Burns, Causes, Symptoms, Diagnosis, Treatment









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Burns injury also known as combustion injury is an impairment of the tissue, which is caused by extreme heat, electricity, chemicals, friction or radiation. Concerning children, in Hungary and worldwide the most affected age group is below the age of 5 years. The most common cause of burn injury in children is scald from hot water.

burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation.[rx] Most burns are due to heat from hot liquids, solids, or fire.[rx] While rates are similar for males and females the underlying causes often differ.[rx] Among women in some areas, risk is related to use of open cooking fires or unsafe cook stoves.[rx] Among men, risk is related to the work environments.[rx] Alcoholism and smoking are other risk factors.[rx]Burns can also occur as a result of self harm or violence between people.[rx]

Types of Burns

Thermal Burns

Thermal burns occur when you come in contact with something hot. Typically, you will suffer a thermal burn when you touch:

  • Flames or fire
  • Hot, molten liquid or steam (referred to as a scald)
  • Hot objects, such as cooking pans, irons, or heated appliances.
  • Put out any fire or flames and stop contact with the hot or heated source.
  • Use cold water to cool the burned area. Do not use ice, as it may further damage the skin.
  • For mild burns, you can find pain relief by applying a cool, wet compress and/or taking acetaminophen or ibuprofen as directed on the bottle. Later, burn creams and ointments can help these burns heal.
  • For more severe burns, loosely apply a sterile bandage or clean cloth to the burned area. Do not remove parts of your skin or pop blisters. Seek medical attention for further treatment.

Chemical Burns

You may receive a chemical burn if your skin and/or eyes come in contact with a harsh irritant, such as acid. Substances that cause chemical burns include:

  • Chlorine
  • Ammonia
  • Bleach
  • Battery acid
  • Strong or harsh cleaners

Take these steps if you have been burned by a chemical: Rinse the burned area under running water for at least 10 minutes. If the chemical has entered your eye, rinse your eye for about 20 minutes to remove traces of the chemical. Then, call 911 or go to the hospital if the burn is:

  • Larger than three inches
  • On your face, hands, feet, groin, or buttocks
  • Still very painful after taking over-the-counter pain medication
  • On a major joint, like the knee

Medical treatment for both thermal burns and chemical burns is similar and may include:

  • Wound cleaning and removing dead skin or tissue
  • IV fluids to regulate body temperature and speed healing
  • Antibiotics to prevent or fight infection
  • Skin grafting (covering the wound with healthy skin from another area of the body to close the wound)

Electrical Burns

  • Electrical burns happen when the body comes in contact with an electric current. Our internal systems are not resistant to electricity, so you may be injured if a strong jolt enters your body.
  • The most common cause of electrical burn is coming in contact with an extension cord where the insulation material has worn away. Low-voltage electrical burns can also occur in the mouth, most commonly when young children place noninsulated cords in their mouth.
  • A burn may appear on your skin if an electric current runs through your body. These burns can be treated like a thermal or chemical burn. However, if you come in contact with an electric current, you should seek emergency medical attention immediately. Electricity can affect internal tissues and muscles and have long-term, negative effects on your health.

Friction Burns

  • A friction burn can occur when skin repeatedly rubs against another surface or is scraped against a hard surface. Like other burns, friction burns are categorized into degrees.
  • Many friction burns are first degree and often heal on their own within three to six days. You can use moisturizing cream at home to care for it. For more serious friction burns, you should seek medical care immediately.

Radiation Burns

Cancer patients undergoing radiation therapy may suffer from an injury known as radiation burn. High-energy radiation is used to shrink or kill cancerous cells, and when it passes through the body, skin cells may be damaged. If you’re frequently receiving radiation treatments, your skin cells may not have enough time to regenerate, and sores or ulcers may develop. The term burn is a misnomer for these wounds, because skin has not actually been burned. However, the wounds can look and feel like burns. Skin must regenerate for the wounds to heal, which can take two to four weeks for mild skin reactions or a few months for more serious reactions.

Care for radiation burns includes

  • Cleaning and moisturizing wounds
  • Avoiding sunlight
  • Wearing loose clothing or bandages over the wound

If you have an injury from radiation, you may also have internal complications and should seek medical treatment immediately.

