One of the most painful injuries that one can ever experience is a burn injury. When a burn occurs to the skin, nerve endings are damaged causing the intense feelings of pain.
The infusion of large quantities of fluid, mainly a salt solution, as many as 3-4 liters daily, has proved satisfactory. Sometimes a life is saved if not more than one-quarter of the body surface has received a third-degree burn. I have given blood transfusions to two patients with severe burns, with recovery in one case and postponement of death in the other.
Burn injuries, have reached epidemic proportions in recent years and are considered a health care problem that is more serious than the polio epidemic when it was at its peak. It has only been in the past several years that the medical profession has begun to recognize and understand the problems associated with burns. Burn accident statistics show that at least 50% of all burn accidents can be prevented. Across the world approximately 4.8 million burn injuries are reported per year. Between 18,000 and 22,000 patients with burns die, and approximately one million will sustain substantial or permanent disabilities resulting from their burn injury.
The kitchen is the most frequent area within the home where burn injuries occur for children newborn to four years in age. The second most frequent area in which burns occur is in the bathroom.
Burns can be of two kinds based on the extent of damage:
Partial Thickness Burns : In partial thickness burns, there may be redness due to capillary dilatation but the underlying germinal layer is intact.
Full Thickness Burns : In full thickness burns, the skin is completely destroyed.
What are the symptoms of Burns?
Besides skin, burn injuries can affect muscles, bones, nerves, and blood vessels. The respiratory system can be damaged, with possible airway obstruction, respiratory failure and respiratory arrest. Burns impair the body’s normal fluid/electrolyte (water & salt) balance, body temperature, body thermal regulation, joint function, manual dexterity. Patients may also suffer emotional and psychological problems.
What causes the burns and the depth of injury?
Thermal : including flame, radiation, or excessive heat from fire, steam, and hot liquids and hot objects.
Radiation : such as from nuclear sources. Ultraviolet light is also a source of radiation burns.
Light : burns caused by intense light sources or ultraviolet light, which includes sunlight.
Electrical : including electrical current and lightning.
Depth of injury
First degree burns are superficial injuries that involve only the epidermis or outer layer of skin. They are the most common and the most minor of all burns. The skin is reddened and extremely painful. The burn will heal on its own without scarring within two to five days. There may be peeling of the skin and some temporary discoloration.
Second degree burns occur when the first layer of skin is burned through and the second layer, the dermal layer, is damaged but the burn does not pass through to underlying tissues. The skin appears moist and there will be deep intense pain, reddening, blisters and a mottled appearance to the skin. Second degree burns are considered minor if they involve less than 15 percent of the body surface in adults and less than 10 percent in children. When treated with reasonable care, second degree burns will heal themselves and produce very little scarring. Healing is usually complete within three weeks.
Third degree burns involve all the layers of the skin. They are referred to as full thickness burns and are the most serious of all burns. These are usually charred black and include areas that are dry and white. While a third-degree burn may be very painful, some patients feel little or no pain because the nerve endings have been destroyed. This type of burn may require skin grafting. As third degree burns heal, dense scars form.
FIRST-AID
Remove patient from source of burn.
Remove smoldering or contaminated clothes.
Apply cold running water over the burnt area.
Cover the victim with clean dry cloth or cling-film.
Elevate the patient.
How can Burns be treated?
Local treatment in partial thickness wounds
Cleaning
Dressing with non-adherent paraffin gauze
Medication in the form of cream
Full thickness wounds
Immediate excision and skin grafting give good results in the long run. Donor skin may be taken from, other unaffected areas, from a relative, from skin banks or from the skin of pigs which are normally compatible with human skin (xenograft).
General treatment
Relieve pain with intravenous pain relievers or local anaesthetic creams.
Fluid replacement into the body to compensate the fluid loss.
Therapy to combat infection that can occur in the burnt area.
Anti microbial therapy.
Nutritional support.
More valuable information about Burns
Area burnt is calculated using the ‘Rule of Nine’ where
¨Head and neck ¨1 X 9 = 9
¨Each arm ¨2 X 9 = 18
¨Each leg ¨2 X 9 = 18
¨Front of the trunk ¨2 X 9 = 18
¨Back of the trunk ¨2 X 9 = 18
¨Perineum ¨1
¨Patient’s hand ¨1%
Complications occurring at the local site
Wound infection
Scarring
Wound contractures
Complications occurring throughout the body
Generalized Infection
Acute peptic ulceration
Seizures
Kidney failure
Psychological disturbance
Frequently asked questions about Burns…
Which specialist should I see if I have Burns?
You should immediately consult a specialist.
What is the prognosis of burn injury?
It can be roughly calculated by adding the patients age + percentage of body area having full thickness burns and if the total value exceeds 100, the patient’s chance of survival is low.
Can Ink help burns?
No, always use cold water only.
Glossary
Capillary : The blood vessels linking arteries and veins.
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