occur.

Full thickness burns are also called third degree burns. Third degree burns may initially appear to be second degree (no blisters, dry/tight/leathery/ brown/tan/waxy or pearly white, no blanching or capillary refill, pain free, and needs grafting to heal). Deep burns can also damage the victim’s ability to breathe. A full thickness burn destroys all layers of skin and any or all of the underlying structures – bones, fat, muscles and nerves. These burns look brown or blackish (charred) with the tissues underneath sometimes appearing white. They can either be extremely painful or can sometimes be surprisingly pain-free if the burn destroys the nerve endings. These burns are critical.

Critical burns can be life threatening and needs immediate medical attention. Remember that it is not always easy to tell how severe a burn is right after it has happened. Call 9-1-1 or your local emergency number if a burn survivor: 1). Is having trouble breathing, 2) Appears to have burns on more than on part of his/her body, 3). Burns on the head, neck, hands, feet, genitals, perineum or major joints, and 4). Burns caused by chemicals, explosives, inhalation burns or electricity, 5). Third degree burns in any age group, and 6). Any survivor with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality.

How do you evaluate a burn? The severity depends on: 1). the temperature of whatever caused the burn, 2). the length of time the victim is exposed to it, 3). the burn’s location on the body, the size of the burn, 4). the victim’s age (other than a minor one to a child or an elderly person), and 5). The victim’s medical condition. Burns caused by hot flames or grease usually need medical attention, especially if the victim is a child or elderly. Burns caused by a hot flames or liquid that contact clothing is also serious. Be aware that the clothing keeps the heat in contact with the skin. Some fabrics even melt and stick to the skin. All these burns may appear minor at first but they can continue to get worse.

TREATMENT OF MINOR THERMAL BURNS

To care for a burn, follow these basic steps. First, stop the burn process. Put out the flames or remove the survivor from the source of the burn. For example, you may have to remove all clothing, diapers, jewelry, belts, metal and restrictive garments since they can retain heat and cause a tourniquet-like effect because of changes in the body tissues. If clothing has ignited, use low-pressure water to extinguish flames or smother the flames with a heavy blanket. After a scald or steam burn or contact with hot surfaces, flush burn area with low pressure running water to cool the burned area. Do not use ice except on minor burns, such as a burned finger from touching a hot stove. After cooling the burned area for several minutes, cover the burn with a dry, clean dressing to help prevent infection. Bandage loosely. Do not put any pressure on the burn. Do not put any kind of ointment or massage therapy lotion on the burn unless it is a very minor burn. Remember that ointments, lotions or oils may seal in heat and does not do much to relieve pain. Do not use other home or work remedies like butter or grease; they cause infection. Do not break blisters; keeping the skin unbroken helps prevent infection.

For minor burns and burns with open blisters that are not bad enough to need medical care, wash the area with a bland soap and water. Keep it clean. Leave the wound open or warp with light gauze. Next, put on an antibiotic bland ointment. Watch for signals of infection. Repeat cleansing process and ointment twice daily.

TREATMENT OF SEVERE BURNS

Stop the burning. For a serious burn, have someone else if possible call 9-1-1 or the local emergency number while you provide immediate care. If you are alone, provide one (1) minute of first aid care, and then make the call. Have a survivor of severe burns lie down unless he or she is having trouble breathing. Keep the survivor comfortable (keeping the survivor from getting chilled or overheated). Do not remove clothing if it is stuck to the burned soft tissue (skin). Raise burned areas above the level of the heart, if possible. Remember that burn survivors chill easily, so protect the survivor from drafts and keep the survivor dry. Please try to obtain the survivor’s past medical history and tetanus status. Don’t apply ice directly to any severe burn. Avoid touching a burn with anything except a clean, dry sterile covering/dressing. Do not try to clean a severe burn. Don’t break blisters. Don’t use any kind of ointment on a severe burn.

TREATMENT OF ELECTRICAL BURNS

If a survivor is being held by the source of electrical power: Turn the power off by removing the fuse for this circuit at the fuse box, or by switching the circuit breaker to “OFF”. Or – before attempting a rescue – use a nonconductive item (such as a wooden broom handle) to move the power source away from the survivor. Again stop the burning process if the clothing has caught fire by using low-pressure water to put out the flames or smother the flames with a heavy blanket. Electrical burns can happen at home, work or on the road (power lines, lightning, defective electrical appliances, equipment or unprotected electrical outlets). Never go near a survivor until you are sure that the power is turned off. If a power line is down, wait for the fire department or the power company. If there are survivors in a car with a downed wire across or under it, warn them not to move and stay in the car.

Did you know that with an electrical burn, the burn itself would not be the major concern? Check breathing and signs of circulation of the survivor is unconscious. Check for other injuries like a possible fracture, head, neck or back injuries. Do not move him/her. Cover an electrical burn with a dry, sterile dressing/covering. Note that because of the danger of possible electrocution and the good chance that the burn is deep and that it involves damaged nerves. The survivor may not feel pain. Do not cool the burn with water. Keep the survivor from getting chilled.

TREATMENT OF CHEMICAL BURNS

Stop the burning process by flushing away the liquid chemical agent with a low pressure running water. A bathroom shower is ideal. Remove clothing and jewelry while continuing to flush until EMS arrives. Stay in the shower for 30 minutes to 1 hour. Do not leave for the hospital until the chemical has been removed or diluted. Do not use neutralizing agents. Remember the stronger the chemical and the longer the contact, the worse the burn. The chemical continues to burn the survivor as long as it is on their skin. Caution: If only one eye has been affected, flush the chemically burned eye from the nose outward to prevent washing the chemical into the unaffected eye.

TREATMENT OF POWDERED CHEMICALS

Brush off as much of the powder as possible with a brush, gloved hands or a towel. Flush burn area with plenty of low-pressure running water.

TREATMENT IF CHEMICAL IS IN THE EYES

Flush eyes thoroughly with low-pressure running water. Hold the survivor’s eyelids open. Remove contact lenses while flushing with water. Do not use neutralizing agents.

FIRST AID INSTRUCTIONS

These first aid instructions apply to all of the above burn injuries:

First: Second: Fourth:

1). Provide first aid 1). Keep survivor warm 1). Contact their physician

2). Assist breathing; use CPR if necessary 2). Wrap in sheet and blankets

3). Stop bleeding Third:

4). Treat for shock 1). Stay with the survivor

5). Prevent further trauma 2. Provide emotional support