SCALD analysis is done to determine the extent of the burn and its severity before developing a treatment plan. This method is used in clinical practice or research when one has relatively limited information about the patient. SCALD stands for S-size, C-cause, A-age, D-depth, and L-location.
Burns are usually described by their size (surface area). Most burns are first-degree burns that only damage the superficial cutaneous layers of skin. These are generally red in color, painful, and may or may not be associated with blisters or swelling. These do not require treatment and heal within a couple of days. Most burns are minor, so often they can be treated at home.
The cause of the burn is important because it’s different for adults vs. children, chemical vs. fire, etc. Chemical burns are usually more severe than fire burns because they involve more deep layers of skin and can cause more damage to structures that are present in the skin, such as blood vessels, muscles, and bones.
The age of the patient is essential because it determines how much subcutaneous fat they have. The older someone is, the less subcutaneous fat there will be, meaning their burns can be deeper and more severe than a child who has more subcutaneous fat.
How deep is the burn? Usually, first-degree burns affect only the top layers of skin and do not go deeper than the second layer. Second-degree burns affect both the first and second layer of skin; this means that they cause blistering and swelling but usually don’t damage any deeper structures. Third-degree burns go through the entire skin layers, blistering isn’t present, but there will be deep second-degree burns. These are usually associated with white or black charring or silver coloration on the skin, along with redness over an area of heat damage.
Where is the burn? Certain body parts have more subcutaneous fat than others; these body parts are prone to burns. For example, perineum or scrotum burn can cause damage to the subcutaneous fat and is very commonly seen in children under the age of one. Heat burns can be extremely severe due to the high blood vessels close to the skin surface. People with darker skin have less visible burns of the same size, but that doesn’t mean less severe.
STEPS ON HOW TO PERFORM SCALD
1. Determine The SCALD Size
The size of a scald can be determined by assessing its depth, also known as ‘degree.’ There are various methods in classifying degrees, the temperature is one of them. The most commonly used classification, however, is that based on medical assessment. This article will only discuss the latter.
2. Assess the SCALD Cause
Scalds are often given medical causes: contact with hot liquids or steam, chemicals, hot objects, and fire. The severity of scald is dependant on the temperature of the object touching the skin. However, in the case of a scald caused by chemicals or fire, it might take even less time for one’s skin to be affected.
3. Assess the SCALD Age
The age of a scald can be determined by assessing its depth and its location. In general, the deeper a scald is and the more layers of the skin it involves, the greater its age will be.
4. Assess the SCALD Depth
The depth of a scald can be determined either by ‘medical assessment’ or ‘clinical assessment.’ The former would comprise visual inspection by a medical professional, after which they would state the magnitude of the scald. Clinical assessment, however, is done by asking the patient himself to describe how deep his injury feels.
5. Assess the SCALD Location
A scald can be either partial-thickness or full-thickness, depending on its depth and age. A scald less than 1mm in depth caused by contact with hot water from the hottest tap shall be referred to as partial thickness. As a rule of thumb. A scald that is deep and has been around for more days is classified as full-thickness.
6. Establish the Appropriate Dressing For the Patient
After assessing the type and depth of a scald, one can determine which dressing would be most appropriate to use. For example, water-based moisturizers and dressings are highly recommended for shallow partial-thickness scalds. In contrast, simple non-adherent dressings such as paraffin gauze would be most suitable for superficial partial-thickness injuries.
7. Follow Up On the Patient
A scald that has not healed within six weeks may require further intervention. A medical professional should be consulted if blisters are present, infection becomes evident, or any signs of scarring.
8. Inform the Patient Of What To Expect
Although some scalds may not require any dressing, some others may still take up to 6 months to heal on their own. This will depend on the size and depth of the injury and how young or old the patient is. On average, such scalds shall take about three months to heal.
9. Inform the Patient Of What Not To Do
Scalds that are deep and have been around for a long time will be more susceptible to infection by bacteria. Therefore, the patient should not share towels or allow other people’s sweat to come into contact with his scald. He should also avoid sleeping on it or exposing it to excessive heat.
10. Post-Intervention Care
The patient must be instructed to keep his injury clean and dry after it has healed completely. This can prevent scarring so long as the site is protected from the sun’s ultraviolet rays which would otherwise cause it to darken.
Following Are Essential Steps To Consider When Identifying And Treating A Burn.
1) Once you have assessed for airway, breathing, and circulation (ABCs), make sure there isn’t a bigger cause for concern
2) The size of the burn can indicate how serious it is and how much it will likely affect the patient
3) The age of a burn can determine how much treatment is necessary
4) Burning over a large area or a certain depth needs more aggressive treatment
5) Knowing exactly where on the body a burn occurred can help you treat it effectively and quickly.