Burn

Ads

Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals. Burns are usually caused by heat (thermal burns), such as fire, steam, tar or hot liquids. Burns caused by chemicals are similar to thermal burns, whereas burns caused by radiation, sunlight and electricity tend to differ significantly

Thermal and chemical burns usually occur because heat or chemicals contact part of (lie body's surface, most often the skin. Thus, the skin usually sustains most of the damage.

However, severe surface bums may penetrate to deeper body structures, such as fat, muscle, or bone. When tissues are burned, fluid leaks into them from the blood vessels, causing swelling and pain. In addition, dam-aged skin and other body surfaces are easily infected because they can no longer act as a barrier against invading organisms.

General effects of burn :

Pain- very severe in superficial burn but almost painless or less pain in deep burn,
Loss of plasma (fluid),
Oligaemic shock
Toxaemia due to plasma loss, infection, biochemical change, toxin from the burnt tissue.

Classification : Bums are classified according to strict, widely accepted definitions. These definitions may not correspond to a person's understanding of those terms. For example a doctor may classify a burn as serious even though the person regards it as minor. The definitions classify the burns depth and the extent of tissue damage.

The depth of injury from a burn is described as first, second, or third degree. First degree burns are the most shallow (superficial). They affect only the top layer of skin (epidermis). Second degree burns extend into the middle layer of skin (dermis). Third degree burns involve all three layers of skin (epidermis, dermis and the fat layer, usually destroying the sweat glands, hair follicles and nerve endings.

Burns are classified as minor, moderate, or severe. The severity determines how they are predicted to heal and whether complications are likely. Doctors deter-mine the severity of the burn by estimating the percentage of tile body surface that has been burned. For adults, doctors use the rule of nines. This method divides almost all of the body into sections of 9 (nine) per cent or two times 9 (nine) per cent (18 per cent). Head and neck bum - nine per cent, each arm nine per cent, Trunk - front 18 per cent and back 18 per cent, leg - each - 18 per cent and genital area 1 per cent. For children doctors use charts that adjust these percent-ages according to the child's age. (Lund Browder charts) adjustment is needed because different areas of the body grow at different rates. All first-degree burns as well as second degree burns that involve less than 15 per cent of the body surface usually are classified as minor, although they may seem severe to the person. A third degree bum, may be classified as minor if it involves less than five per cent of the body surface, unless it involves the face, hands, feet, or genitals. Burns involving these areas or involving deeper layers of skin over larger areas of the body are classified as moderate or, more often, as severe.

Complications : .Most minor burns are superficial and do not cause explications. However, deep second degree and third degree burns swell and take more time to heal. Deeper born can cause scar tissue to form which shrinks as it heals. Scars occurring at a joint may result in contractures restricting movements. Severe bums can cause serious complications due to extensive fluid loss and tissue damage. Dehydration eventually develops in people with widespread burns, because fluid seeps from the blood to the burned tissue. In severe dehydration shock develops. Destruction of muscle tissues occurs in deep third degree burn (rhab-domyolysis). The muscle tissue releases myoglobin, one of the muscle's protein, into the blood. Presence of myoglobin in high concentration may harm the kidneys. Thick, crusty surface (eschars) arc produced by deep third-degree burns. Eschars can become too tight, cut-ting of blood supply to healthy tissues or impairing breathing.

Symptoms and diagnosis : First degree burns are red, moist, swollen, .and painful. The burned area whitens (blanches) when lightly touched but does not develop blisters. Second degree burns are red, swollen, and painful, and they develop busters that may ooze a clear fluid.

The burned area may blanch when touched. Third degree bums usually are not painful because the nerve have been destroyed. The skin becomes leathery and may be white, black, or bright red. The burned area does not blanch when touched, and hairs can easily be pulled from their roots without pain. No blister develop.

The appearance and symptoms of deep burns can worsen during the first hours or even days after burn.

Management: Emergency and first aid :

Removal of the patient from the source of burn.
Removal of clothings from the burnt area.
Application of cold (a) Immersion in cold water (b) covering with wet cloth.
Covering the burn area as quickly as possible by sterile dressing (some school of thought like to keep the burn area dry, clean and open without any dressing).
Strict aseptic precaution.
Removal of loose skin.
Washing of he bum area by normal saline to clean and remove debris, foreign substances - if any
Intravenous infusion of dextrose saline to be started according to severity of burn.

General principles of treatment :

A. Local treatment is to prevent infection and promote healing. Minor burns are cleaned with acriflavin, cetavlon or cetrimide and dressed. Major bums are treated by (a) closed dressing) method and exposure method.

Exposure method is undertaken in bums of face, perineum, genitalia and single surface of the trunk. Here burn surface is open to the air, plasma exudate dries and forms a scab under which skin heals. In closed method burn is cleaned with cetavlon /acriflavin and loose skin and blister are removed, penicillin or silver sulphadiazine ointment is applied, then covered with vaseline or tullegnas gauze (sofra tullae), cottong wool and bandage.

B. General treatment :

Inj. morphine 15 mg IV or 1ms for pain
Infusion of plasma or plasma substitute for shock
3. Inj, penicillin in recommended dose for 5-7 days.
Antibiotics should be changed accord c/s report.
Tetanus prophylaxis.

Fluid loss calculation is done on the basis of rule of nine.

Volume of plasma to be transfused is given by the formula : Total percentage area of burn X wt. in kg X 5ec = ml of plasma to be given during each of 6 periods. The first three periods are 4 hours each, the next 2 periods are 6 hours each and the last is 12 hours. Patients with deep or extensive burn should have 50 per cent of the fluid replaced as blood, when plasma is not available dextran or dextrose saline may be given. All adults with burns more them 15 per cent of body surface and children 10 per cent or more require transfusion of plasma.

Prognosis : First and second degree burns hell in days to weeks without scarring. Deep second degree and small third degree burns take weeks to heel and usually cause scarring. Larger third degree burns require skin grafting. Burns that involve more then 90 per cent of he body surface, or more than 60 per cent in aft older persons, usually are fatal.

Submitted By:
DR. MASWOODUR RAHMAN PMNCE

Similar of Burn