The major factors to consider when evaluating the burned skin are the extent of the burns (usually calculated by the percentage of total body surface area (% TBSA) burned) and the estimated depth of the burns (superficial, partial thickness or full thickness).

Extent of the Burn

Several methods are available to estimate the percentage of total body surface area burned.

  • Rule of Nines – The head represents 9%, each arm is 9%, the anterior chest and abdomen are 18%, the posterior chest and back are 18%, each leg is 18%, and the perineum is 1%. For children, the head is 18%, and the legs are 13.5% each.
  • Lund and Browder Chart – This is a more accurate method, especially in children, where each arm is 10%, anterior trunk and posterior trunk are each 13% and the percentage calculated for the head and legs varies based on the patient’s age.
  • Palmar Surface – For small burns, the patient’s palm surface (excluding the fingers) represents approximately 0.5% of their body surface area, and the hand surface (including the palm and fingers) represents about 1% of their body surface area.

Depth of the Burn

Burn depth is classified into one of three types based on how deeply into the epidermis or dermis the injury might extend.

  • Superficial burns – (First Degree) involve only the epidermis and are warm, painful, red, soft and blanch when touched. Usually, there is no blistering. A typical example is a sunburn.
  • Partial thickness burns – (Second Degree) extend through the epidermis and into the dermis. The depth into the dermis can vary (superficial or deep dermis). These burns are typically very painful, red, blistered, moist, soft and blanch when touched. Examples include burns from hot surfaces, hot liquids or flame.
  • Full-thickness burns – (Third Degree) extend through both the epidermis and dermis and into the subcutaneous fat or deeper. These burns have little or no pain, can be white, brown, or charred and feel firm and leathery to palpation with no blanching. These occur from a flame, hot liquids, or superheated gasses.

When calculating the extent of burn, only partial thickness and full thickness burns are considered, and superficial burns are excluded.

Burns may also produce emotional and psychological distress.

Type[rx] Layers involved Appearance Texture Sensation Healing Time Prognosis Example
Superficial (1st-degree) Epidermis[rx] Red without blisters[rx] Dry Painful[rx] 5–10 days[rx][rx] Heals well.[rx] Repeated sunburns increase the risk of skin cancer later in life.[19] A sunburn is a typical first-degree burn.
Superficial partial thickness (2nd-degree) Extends into superficial (papillary) dermis[rx] Redness with clear blister.[rx]Blanches with pressure.[rx] Moist[rx] Very painful[rx] 2–3 weeks[rx][rx] Local infection (cellulitis) but no scarring typically[rx] Second-degree burn of the thumb
Deep partial thickness (2nd-degree) Extends into deep (reticular) dermis[rx] Yellow or white. Less blanching. May be blistering.[rx] Fairly dry[rx] Pressure and discomfort[rx] 3–8 weeks[xx] Scarring, contractures (may require excision and skin grafting)[rx] Second-degree burn caused by contact with boiling water
Full thickness (3rd-degree) Extends through entire dermis[rx] Stiff and white/brown.[rx] No blanching.[rx] Leathery[rx] Painless[rx] Prolonged (months) and incomplete[rx] Scarring, contractures, amputation (early excision recommended)[rx] Eight day old third-degree burn caused by motorcycle muffler.
4th-degree Extends through entire skin, and into underlying fat, muscle and bone[1] Black; charred with eschar Dry Painless Requires excision[rx] Amputation, significant functional impairment and in some cases, death.[rx] 4th-degree burn

Cause of Burns

Burns may be caused by

  • Abuse
  • Chemicals such as strong acids, lye, paint thinner or gasoline
  • Electric currents
  • Fire
  • Hot liquid
  • Hot metal, glass or other objects
  • Steam
  • Radiation from x-rays
  • Sunlight or ultraviolet light

Symptoms of Burns

  • Blisters
  • Pain  – The degree of pain is not related to the severity of the burn as the most serious burns can be painless
  • Peeling skin
  • Red skin
  • Shock – Symptoms of shock include pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness
  • Swelling
  • White or charred skin
  • Heart rhythm disturbances following electrical injury

Diagnosis of Burns

Burn injury patients who should be referred to a burn unit include the following:

  • all burn patients less than 1 year of age

  • all burn patients from 1 to 2 years of age with burns >5% total body surface area (TBSA)

  • patients in any age group with third-degree burns of any size

  • patients older than 2 years with partial-thickness burns greater than 10% TBSA

  • patients with burns of special areas—face, hands, feet, genitalia, perineum or major joints

  • patients with electrical burns, including lightning burns

  • chemical burn patients

  • patients with inhalation injury resulting from fire or scald burns;

  • patients with circumferential burns of the limbs or chest;

  • burn injury patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality;

  • any patient with burns and concomitant trauma;

  • paediatric burn cases where child abuse is suspected;

  • burn patients with treatment requirements exceeding the capabilities of the referring centre;

  • septic burn wound cases.

