Burns

What are the categories of burns? The categories of burns and their treatment very much depend on the depth, area and location of the burn. Burn depth is generally categorized as first, second or third degree. A first degree burn is superficial and has similar characteristics to a typical sun burn. The skin is red in color and sensation is intact. In fact, it is usually somewhat painful. Second degree burns look similar to the first degree burns; however, the damage is now severe enough to cause blistering of the skin and the pain is usually somewhat more intense. In third degree burns the damage has progressed to the point of skin death. The skin is white and without sensation. Regardless of the type of burn, the result is fluid accumulation and inflammation in and around the wound. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. Damage to the skin can predispose the burn victim to both infection at the site of the wound as well as internally. What is the significance of the total body area affected? In addition to the intensity, the total area of the burn is significant. This is usually measured in terms of percent of total body burnt. The skin acts as a barrier from the environment, and without it, patients are subject to infection and fluid loss. Burns that cover more than 15% of the total body surface can lead to shock and require hospitalization for intravenous fluid resuscitation and skin care. How important is the location of a burn? Burn location is even more important than the above factors. Burns of the neck or signs of burns to the nose or mouth can require emergent guarding of the patient's airway, as swelling can result in life-threatening obstruction of the airway. Burned tissue shrinks and can cause damage to underlying structures. Burns that extend circumferentially around body structures require surgical release of the tissue, often referred to as escharotomy. Finally, all eye burns require special attention as soon as possible. Burns to the eye may lead to clouded or lost vision if tissues, such as the cornea, are injured.

BURN FIRST AID TREATMENT 1. First remove any constricting jewelry, such as rings. 2. Do NOT use butter or oils on a burn. 3. The effected area should be dowsed with cool water as soon as possible. It can be cleansed gently with chlorhexidine solution. Do NOT apply ice or cool to near-freezing temperatures (this can cause additional tissue injury). 4. A tetanus booster should be obtained if not administered within the previous 5 years. First degree thermal burns can be treated with local skin care such as aloe vera. Many topical antibiotics and antiseptics are available in the drug store for minor burns. All second and third degree thermal burns and the complicated locations listed above need immediate physician evaluation. Special topical antiseptic creams are used for more serious burns, including silver sulfdiazine, silver nitrate, and mafenide acetate creams. Burns can be caused by heat (thermal), as well as by electricity, and chemicals.

What about electrical burns? Any significant burn resulting from electricity, requires immediate physician evaluation. These burns often result in serious muscle breakdown, electrolyte abnormalities, and occasionally kidney failure. The actual site of damage can be internal and may not be visible on the skin surface.

What about chemical burns? The treatment for chemical burns is similar to thermal burns except copious amounts of water should be used to irrigate the effected region. Contaminated clothing should be removed. Do NOT attempt to neutralize the burn with a reciprocal chemical. This may cause a chemical reaction that could result in a thermal burn too! Many chemicals have, in addition, specific treatments that can further reduce the resulting skin damage. If you are uncertain, call your local poison control center or make a quick trip to your local Emergency Room.

Definition

A burn is damage to the skin and sometimes to the underlying tissues. Burns are categorized according to the depth and extent of the damage to the skin: Superficial burn (also called first-degree burn) o Mildest type of burn o Often caused by ultraviolet light, or very short (flash") flame exposure o Affects only the outer layer of the skin (epidermis) o Normally does not cause scarring o Takes about three to six days to heal Superficial partial-thickness burn (also called second-degree burn) o Often caused by a scald (spill or splash) or short (flash) flame exposure o Affects the outer layer of the skin more deeply, usually causing blistering o Usually does not cause scarring, but may cause long-term skin color changes o Takes about one to three weeks to heal Deep partial-thickness burn (also called second-degree burn) o Often caused by a scald (spill), may involve flame, oil, or grease o Affects the outer and underlying layer of skin (dermis), causing blistering o Usually causes scarring o Usually takes more than three weeks to heal Full-thickness burn (also called third-degree burn) o Very serious o Often caused by scald (immersion), may involve flame, steam, oil, grease, chemicals, or high-voltage electricity o Damages all layers of the skin, and may involve the tissues underneath (muscle and bone) o Causes scarring o Will heal only at the wound edges by scarring, unless skin grafting is done

