What is Burns ?
Burns are one of the most common household injuries and burns are a global public health problem. which is damage to the skin because the skin is the largest organ in the body and it regulates the body's temperature, It also prevents the evaporation of bodily fluids and acts as a barrier against infection. Skin damage resulting from burns can be minor or can present a life-threatening emergency, depending on the heat's intensity, the total area of tissues burned, and the length of exposure to the skin. Burns can effect any other body parts caused by extreme heat, flame, contact with heated objects, or chemicals. Most people can recover from burns without serious health consequences, depending on the cause and degree of injury. More serious burns require immediate emergency medical care to prevent complications and death.
Classification of burns with illustration
Burns are classified based upon their depth and there are three primary types of burns: first-, second-, and third-degree. Each degree is based on the severity of damage to the skin, with first-degree being the most minor and third-degree being the most severe. Damage includes:
First-degree burns involve the outermost layer of the skin, called the epidermis and superficial and causes local inflammation of the skin.Redness, tenderness or pain, and swelling usually describe these burns. There's usually no blistering. Complete recovery usually occurs within a week, often with peeling and sometimes with temporary, mild changes in skin tone. First-degree burns often occur after over-exposure to UV rays of the sun which we called sunburns, or after coming in contact with a hot object.
Since this burn affects the top layer of skin, the signs and symptoms disappear once the skin cells shed. First-degree burns usually heal within 7 to 10 days without scarring.You should still see your doctor if the burn affects a large area of skin, more than three inches, and if it’s on your face or a major joint ( shoulder, knee, elbow, spine and forearm). Furthermore they are usually treated with home care and it should as fast as you can. Many people use ice with first-degree burns and this is a big mistake which make the burns worst.
Second-degree burns involve damage to the second layer of skin, called the dermis which is deeper. These very painful burns look pink, moist and soft. Blisters usually appear and fluid might ooze from the skin. Over time, thick, soft, scab-like tissue called fibrinous exudate may develop over the wound.
Due to the delicate nature of these wounds, keeping the area clean and bandaging it properly is required to prevent infection. This also helps the burn heal quicker. Depending on the damage to the dermis, these burns may take anywhere from 2 to 6 weeks to heal but often with pigment changes to the skin.Scarring may result if it’s healing by two week. Such burns often result from severe UV exposure and scalds.
Third-degree burns involve the most damage, extending through every layer of skin: to the epidermis, the dermis, and the hypodermis, the third layer of skin. As a result, the full thickness of the skin is damaged. Fat, nerves, muscles, and bones may be affected. Damage of this sort causes the skin to appear a filmy white. The area isn't generally painful because nerve endings have been damaged. Since a large amount of tissue may be destroyed, healing is very slow and considerable scarring results. Later on, contractures (permanent tightening of tissue that prevents normal movement) can occur due to the deep scarring and occasionally tissue may have to be cut or "released" to relieve underlying pressure. Deep burns may result from contact with fires, electricity, or corrosive chemicals.
Burns are not static and may mature. Over a few hours a first degree burn may involve deeper structures and become second degree. Think of a sunburn that blisters the next day. Similarly, second degree burns may evolve into third degree burns.
Regardless of the type of burn, inflammation and fluid accumulation in and around the wound occur. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. A burn is also a break in the skin, and the risk of infection exists both at the site of the injury and potentially throughout the body.
Inhalational burns can lead to airway swelling and inability to breathe; people with these injuries must be brought to a hospital as soon as possible, even if they initially do not have breathing difficulties.
Assessment of burns using rule of nine
Overall, burn severity is a measurement of the depth of burning and the size of the burn. Measuring the size of a burn is difficult because every person is different in size, shape, and weight. It's impossible to simply choose what universal size of a burn is significant. A square foot of burned surface area is much worse to a person who weighs 130 pounds than it is to someone who weighs 200 pounds.
To account for inequities in size and shape, the burned surface area is calculated as a percentage of total body area. Of course, we don't actually know how many square inches of skin covers any single person, but we do know about how much of our skin it takes to cover our arms and legs, for example.