Treatment of Burns

Basic guidance on first aid for burns is provided below.

What to do

  • Stop the burning process by removing clothing and irrigating the burns.
  • Extinguish flames by allowing the patient to roll on the ground, or by applying a blanket, or by using water or other fire-extinguishing liquids.
  • Use cool running water to reduce the temperature of the burn.
  • In chemical burns, remove or dilute the chemical agent by irrigating with large volumes of water.
  • Wrap the patient in a clean cloth or sheet and transport to the nearest appropriate facility for medical care.

What not to do

  • Do not start first aid before ensuring your own safety (switch off electrical current, wear gloves for chemicals etc.)
  • Do not apply paste, oil, haldi (turmeric) or raw cotton to the burn.
  • Do not apply ice because it deepens the injury.
  • Avoid prolonged cooling with water because it will lead to hypothermia.
  • Do not open blisters until topical antimicrobials can be applied, such as by a health-care provider.
  • Do not apply any material directly to the wound as it might become infected.
  • Avoid application of topical medication until the patient has been placed under appropriate medical care.

The aims of first aid should be to stop the burning process, cool the burn, provide pain relief, and cover the burn.burn.[rx]

A superficial scald suitable for management in primary care

  • Stop the burning process—The heat source should be removed. Flames should be doused with water or smothered with a blanket or by rolling the victim on the ground. Rescuers should take care to avoid burn injury to themselves. Clothing can retain heat, even in a scald burn, and should be removed as soon as possible. Adherent material, such as nylon clothing, should be left on. Tar burns should be cooled with water, but the tar itself should not be removed. In the case of electrical burns the victim should be disconnected from the source of electricity before first aid is attempted.
  • Cooling the burn—Active cooling removes heat and prevents progression of the burn. This is effective if performed within 20 minutes of the injury. Immersion or irrigation with running tepid water (15°C) should be continued for up to 20 minutes. This also removes noxious agents and reduces pain, and may reduce oedema by stabilising mast cells and histamine release. Iced water should not be used as intense vasoconstriction can cause burn progression. Cooling large areas of skin can lead to hypothermia, especially in children. Chemical burns should be irrigated with copious amounts of water.water.[rx]
  • Analgesia – Exposed nerve endings will cause pain. Cooling and simply covering the exposed burn will reduce the pain. Opioids may be required initially to control pain, but once first aid measures have been effective non-steroidal anti-inflammatory drugs such as ibuprofen or co-dydramol taken orally will suffice.
  • Covering the burn – Dressings should cover the burn area and keep the patient warm. Polyvinyl chloride film (cling film) is an ideal first aid cover. The commercially available roll is essentially sterile as long as the first few centimetres are discarded. This dressing is pliable, non-adherent, impermeable, acts as a barrier, and is transparent for inspection. It is important to lay this on the wound rather than wrapping the burn. This is especially important on limbs, as later swelling may lead to constriction. A blanket laid over the top will keep the patient warm. If cling film is not available then any clean cotton sheet (preferably sterile) can be used. Hand burns can be covered with a clear plastic bag so as not to restrict mobility. Avoid using wet dressings, as heat loss during transfer to hospital can be considerable.
  • 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.
  • Dressings – Your care team may also use various specialty wound dressings to prepare the wound to heal. If you are being transferred to a burn center, your wound will likely be covered in dry gauze only.
  • Drugs that fight infection – If you develop an infection, you may need IV antibiotics.
  • Tetanus shot – Your doctor might recommend a tetanus shot after a burn injury.
  • Cleaning – Mild soap and water or mild antibacterial wash. Debate continues over the best treatment for blisters. However, large blisters are debrided while small blisters and blisters involving the palms or soles are left intact.
  • Covering – Topical antibiotic ointments or cream with absorbent dressing or specialized burn dressing materials are commonly used.
  • Comfort – Over-the-counter pain medications or prescription pain medications when needed. Splints can also provide support and comfort for certain burned areas.

