Burns are some of the most common types of injuries that we encounter in our day-to-day life.
All of us face this trauma on a regular basis, and that makes it important for us to know about burns in detail, to do a quick first aid on us or anyone who has suffered from burns.
Timely and quick first aid can go a long way in helping and saving the patient, and aid the physician to perform a more effective job to help the sufferer. Burns may range from a very small injury like the ones from a candle to those from a major trauma that requires hospitalization.
But burns, be it small or extensive, is not a very pleasant experience and causes a lot of physical and mental agony to the injured.
Burns can be defined as a type of necrosis, which could be coagulative in nature, caused by heat, transferred from a source to the body.
Burns is a type of injury caused to the body by dry heat whereas injuries that are caused by wet or moist heat like the ones caused by steam are termed as ‘SCALDS’ which are equally common to burn injuries.
A temperature of more than 44° Celsius is necessary to cause a burn to the body.
TYPES OF BURNS:
Burns are broadly classified into three types,
- THERMAL BURNS
- ELECTRICAL BURNS
- CHEMICAL BURNS
Thermal burns include burns caused by flames and scald burns (moist heat burns).
Based on the depth of the injury and the layer of the skin involved,
FIRST DEGREE BURN:
- Only the epidermis (the most superficial or the outermost layer of the skin) is involved in these types of burns.
- Pain is usually present in case of first-degree burns
- Swellings or masses are usually common
- A reddish or erythematous appearance of the skin with blisters is present.
- Healing usually takes place within 3 to 5 days of the injury.
SECOND DEGREE BURNS:
- The varying depth of the dermal layers are affected
- Pain may or may not be present depending upon the depth of the injury. But pain is usually present in 90% of the cases.
- Swellings, blistering, and masses are common
- The skin may appear pale or whitish, soft, waxy, and elastic in nature, pain sensation may be present to a needle prick
- Usually takes 10 to 20 days to heal, which is usually accompanied by hypertrophic scars (scars that are raised from the skin and are characterized by an excess amount of collagen deposition).
THIRD DEGREE BURNS:
- In these types of burns, the entire depth of the dermis and the epidermis are involved.
- The sensation of pain is completely lost in this degree of burn
- No swelling, mass, or blistering is usually present.
- The skin might appear tough, dry, eschared (a type of dried and dead skin that falls off like a scab) and the subcutaneous veins might show out heavily thrombosed, no pain sensation to needle prick is present.
- Might take more than 3 to 5 weeks for the eschar to separate. Hospitalization is compulsory in these types of cases and a surgical intervention done by the means of grafting.
FOURTH DEGREE BURNS:
- A most severe form of burn injury.
- These are potentially life-threatening burns that cross the entire thickness of the skin and cause injury to the muscles, ligaments, tendons, and bone.
- Causes a lot of complications like infections.
CAUSES OF BURN INJURY:
There are a large number of causes for a burn injury to occur like,
- Accidental fire outbreaks
- Contact with hot liquids or steam
- Electric currents
- A certain form of radiation like X-rays
- Tanning beds especially common in western cultures, ultraviolet radiation, sunlight, etc.
- Contact with chemicals like acids, dyes, etc.
MECHANISM OF BURN INJURY:
Let us try to understand what happens in the body after we get exposed to a burn injury. This mechanism is common from minor injuries to fourth-degree burns.
After a burn, the heat from the source causes coagulation necrosis of the skin (dermis and epidermis) and the underlying subcutaneous fat.
This coagulative necrosis further causes’s release of certain vasoactive peptides which causes an alteration in the capillary permeability that ultimately leads to loss of fluids, this gives rise to severe hypovolemia (an abnormal decrease in the volume of blood plasma usually as a result of dehydration or bleeding). This hypovolemia causes decreased cardiac output and renal blood flow. This explains the oliguria (abnormally low levels of urine output) present in burn patients. Pulmonary edema caused due to altered pulmonary resistance might cause infection leading to Systemic Inflammatory Response Syndrome (SIRS) leading to Multiple Organ Dysfunction Syndrome (MODS).
Now having an idea about the causes, mechanisms, and types let’s take a look at the most important aspects like prevention, some basic management or first aid, and certain forms of treatment after hospitalization for treatment of burns.
PREVENTION OF BURN INJURIES:
As every one of us knows and always agrees to the saying, “Prevention is better than cure” this applies and hugely makes sense for burns. Being careful and vigilant, when being around the fire or any hot objects for that sense, can save us from a lot of physical and mental pain. These simple tips can help us remain careful,
- Make homes childproof if there are infants or children in the household. Start by blocking out or locking the heating grills, stoves, room heaters, etc.
- Always check the temperature by taking small portions before consuming hot food
- Avoid placing any form of electrical appliances near water
- Avoid access to children in the cooking area.
- Never wear clothes that easily catch fire easily or loose-fitting clothes when working next to a fire
- Never use chemicals without using protective clothing or eye-wear
- Make sure there is a fire extinguisher on every floor and ensure that they are in working condition, get them inspected frequently
- Unplug electrical devices and make sure they are out of reach from kids.
Follow these simple steps to ensure safety at your home and in your neighborhood.
FIRST AID AND MANAGEMENT OF BURNS:
- Before ensuring any form of treatment makes sure to move the patient away to safety. E.g., away from the source of fire, etc.
- Put out the fire like rolling over the floor, or using a sack over the victim and rolling him on the floor to put out the fire.