The rule of nine ; The rule of nines was devised by Pulaski and Tennison in 1947, and published by AB Wallace in 1951. And its to approximate the percentage of burned surface area, the body has been divided into eleven sections such as Head /Right arm / Left arm / Chest / Abdomen / Upper back / Lower back / Right thigh / Left thigh / Right leg (below the knee) / Left leg (below the knee).
Each of these sections takes about nine percent of the body's skin to cover it. Added all together, these sections account for 99 percent. The genitals make up the last one percent of total body surface area (insert lame joke here).
To apply the rule of nines, add up all the areas of the body that are burned deep enough to cause blisters or worse (2nd or 3rd degree burns). As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
Since kids are shaped so much different than adults, there are adjustments made to the rule of nines, which of course ruins the point of making this tool the rule of nines. Indeed, so many variations exist for different age groups that it would be fruitless to go into them here.
If more than15%-20% of the body is involved in a burn, significant fluid may be lost. Shock may occur if inadequate fluid is not provided intravenously. As the percentage of burn surface area increases, the risk of death increases as well. Patients with burns involving less than 20% of their body should do well, but those with burns involving greater than 50% have a significant mortality risk, depending upon a variety of factors, including underlying medical conditions and age.
Effect of Burn injury
A severe burn can be a seriously devastating injury — not only physically but emotionally. It can affect not only the burn victim, but the entire family. Persons with severe burns may be left with a loss of certain physical abilities, including loss of limb(s), disfigurement, loss of mobility, scarring, and recurrent infections because the burned skin has decreased ability to fight infection. In addition, severe burns can penetrate deep skin layers, causing muscle or tissue damage that may affect every system of the body.
Burns can also cause emotional problems such as depression, nightmares, or flashbacks from the traumatizing event. The loss of a friend or family member and possessions in the fire may add grief to the emotional impact of a burn.
Management of burns
First Aid
Protect the burned person from further harm. If you can do so safely, make sure the person you're helping is not in contact with the source of the burn. For electrical burns, make sure the power source is off before you approach the burned person.
Make certain that the person burned is breathing. If needed, begin rescue breathing if you know how.
Remove jewelry, belts and other restrictive items, especially from around burned areas and the neck. Burned areas swell rapidly.
Cover the area of the burn. Use a cool, moist bandage or a clean cloth.
Cool the burn. Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases.
Remove rings or other tight items from the burned area. Try to do this quickly and gently, before the area swells.
Don't break blisters. Fluid-filled blisters protect against infection. If a blister breaks, clean the area with water (mild soap is optional). Apply an antibiotic ointment. But if a rash appears, stop using the ointment.
Bandage the burn. Cover the burn with a sterile gauze bandage (not fluffy cotton). Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
Medical Management
After you have received first aid for a major burn, your medical care may include medications and products that are intended to encourage healing..
Water-based treatments. Your care team may use techniques such as ultrasound mist therapy to clean and stimulate the wound tissue.
Fluids to prevent dehydration. You may need intravenous (IV) fluids to prevent dehydration and organ failure.
Pain and anxiety medications. Healing burns can be incredibly painful. You may need morphine and anti-anxiety medications — particularly for dressing changes.
Burn creams and ointments. If you are not being transferred to a burn center, your care team may select from a variety of topical products for wound healing, such as bacitracin and silver sulfadiazine (Silvadene). These help prevent infection and prepare the wound to close.
Surgical Management
Breathing assistance. If you've been burned on the face or neck, your throat may swell shut. If that appears likely, your doctor may insert a tube down your windpipe (trachea) to keep oxygen supplied to your lungs.
Feeding tube. People with extensive burns or who are undernourished may need nutritional support. Your doctor may thread a feeding tube through your nose to your stomach.
Easing blood flow around the wound. If a burn scab (eschar) goes completely around a limb, it can tighten and cut off the blood circulation. An eschar that goes completely around the chest can make it difficult to breathe. Your doctor may cut the eschar to relieve this pressure.
Skin grafts. A skin graft is a surgical procedure in which sections of your own healthy skin are used to replace the scar tissue caused by deep burns. Donor skin from deceased donors or pigs can be used as a temporary solution.
Conclusion
Prevention of burn injuries, based on the epidemiology of burn in developing countries, remains a major way of reducing the current spate of morbidity and mortality in our patients.