Use of topical creams should be avoided at this stage as these may interfere with subsequent assessment of the burn. Cooling gels such as Burnshield are often used by paramedics. These are useful in cooling the burn and relieving pain in the initial stages.stages.[rx]

The American Burn Association recommends burn center referrals for patients with

  • partial thickness burns greater than 10% total body surface area
  • full thickness burns
  • burns of the face, hands, feet, genitalia, or major joints
  • chemical burns, electrical, or lighting strike injuries
  • significant inhalation injuries
  • burns in patients with multiple medical disorders
  • burns in patients with associated traumatic injuries

Patients being transferred to burn centers do not need extensive debridement or topical antibiotics before transfer.  Whether transferring or referring to a burn center, you should contact them before beginning extensive local burn care treatments.

Remove any Sources of Heat

  • Remove any clothing that may be burned, covered with chemicals, or that is constricting.

  • Cool any burns less than 3 hours old with cold tap water (18 degrees centigrade is adequate) for at least 30 minutes and then dry the patient.

  • Cover the patient with a clean dry sheet or blanket to prevent hypothermia.

  • Use of Burnshield [] is a very effective means of cooling and dressing the injury for the first 24 hours.

  • Rings and constricting garments must be removed.

Assess Airway/Breathing

  • Careful airway assessment must be done where there are flame or scald burns of the face and neck. Intubation is generally only necessary in the case of unconscious patients, hypoxic patients with severe smoke inhalation, or patients with flame or flash burns involving the face and neck. Indications for airway assessment include the presence of pharyngeal burns, air hunger, stridor, carbonaceous sputum, and hoarseness.

  • All patients with major burns must receive high-flow oxygen for 24 hours.

  • Always consider carbon monoxide poisoning in burn patients. They may have the following symptoms: restlessness, headache, nausea, poor co-ordination, memory impairment, disorientation, or coma. Administer 100% oxygen via a non-rebreathing face mask; if possible, measure blood gases including carboxy haemoglobin level.

  • If breathing seems to be compromised because of tight circumferential trunk burns, consult with the burn centre surgeons immediately regarding the need for escharotomy.

Circulation

  • Stop any external bleeding.

  • Identify potential sources of internal bleeding.

  • Establish large-bore intravenous (IV) lines and provide resuscitation bolus fluid as required in all compromised patients, using standard ATLS protocols []. Perfusion of potentially viable burn wounds is critical.

Estimate the Percentage Total Body Surface Area (%TBSA) Burned

Initially, use the Rule of Nines. In the case of all paediatric patients and for a more accurate assessment, use the Berkow diagram; alternatively, the patient’s unstretched open hand represents 1% of TBSA.

Accurate estimation of burn size is critical to ongoing fluid replacement and management.

Ongoing Losses (Once the Patient Has Been Stabilised)

  • Patients with <10% TBSA burns can be resuscitated orally (unless the patient has an electrical injury or associated trauma). This needs ongoing evaluation and the patient may still require an IV line.

  • In the case of patients with burns 10–40% TBSA, secure a large-bore IV line; add a second line if transportation will take longer than 45 minutes.

  • Burns >40% TBSA require 2 large-bore IV lines.

  • If the transfer will take less than 30 minutes from the time of call, do not delay transfer for an IV line.

Reminder

IV lines may be placed through the burned area if necessary (suture to secure). Avoid the saphenous vein if at all possible, and avoid cut-downs through unburned skin if possible. An intraosseous line is an excellent alternative in children.

  • Initiate fluids for ongoing resuscitation and fluid losses using the Parkland formula 4mL  crystalloid×(kg of body weight)×(%burn)=mL  in  first  24  hours, with half of this total given in the first 8 hours after injury (note that this is the time from burn, not from presentation to healthcare services). Children must have their daily maintenance fluids added to these replacement fluids (including dextrose).

Example

In the case of a patient weighing 70 kg with a 50% TBSA burn, (4 × 70 × 50) = 14 000 mL needed in the first 24 hours. Half is needed in the first 8 hours after injury.

