Clinical Example

The child A.Z., four years old, was burned with flame in a domestic environment on 30 September 2001. After first aid in a regional hospital, the patient, receiving intravenous therapy with isotonics, was transferred to our centre approximately 5 h post-burn. The diagnosis on admission was second- and third-degree 40% TBSA burns in the trunk, head, and extremities. The third-degree burns, in the posterior part of the trunk and extremities, were calculated as 30% TBSA. Resuscitation was performed immediately with Ringers lactate according to the Carvajal formula, i.e. 3.6 ml/kg/% in 24 h with a total Na+ load of 0.4 mEq/kg/%. The child successfully overcame the shock phase, with a mean urinary rate of 1.5 ml/kg/h. In this phase we observed generalized oedema in the head, which reduced after 48 h. On day 3 we observed the onset of the systemic inflammatory response syndrome (SIRS), with high values of temperature (> 39 C), cardiac rate (> 100/min), respiratory rate (> 28/min), and leucocytosis (12,000/mm3. In the expectation of severe life-threatening sepsis, we decided to begin antimicrobial therapy as soon as possible and we therefore administered ceftazidime and amikacin intravenously. This scheme was applied because in recent times we have observed a rapid development of gram-negative pathogens in our patients. Our action was correct because on day 7 post-burn the wound culture confirmed gram-negative pathogens

Introduction

A burn can be caused by heat (flames, hot grease, or boiling water), the sun (solar radiation), chemicals or electricity. When a burn breaks the skin, infection and loss of fluid can occur; burns can also result in difficulty breathing. If a burn victim has trouble breathing, has burns on more than one part of the body, or was burned by chemicals, an explosion, or electricity immediately. Burns caused by flames or hot grease usually require medical attention as well, especially if the victim is a child or an elderly person

Burns are often categorized as first-, second-, or third-degree burns, depending on how badly the skin is damaged. Each of the injuries above can cause any of these three types of burn. But both the type of burn and its cause will determine how the burn is treated. All burns should be treated quickly to reduce the temperature of the burned area and reduce damage to the skin and underlying tissue (if the burn is severe).

Risk Factors

Age - children and elderly Drug use - Use of alcohol and illegal drugs increases risk of burns. Gender - Men are more than twice more likely to suffer burn injuries than women. Seasonal Burns occur more often during holidays celebrated with fireworks and school breaks. Smoking Socio-economic status People living in substandard or older housing, as well as those in low income neighbourhoods are more likely to experience burns. Sun Unsafe heating practices Use of heated foods and containers, hot water heaters set above 130 F, and unsafe storage of flammable or caustic materials put you at higher risk of burns. Also, the use of wood stoves and exposure to heating sources or electrical cords puts you at risk of burns.

Signs and Symptoms of First Degree Burns

Injuries are superficial / mild Swelling& redness of the injured area Pain develops No blisters seen Burned area becomes white on touch Takes 3-6 days to heal

Immediate Emergency Medical Intervention

Remove patient from heat source Remove the burnt clothing Run cool water over burnt area Gently clean the injured area Gently dry Apply anti biotic such as Silver Sulphadiazine Use a sterile bandage to cover burns Take tetanus vaccination, if required

Signs and Symptoms of second Degree Burns

Burns extends to middle skin layer, dermis Swelling, redness and pain observed Burnt area may turn white on touch Blisters develop, that ooze a clear fluid Scars may develop Restricts movement, if injury occurs at joint Dehydration may occur Healing time varies, depends on extent of injury

Immediate Emergency Medical Intervention

Clean the affected area thoroughly Gently dry Apply antibiotic cream over affected area Make the patient lie down Keep burnt body part at a raised level Skin graft may be required Physical therapy may be essential to aid mobility Splints may be used to rest affected joints Hospitalization is essential

Signs and Symptoms of Third Degree Burns

Damage occurs to all 3 skin layers Destroys adjacent hair follicles, sweat glands, nerve endings Lack of pain due to destroyed nerves Injured area does not turn white on touch No blisters observed Swelling occurs Skin develops leathery texture Discoloration of skin observed Scars develop

Crusty surfaces (Eschars) developimpairs circulation Dehydration occurs resulting in shock Symptoms may worsen with time Disfigurement may result Healing depends on extent of injury 90% body surface injury results in death 60% injury in elderly, fatal

Immediate Emergency Medical Intervention

Requires immediate hospital care Dehydration treated through intravenous fluid supply Oxygen is administered Eschars are surgically opened Periodically run clean cool water over burns Nutritious diet helps to heal quickly Regular monitoring essential Mental Depression treated by antidepressants

Diagnostic Test
Biopsy Biopsy refers to removing and studying sample tissue. In the case of burn patients, biopsy is a diagnostic test that is useful because it examines the extent of collagen damage to the skin, vascular damage to the tissue, and damage to cell proteins in the skin.

Thermography Other tests used for burn victims are less familiar than a standard biopsy. Thermography is the term for studies of burn temperature. When attempting to determine the exact depth of a burn wound, doctors can use thermography as a diagnostic tool because deeper wounds are cooler than more superficial wounds. There is reduced vascular perfusion, or blood circulation, to the deeper wounds, leading to a lower temperature.

Video Angiography Another diagnostic test for burn evaluation is a process known as laser fluorescence videography. This sophisticated technique measures changes in the perfusion of tissues by injecting a substance called indiocyanine green intravenously. Damaged tissues have poor circulation, which is visualized by the videography.