Causes
Burns can be caused by: Heat or flame (thermal burns) o Hot foods or drinks such as boiling water, tea, or coffee o Hot oil or grease o Hot tap water o Direct heat such as stoves, heaters, or curling irons o Direct flame o Flammable liquids such as gasoline o Fireworks Chemicals (chemical burn) strong acids or strong bases such as: o Cleaning products o Battery fluid o Pool chemicals o Drain cleaners Sunlight (sunburn) Electricity (electrical burn) o Damaged electrical cords o Electrical outlets o High-voltage wires o Lightning

 Radiation (radiation burn) o Nuclear radiation o X-rays o Radiation therapy for cancer treatment o Tanning beds

Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. Risk factors for burns include: Age: Less than 4 years Sex: Male Low socio-economic status Smoking Alcohol use Illegal drug use Absent or non-functioning smoke detectors Substandard or older housing Unsupervised or improperly supervised children Using tap water hotter than 120 degrees

Symptoms
Burn symptoms and signs vary depending on the type of burn. Superficial Burn Symptoms include: Burned area turns red and is painful The area blanches (turns white) when you press on it The area may swell, but it is dry and there is no blistering Superficial Partial-thickness Burn Symptoms include: Blisters The area is moist, red, and weeping The area blanches (turns white) when you press on it Painful to air and temperature

Deep Partial-thickness Burn Symptoms include: Blisters, usually loose and easily unroofed The area can be wet or waxy dry The skin color can vary from patchy, to cheesy white, to red The area does not blanch (turn white) with pressure May or may not be painful, can perceive pressure

Full-thickness Burn Symptoms include: Skin can appear waxy white, leathery gray, or charred and blackened May not be painful if nerves have been damaged, the only sensation may be to deep pressure

Diagnosis
The doctor will ask how the burn occurred and will examine the burned area. Treatment will depend on the cause of the burn, how deep the burn is, and how wide an area of the body is covered. Doctors have methods and charts to estimate the total percentage of body surface area (TBSA) affected by the injury. This estimate is age dependent; for example, the head represents a larger percentage of surface area in a baby than in an adult.

Treatment
Treatment for a burn depends on the cause. Quick treatment is important and can lessen the damage to the tissues. General Guidelines for Self Care of Burns: You can treat a superficial burn as minor, unless it involves large areas of the hands, feet, face, groin, buttocks, or a major joint. For these areas, or severe and extensive sunburn, see your doctor. You can treat a superficial partial-thickness burn as minor if it is no bigger than 2 to 3 inches in diameter. However, if the burned area is larger, or if the burn is on the hands, feet, face, groin, buttocks, or a major joint, seek medical attention immediately. For more serious burns, like deep partial-thickness or full-thickness burns, seek medical attention immediately or call 911. For more serious burns, until an emergency unit arrives: o Do not take off any clothing that is stuck to the burn o Make sure the victim is not near or in contact with any smoldering materials, or exposed to further smoke or heat

o Do not soak the burn in water, but you can cover the area with a cool moist sterile bandage or clean cloth o As with any severe injury, make sure the person is breathing and administer CPR if necessary

First Aid for Minor Burns Cool the burn with running water or a cold damp cloth.Do not use ice. Do not use butter, grease, oils, or ointments on the burn. Cover the burn with sterile gauze or a clean cloth. Do not use a fluffy cloth such as a towel or blanket. Take an over-the-counter pain reliever, like acetaminophen (Tylenol). Do not break any blisters. If you see signs of infection, get medical attention. Signs of infection include: o Increased pain o Redness o Fever o Swelling or oozing

Once a minor burn is completely cooled you can consider using a lotion or moisturizer to prevent drying and make the area more comfortable.

