WHAT IS BURNS?
The skin takes the most space in our bodies and its could be damaged by many factors includes burns. In addition, Burns are injuries primarily to the skin and underlying tissue which also defined as severe skin damage that cause affected skin cells to die. It can be caused by several factors such as: Heat, chemicals, electricity, and radiation.
Burns classified depends on how deep and extent the injury according to the skin layers, there are three degrees of burns:
1- First Degree Burns:
Involve the outer layer of our skin which called the epidermis, burns in this layer cause Redness, pain, swelling and no blistering, these burns mostly caused by over-exposure to UV sun lights or direct contact with a hot object.
2- Second Degree Burns:
Involve the next layer of the skin which called the dermis, burns can be described as painful, moist and soft, also blisters filled with fluids may be present, these burns mostly caused by severe-exposure to UV and contact with hot liquids or fire.
3- Third Degree Burns:
This degree of burn affects all the layers of the skin (epidermis, dermis, and hypodermis), As a result, all skin layers are affected and damaged includes: nerves, fat, muscles, and bone may be affected, this burn described as painless due to the nerve ending damage, these burns can be caused by contact with fires, electricity, or corrosive chemicals.
This table shows the difference between the degrees of the burns:
Assessment of burns:
Every disease has its own assessment and examine burns depends on the proportion of the body surface and the depth of the area that has been burnt. The “Rule of 9” is used as a guide to estimate the burned surface area by dividing the body into anatomical regions that represent 9% (or multiples of 9%) of the total body surface, morbidity, and mortality rises with increasing burned surface area. The body is divided into 11 equal parts making this 99% and 1% is given to perineum. 9% represent the head and each upper limb; 18% refers to each lower limb, front of trunk and back of trunk in adults. Anyway, in newborns and children (younger than 10 years) the assessment is different because the body is smaller than the head and in this case the Rule of Nine is not applicable. Lund and Browder chart can be used for the estimating the burns in the children. Another assessment tool is the Rule of Palm which one hand is closed and its equal 1% of the body surface area. According to the severity burns can be classified as minor, moderate and critical burns.
Minor burns:
Burns less than 15% in adults and 10% in children (excluding chemical, electrical burns and burns of face, hands, and perineum). These burns can be treated on out-patient basis.
Moderate burns:
Burns between 15-25% in adults and 10-15% in children. And these burns may require hospitalization.
Critical burns:
Burns above 25% in adults, 15% in children and 5% in newborn and infants. Such as:
• Electrical burns
• Chemical burns
• Respiratory burns
• Burns associated with other injuries
Above shown how the 9% TBSA which it’s the total body surface area. In this assessment erythema, reddening of the skin without epidermis not counting.
Effect of Burn Injury:
The effect of burns not limited physically only, it also causes emotional damage, not only the patient will be a victim also the whole family will be, being a patient with a severe burn may results in losing a limb or loss physical abilities, disfigurement, scarring and chronic infection. Furthermore, burn sufferers may enter in depression, isolation themselves from the social life. In seek to help the patient after the accident a rehabilitation team should be provided. Rehabilitation team is responsible of returning the patient to the highest level of independence and to improve the overall quality of life including physical, emotional and social aspects.
However, mild burns like first-degree burn may not affect the body seriously, unlike more serious burns like the second- and the third-degree burns which can cause more damage to the body including dehydration, shock and chemical imbalances. Also, it can destroy muscle tissue and damage some organs such as the kidneys. As well, severe burns can develop and stop blood flow or restrict breathing in some accidents which considered a real threat to the patient.
Managements of burns:
Accidents nowadays are common and can be happen in any place at any time which always require a management to prevent more damage to the skin especially in burn cases you should know how to manage the situation and start the first aid quickly. However, all treatments depend on the type of burn and it should be kept clean as well.
Initial management includes assessment and maintenance using the ABCDE approach:
A check airways obstruction,
B Breathing, look, feel, listen for the general signs of respiratory distress: sweating, central cyanosis and count the respiratory rate (normal 12-20 breaths min-1)
C Circulation, assess the limb temperature, state of the veins and count patient’s pulse rate.
D Disability, Examine the pupils, make initial assessment for patient’s consonscious level.
E Exposure, patient should be examined to estimate of the burn area.
First aid:
It must be a very quick action and there are steps that should be followed if burns occurred:
1- make sure the area is safe, Call the emergency number and grab the First Aid kit.
2- if the person awakes ask him about his name and what happened.
3- if the person on fire, start put out the fire.
4- remove any jewelry and clothing around the affected area, so it’s not stuck on the skin.
5- if the burn area is small, cool it with cold but not ice-cold water until the pain is reduced.
6- cover the person with a dry blanket.
7- check for signs of shock (for large area burns).
Medical management:
The treatment of a burn depends on the type of burn. However, all burns must be kept clean and adequate dressing should be applied based on severity of wounds.
Once the patient's go to the hospital other procedures will be followed:
1- start to sterile the burn, the aim is to help the wound to heal and prevent the infection.
2- According to WHO burn management, tetanus prophylaxis is a must to be administer for all cases to prevent tetanus after burns except for very small burns.
3- Gently cleanse the burn with 0.25% (2.5 g/litre) chlorhexidine solution, 0.1% (1 g/litre) cetrimide solution, or another mild water-based antiseptic.
4- alcohol-based solutions shouldn’t be used.
5- Gentle scrubbing will remove the loose necrotic tissue, a thin layer of antibiotic cream should be added (silver sulfadiazine).
6- Dress the burn with petroleum gauze and dry gauze thick enough to prevent seepage to the outer layers.
Pain can interfere with wound care, as inadequate control can lead to treatment failure, moreover it’s important to reexamine the wound as it may a sign of infection
each degree of burns should be treated in specific way, as first-degree burns can be treated by normal skin care products such as moisturizing creams (aloe Vera) or antibiotic ointment, apply a dry gauze bandage will help and protect the area from any infection, paracetamol can be used as a pain killer for this type of burns. Second degree burn can be treated with antibiotic cream and other creams prescribed by the doctor, Surgery may be required for third degree burns for skin grafting, also for severe cases I.V antibiotic for infection prevention and I.V fluids replacement to replace the fluids lost after the accident.
Surgical management:
Once the burn patient has been resuscitated and stabilized, restoring anatomy, preserving function, and rehabilitating the patient are the next priorities, to accomplish surgery for the affected area, the surgeon must evaluate the extent to which tissue is missing and identify potential donor sites or other solutions to best manage skin and soft tissue defects. The aim is to restructure like tissue with like tissue, restoring function.
Conclusion:
Finally, at the end of this research we highlight the definition of burns and cover many aspects of this topic like explaining the three degrees, how to assess the burn and how to manage the burn.