Example

The fluid requirements of a child weighing 15 kg with a TBSA burn of 40% (4 × 15 × 40) = 2400 mL in the first 24 hours plus maintenance requirements of 1250 mL (1000 mL + 250 mL) = 3650 mL in the first 24 hours. Half is needed in the first 8 hours after injury.

Reminder

Do not give dextrose solutions (except for maintenance fluids in children)—they may cause an osmotic diuresis and confuse adequacy of resuscitation assessment. Ideally, use Ringer’s lactate or normal saline for replacement fluid and a 5% dextrose-balanced salt solution for the child’s maintenance.

This is only a guide, and ongoing evaluation is essential as patients may need more fluids than calculated. Use the patient’s vital signs and, most importantly, urine output to guide ongoing requirements.

Assess Urine Output (This Is the Best Guide to Resuscitation)

  • Insert a Foley catheter in patients with burns >15% TBSA. Adequate urine output is 0.5 mL/kg/h in adults and 1.5 mL/kg/h in children. Lasix and other diuretics must not be given to improve urine output; increase IV fluid rates to increase urine output. Observe urine for burgundy colour (seen with massive injuries or electrical burns). There is a high incidence of renal failure associated with these injuries, requiring prompt and aggressive intervention.

If the urine is red or brown consult a burn centre.

Insert a Nasogastric Tube

  • Insert a nasogastric tube in any patient with burns >30% TBSA, or any patient who is unresponsive, shocked, or with burns >20% if preparing for air or long-distance transportation.

Decompression Incisions (Escharotomy)

  • Assess for circumferential full-thickness burns of the extremities or trunk. Elevate the burned extremities on pillows above the level of the heart. If transfer will be delayed, discuss indications and methods for decompression incisions (escharotomies) with a burn surgeon.

Medication

  • Give tetanus immunisation.

  • After fluid resuscitation has been started, pain medication may be titrated in small intravenous doses (not intramuscular). Blood pressure, pulse, respiratory rate, and state of consciousness should be assessed after each increment of IV morphine.

Wound Care

  • Debridement and application of topical antimicrobials are usually unnecessary. Initial wound care needs to ensure that the burn is kept covered and the patient is kept warm. Plastic food wrap (such as Gladwrap) is ideal.

  • Apply a thin layer of silver sulfadiazine to open areas if transportation will be delayed for more than 12 hours.

  • Use of Burnshield is a very effective means of cooling and dressing the injury in the first 24 hours.

General Items

  • A history, including details of the accident and preexisting diseases/allergies, should be recorded and sent with the patient.

  • Copies of all medical records, including all fluids (calculation of fluids administered) and medications given, urine outputs, and vital signs must accompany the patient. These specific details may be recorded on the back of the burn size assessment sheet.

  • The burn centre will arrange transport if appropriate.

  • In the case of paediatric patients not accompanied by a parent, obtain consent in consultation with your burn centre.

Special Considerations with Chemical Burns (Consult Burn Centre)

Remove all clothing, Brush powdered chemicals off the wound, then flush chemical burns for a minimum of 30 minutes using copious volumes of running water. Be careful to protect yourself.

Never neutralise an acid with a base or vice versa; the heat generated can worsen the burn.

Irrigate burned eyes using a gentle stream of saline. Follow with an ophthalmology consultation if transportation is not imminent. Determine what chemical (and what concentration) caused the injury.

Special Considerations with Electrical Injuries (Consult Burn Centre)

  • Differentiate between low-voltage (<1000 v) and high-voltage (>1000 v) injuries.

  • Attach a cardiac monitor; treat life-threatening dysrhythmias as needed.

  • Assess for associated trauma; assess central and peripheral neurological function.

  • Administer Ringer’s lactate; titrate fluids to maintain adequate urine output or to flush pigments through the urinary tract (see urine output above). Useful laboratory test: arterial blood gas levels with acid/base balance.

  • Using pillows, elevate burned extremities above the level of the heart. Monitor distal pulses.

