Burns and their Management

Classification of Burns and Their Management

A burn is a physical problem with the skin or other tissues that is caused by heat, cold, electric current, artificial substances, friction, or strong radiation like a sunburn.

Risk factors:-

The majority of burns are caused by the intensity of hot materials, liquids, or fire.

A- Burns primarily take place at home or at work. Burns in the house are associated with domestic kitchens, which may include ovens, flares, and hot liquids. Burn-related injuries at work include burns from fire, chemicals, and electricity.

B- Smoking and alcoholism are other risk factors.

C- Burns can also occur as a result of interpersonal violence or self-destructive behaviour.

Classification of burns

1-First-degree Burns

Only the epidermis, the skin's outermost layer, is impacted by first-degree burns. The burn site is painful, red, dry, and blister-free. One example is a minor sunburn.

2- Second-degree Burns

The epidermis and a portion of the dermis are both affected by second-degree burns. The burn site appears red, blistering, and could be painful and swollen.

3-Third-degree Burns

The epidermis and dermis are destroyed by third-degree burns. They might penetrate subcutaneous tissue, the skin's deepest layer. The burn spot may seem blackened , burned or white.

4-Fourth-degree Burns

Burns of the fourth degree penetrate the skin's surface as well as underlying tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.

Burns are most frequently associated with women in a large portion of the world with the use of unsafe cook ovens or open cooking fires. They are more likely to occur in men as a result of dangerous working situations. Excessive burns can be fatal,but new treatments introduced have improved outcomes, particularly in children and young people. The long-term outcome is related on the amount burned and the age of the affected person.

symptoms and consequences

Superficial burns result in pain that lasts a few days, followed by skin-stripping throughout the course of the following few days. People with more severe burns could complain about pressure or show signs of irritation rather than being in pain. Full-thickness burns may have a frigid disposition toward a light touch or cut. Extreme burns might be pink, white, or dark, but superficial burns are typically red in colour. However, these findings are not conclusive. burns around the mouth or seared hair inside the nose may indicate that effects in the respiratory routes have occurred.

The following symptoms are more concerning:

windedness, dryness, and stridor or wheezing.

Up to 90% of adults and nearly all children experience irritation during the repair process. After an electrical injury, deadness or shivering may last for a long period. Burns can also cause severe psychological problems.

Pathophysiology

As we know that Proteins start to lose their three-layered form and start to disintegrate at temperatures higher than 44 °C (111 °F).Damage to cells and tissues results from this.

Many of the immediate health effects of burns are brought on by the skin's failure to perform its generally expected functions, which include protection from microscopic organisms, skin sensation, internal temperature regulation, and prevention of water loss from the body. These capacities can be compromised, which can lead to bacterial infection, cutaneous numbness, hypothermia, and hypovolemic shock through dehydration. Cell films become disrupted, causing cells to lose potassium to the environment outside of the cell and absorb sodium and water.

There is a severe provocative reaction in large burns (more than 30% of the entire body surface area). As a result, there is an increased leakage of liquid from the capillaries, which causes tissue edema. As a result, there is a general decrease in blood volume, and any residual blood suffers greatly from plasma loss, thickening the blood. Kidney failure and stomach ulcers may result from unfavourable blood flow to organs like the kidneys and gastrointestinal tract.

A hypermetabolic state can be brought on by increased catecholamine and cortisol levels, and it can last for years.

This is associated with improved digestion, a rapid heartbeat, and terrible invulnerable capacity.

"The Rule of Nines"

Doctors and emergency medical personnel frequently use the rule of nines to quickly determine a burn victim's treatment requirements. According to the rule of nines, the percentage of body surface area that is damaged is either nine or a multiple of nine.

The rule of nines for adults is:

Body part and Percentage

Arm (including the hand)-9% each

Anterior trunk (front of the body)-18%

Genitalia-1%

Head and neck-9%

Legs (including the feet)-18% each

Posterior trunk (back of the body)-18%

Treatment

The process of revival begins with an evaluation and modification of the person's respiration, airway, and dissemination. Early intubation may be necessary if inward breath injury is suspected. This is followed by care for the actual burn wound. With significant burns, early care is crucial. Protein supplements should also be increased, and minor components and nutrients are frequently required. Individuals with significant burns may be covered in clean sheets until they arrive at a hospital. The benefits of hyperbaric oxygenation may outweigh those of traditional treatments.

Burns can be very challenging, and several options may be used to controle pain. These contain opioids like morphine as well as common analgesics (like ibuprofen and acetaminophen). Along with analgesics, benzodiazepines can be used to treat anxiety. Allergy medications, kneading, or transcutaneous nerve feeling may be used to treat tingling while the body is healing. Gabapentin may be used in patients who do not respond to antihistamines.

For patients with large burns (>60% TBSA), intravenous anti-microbials are advised. Calcium gluconate is a specific counteractant for burns caused by hydrofluoric corrosive and can be either topically or intravenously. The evidence for steroid use is ambiguous.

Above all, the burn wound care is most important.

Surgical Treatment for Burns

Escharotomy: A cut performed in a burn to release pressure and promote blood flow. Treatment for compartment syndrome and circumferential burns is done in this manner.

Fasciotomy- An incision performed in the fascia to release pressure and improve blood flow is known as a fasciotomy.