- Three simple words to remember are, “To stop, drop and roll”
- Remove any clothing present above the burnt part. After putting out the fire, remember to cool the burned portion in the skin, this might provide a form of pain relief and might delay the process of damage to the underlying vascular structures. This process of cooling should be somewhere between 10 minutes to an hour
- Administering oxygen flow is necessary if we detect the victim to be unconscious.
- Remember to check in the airway is patent, breathing and circulation are normal.
- Elevate the burned part above the body level or precisely above the heart level to avoid swelling, making the person sit upright might prove to be very helpful to ensure uninterrupted breathing and less discomfort. Cover the burned part with a moist sterile gauze if available or use clean wet towels.
- Make sure the patient is comfortable and check for any secondary injuries suffered.
- In case of massive injuries make sure to stabilize the head and spine properly in order to avoid any further damage. Stabilization can be done by avoiding movement and placing rolled towels to keep the head in line with the spine or use both the hands-on either side of the patient’s head and hold firmly.
It is very important to note that in the case of 3rd-degree burns,
- Do not remove the burned clothing from the patient
- Remember not to immerse severe burns in cold water as it might cause a drop in the body temperature ultimately leading to the deterioration of blood pressure and circulation.
- Perform these tasks effectively and stay with the patient until the paramedics arrive and hand over the patient for further treatment.
It is also important to know that major or large burns require immediate hospitalization. A burn can be classified as a major burn if they fall under the following categories,
- The burn covers a large area of body parts like the hands, legs or joints and larger blisters develop over that region.
- When the burn id due to electric current, chemicals and involves smoke inhalation.
After hospitalization the following forms of treatment are done:
- Swelling in the airway as a result of burns might cause them to close up causing breathing difficulties in the patient.
- Hence, the doctor might perform endotracheal tube intubation until the swelling subsides and the patient is able to breathe on his own
- If the airway patency diagnosed in a later stage or when the larynx becomes inflamed making it difficult to perform an endotracheal intubation a procedure called ‘cricothyroidotomy’ done to make the airway patent.
- Checking the respiratory rate, pulse, and oxygen circulation are very important. The patient should be monitored closely till they stabilize.
- The patient is provided warm humidified oxygen to aid in breathing.
One of the most important aspects of burn management is maintaining the fluid balance in the system,
- The fluid balance could be maintained through intravenous lines to perfuse the organs in the body. The most common fluid is the ringer’s lactate solution (a form of crystalloid). Later maintenance can be done using dextrose saline.
- Fluid rehydration can also be taken in the oral form provided the solution is properly balanced with the required salts or electrolytes.
Monitoring the urinary output is also important to know the amount of fluid lost from the body.
TREATMENT OF BURNS:
Dressing of the wound is usually done using the hydrocolloid dressing, paraffin gauze or the artificial or natural dressings.
In certain cases, an antibacterial dressing is done before surgeries to avoid microbial invasion.
The treatment of burns can broadly be classified as open and closed methods
THE OPEN METHOD:
- Most commonly followed for minor wounds or if the patient is in a hospital setting with proper fumigated ward facilities.
- The wound is left open to the atmosphere after topical application of silver sulfadiazine cream.
THE CLOSED METHOD:
- The closed method involves the application of medications like silver sulfadiazine over which 1% silver nitrate, mafenide cotton rolls applied and a bandage secured.
- This method has certain advantages over the open methods like less pain, reduced infection, sogging, and better medication penetration.
THE TANGENTIAL EXCISION:
- This form of treatment is usually done to prevent the risk of septicemia (a condition caused due to the invasion of bacteria in the bloodstream affecting a lot of organs) and secondary infection.
- Decrease the timing of hospital stay.
- To decrease the incidence of occurrence of scarring and contractures.
- Reducing the cost of treatment.
Tangential excision is a process in which the burn wound is excised tangentially until fresh bleeding occurs. This is followed by skin grafting over the burnt region. The graft can be procured from the same donor from a normal region with the thighs being the most common donor region. In cases where the skin graft cannot be taken from the donor, skin banks are used. Mesh expanders and cell cultures are also used.
In cases where the damage is severe and the above treatment modalities cannot be followed, surgery has to be performed after careful evaluation of the body status.
Some of the procedures include Free Skin Grafting (FSG) in the form of split thickness grafts and full thickness graft as we already saw.
- FSG is mostly done in cases of avulsive or degloving injuries, after excisions of large tumors following surgeries for cancer or pathological processes.
- After lesion excisions from the oral cavity and resurfacing reconstructed vagina in cases of vaginal agenesis (mucosal loss)
Other modalities include use of local, regional and distant flaps to treat a wound.
Drug administration is very important in burn injuries. The commonly used drugs are
- Broad-spectrum antibiotics like cephalosporins
- Narcotic pain killers (in the form of intra-muscular injections) like morphine, pethidine etc. to manage the severe pain
COMPLICATIONS OF BURNS:
- Sepsis or infection is the most common complication followed by fluid loss, drop in the blood pressure, breathing problems after inhalation smoke injuries, scarring commonly referred to as keloids, and scar tissue shortening referred to as contractures.
- Death in severe cases
DEATH IN BURN PATIENTS:
- The hypovolemic shock from uncontrolled loss of body fluids
- The septicemic shock from bacterial invasion (common causes).
- Chocking or suffocation from respiratory injuries or injuries of head and neck.
Thus having seen and understood about burns it is very important to stay careful and avoid getting one since these are some of the most easily acquired injuries. Try to follow the above said simple steps as first aid before help arrives and benefit from it.