For burns classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain urine output > 0.5 mL/kg/hour.  One commonly used fluid resuscitation formula is the Parkland formula. The total amount of fluid to be given during the initial 24 hours = 4 ml of LR × patient’s weight (kg) × % TBSA.  Half of the calculated amount is administered during the first eight hours beginning when the patient was initially burned. For example, if a 70 kg patient has a 30% TBSA partial thickness burn they will need 8400 mL Lactated Ringer solution in the first 24 hours with 4200 mL of that total in the first 8 hours [(4 mL) × (70 kg) × (30% TBSA) = 8,400 mL LR]. Remember that the fluid resuscitation formula for burns is only an estimate and the patient may need more or less fluid based on vital signs, urine output, other injuries or other medical conditions (see Burns, Resuscitation, and Management for discussion of the management of severely burned patients).

Dressing changes

The practice of subsequent dressing changes is varied. Ideally the dressing should be checked at 24 hours. The burn wound itself should be reassessed at 48 hours and the dressings changed, as they are likely to be soaked through. At this stage the depth of burn should be apparent, and topical agents such as Flamazine can be used.

Depending on how healing is progressing, dressing changes thereafter should be every three to five days. If the Jelonet dressing has become adherent, it should be left in place to avoid damage to delicate healing epithelium. If Flamazine is used it should be changed on alternate days. The dressing should be changed immediately if the wound becomes painful or smelly or the dressing becomes soaked (“strike through”).

Any burn that has not healed within two weeks should be seen by a burn surgeon.

Specialist dressings

Many specialist dressings are available, some developed for specific cases, but most designed for their ease of use. The following are among the more widely used.

Flamazine – is silver sulfadiazine cream and is applied topically on the burn wound. It is effective against gram negative bacteria including Pseudomonas. Infection with the latter will cause the dressing to turn green with a distinctive smell. Apply the cream in a 3-5 mm thick layer and cover with gauze. It should be removed and reapplied every two days. There is a reported 3-5% incidence of reversible leucopenia.

Granulflex  is a hydrocolloid dressing with a thin polyurethane foam sheet bonded onto a semipermeable film. The dressing is adhesive and waterproof and is therefore useful in awkward areas or where normal dressings are not suitable. It should be applied with a 2 cm border. By maintaining a moist atmosphere over the wound, it creates an environment suitable for healing. It usually needs to be changed every three or four days, but it can be left for seven days. A thinner version (Duoderm) is also available.

Mepitel – is a flexible polyamide net coated with soft silicone to give a Jelonet-type of dressing that is non adhesive. It is a useful but expensive alternative to Jelonet when easy removal is desirable, such as with children.

Facial burns

Facial burns should be referred to a specialist unit. However, simple sunburn should be left exposed as dressings can be awkward to retain on the face. The wound should be cleansed twice daily with mild diluted chlorohexidine solution. The burn should be covered with a bland ointment such as liquid paraffin. This should be applied every 1-4 hours as necessary to minimise crust formation. Men should shave daily to reduce risk of infection. All patients should be advised to sleep propped up on two pillows for the first 48 hours to minimise facial oedema.

Follow up

Burns that fail to heal within three weeks should be referred to a plastic surgery unit for review. Healed burns will be sensitive and have dry scaly skin, which may develop pigmental changes. Daily application of moisturiser cream should be encouraged. Healed areas should be protected from the sun with sun block for 6-12 months. Pruritis is a common problem.

Physiotherapy—Patients with minor burns of limbs may need physiotherapy. It is important to identify these patients early and start therapy. Hypertrophic scars may benefit from scar therapy such as pressure garments or silicone. For these reasons, all healed burns should be reviewed at two months for referral to an occupational therapist if necessary.

Support and reassurancePatients with burn injuries often worry about disfigurement and ugliness, at least in the short term, and parents of burnt children often have feelings of guilt. It is important to address these issues with reassurance.[rx]

Surgical and other procedures

You may need one or more of the following procedures:

  • 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.
  • Plastic surgery. Plastic surgery (reconstruction) can improve the appearance of burn scars and increase the flexibility of joints affected by scarring.

Complications of Burns

Deep or extensive burns can lead to many complications, including:

  • Breathing problems
  • Bone and joint problems
  • Dangerously low body temperature
  • Infection and sepsis
  • Low blood volume
  • Scarring
  • Tetanus

Infection is the most common complication. In order of frequency, potential complications include: pneumonia, cellulitis, urinary tract infections and respiratory failure. Pneumonia commonly occurs in those with inhalation injuries.