Special Cases:
First Aid for Chemical Burns If the chemical causing the burn is a powder, brush the powder away from the skin first. Check the package insert for emergency information. For certain dry or powdered chemicals it may not be appropriate to flush the skin with water. If indicated, flush the skin with cool running water for 20 minutes or more. Remove any contaminated clothing or jewelry while flushing the skin. If the eyes are affected, flush eyes with cold water until medical help arrives. Cover burn with sterile gauze or a clean cloth. Do not use a fluffy cloth such as a towel or blanket. Do not break any blisters. Keep the person from becoming chilled or overheated. Take the person to the nearest hospital if there are any signs of shock, difficulty breathing, or if the chemical burn occurred on the eye, hands, feet, groin, face, buttocks, or over a major joint. Emergency medical assistance is also indicated if the chemical caused a partial-thickness burn greater than 2-3 inches in diameter, or if you are unsure if a substance is toxic. First Aid for Electrical Burns

 Stop the electrical current by unplugging the appliance from the electrical outlet . Do not touch the person until the current has been stopped. If you cannot turn off the source of the electricity, move the source away from you and the person by using a nonconducting object, such as cardboard, plastic, or wood. Once you and the person are clear of the source of electricity, check the person for airway, breathing, and circulation. Start CPR if necessary. Cover burn with sterile gauze or a clean cloth. Do not use a fluffy cloth such as a towel or blanket. Do not break any blisters. Keep the person from becoming chilled or overheated. All patients with electrical burns or jolts need to go to a hospital immediately. Electrical burns can cause serious internal damage, without much evidence on the skin. In such cases, people need to be evaluated for heart rhythm disturbances as well as burns.

Hospitalization A doctor will decide if hospitalization is necessary based on many factors. These include: age, the cause of the burn, and the extent and depth of the burn. Reasons to hospitalize a person who has more than a minor burn may include: Age: younger than 5 years or older than 55 years Suspected child abuse Extensive burn: using TBSA (total body surface area) and age charts Very small deep burns on the hands, face, feet, or perineum (groin/genital area) Burns that may require complicated dressing changes, elevation, or continued physician observation High-voltage injury or burn Suspected or known inhalation injury Circumferential burn Other medical problems that predispose a person to infection, such as: o Diabetes o Immunosuppression o Sickle cell disease

Medical Treatment for Major Burns If the burn is serious, the following treatments may be administered in a hospital: Oxygen to help with breathing Intubation the insertion of a tube in the throat to help with breathing Intravenous fluids to replace those lost from the burn Skin graft skin taken from another part of the body, another person, or an animal such as a pig is attached to the burned area to replace the damaged skin

 Splints placed on joints to help maintain mobility Physical therapy, in the case of large burns

Prevention
Most burns are the result of accidents. To prevent burns: Teach children about fire prevention and keep dangerous materials out of reach. Make sure smoke detectors are installed and in working orders. Replace batteries twice a year. (One way to remember to do this is to change batteries the same days you change the clocks for daylight savings time.) When cooking, keep pot handles turned toward the back of the stove. Supervise young children in the kitchen and around fireworks. Set the temperature on the water heater to 120 degrees Fahrenheit. Make sure childrens sleep wear is flame-retardant. Dont hold children in your arms or lap while cooking, serving, or eating hot foods or liquids. Do not leave matches, lighters, candles, or burning cigarettes unattended. Wear protective gloves and clothing when handling caustic chemicals. Put protective covers on electrical outlets. Do not wear loose-fitting sleeves while cooking. Keep children and pets away from the stove while cooking. Make sure electrical cords are not hanging over the edge of countertops. Store chemicals and cleaners in a locked cabinet. Children younger than one year can sustain partial-thickness burns from hot seat belt straps or buckles in car seats. Make sure car seats are not hot before putting a child in the seat. If you park in the sun, cover the seat with a towel.