Other complications may include

  • Anemia secondary to full thickness burns of greater than 10% TBSA is common.
  • Electrical burns may result in compartment syndrome or rhabdomyolysis.
  • Blood clotting in the veins of the legs occurs in 6-25% of patients with extensive burns.
  • The hypermetabolic state that may persist for years after a major burn may result in a decreased bone density and muscle mass.
  • Keloids may form subsequent to a burn.
  • Following a burn, psychological trauma and post-traumatic stress disorder my develop.
  • Scarring may aresult in a disturbance in body image.
  • In the developing world, significant burns may result in social isolation, poverty, and child abandonment.

Other Risk Factors

There are a number of other risk factors for burns, including

  • occupations that increase exposure to fire;
  • poverty, overcrowding and lack of proper safety measures;
  • placement of young girls in household roles such as cooking and care of small children;
  • underlying medical conditions, including epilepsy, peripheral neuropathy, and physical and cognitive disabilities;
  • alcohol abuse and smoking;
  • easy access to chemicals used for assault (such as in acid violence attacks);
  • use of kerosene (paraffin) as a fuel source for non-electric domestic appliances;
  • inadequate safety measures for liquefied petroleum gas and electricity.

Prevention

Burns are preventable. High-income countries have made considerable progress in lowering rates of burn deaths, through a combination of prevention strategies and improvements in the care of people affected by burns. Most of these advances in prevention and care have been incompletely applied in low- and middle-income countries. Increased efforts to do so would likely lead to significant reductions in rates of burn-related death and disability.

Prevention strategies should address the hazards for specific burn injuries, education for vulnerable populations and training of communities in first aid. An effective burn prevention plan should be multisectoral and include broad efforts to

  • improve awareness
  • develop and enforce effective policy
  • describe burden and identify risk factors
  • set research priorities with promotion of promising interventions
  • provide burn prevention programmes
  • strengthen burn care
  • strengthen capacities to carry out all of the above.

The document A WHO plan for burn prevention and care discusses these 7 components in detail.

In addition, there are a number of specific recommendations for individuals, communities and public health officials to reduce burn risk.

  • Enclose fires and limit the height of open flames in domestic environments.
  • Promote safer cookstoves and less hazardous fuels, and educate regarding loose clothing.
  • Apply safety regulations to housing designs and materials, and encourage home inspections.
  • Improve the design of cookstoves, particularly with regard to stability and prevention of access by children.
  • Lower the temperature in hot water taps.
  • Promote fire safety education and the use of smoke detectors, fire sprinklers, and fire-escape systems in homes.
  • Promote the introduction of and compliance with industrial safety regulations, and the use of fire-retardant fabrics for children’s sleepwear.
  • Avoid smoking in bed and encourage the use of child-resistant lighters.
  • Promote legislation mandating the production of fire-safe cigarettes.
  • Improve treatment of epilepsy, particularly in developing countries.
  • Encourage further development of burn-care systems, including the training of health-care providers in the appropriate triage and management of people with burns.
  • Support the development and distribution of fire-retardant aprons to be used while cooking around an open flame or kerosene stove.

To reduce the risk of common household burns

  • Never leave items cooking on the stove unattended.
  • Turn pot handles toward the rear of the stove.
  • Don’t carry or hold a child while cooking at the stove.
  • Keep hot liquids out of the reach of children and pets.
  • Keep electrical appliances away from water.
  • Check the temperature of food before serving it to a child. Don’t heat a baby’s bottle in the microwave.
  • Never cook while wearing loose fitting clothes that could catch fire over the stove.
  • If a small child is present, block his or her access to heat sources such as stoves, outdoor grills, fireplaces and space heaters.
  • Before placing a child in a car seat, check for hot straps or buckles.
  • Unplug irons and similar devices when not in use. Store them out of reach of small children.
  • Cover unused electrical outlets with safety caps. Keep electrical cords and wires out of the way so that children can’t chew on them.
  • If you smoke, never smoke in bed.
  • Be sure you have working smoke detectors on each floor of your home. Check them and change their batteries at least once a year.
  • Keep a fire extinguisher on every floor of your house.
  • When using chemicals, always wear protective eyewear and clothing.
  • Keep chemicals, lighters and matches out of the reach of children. Use safety latches. And don’t use lighters that look like toys.
  • Set your water heater’s thermostat to below 120 F (48.9 C) to prevent scalding. Test bath water before placing a child in it.

References

Burns

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