BURN

•A burn is a type of injury that may be caused by heat, electricity,

chemicals, light, radiation, or friction.

•Depending on the location affected and the degree of severity, a burn

victim may experience a wide number of potentially fatal complications
including shock, infection, electrolyte imbalance and respiratory
distress.

•Beyond physical complications, burns can also result in severe

psychological and emotional distress due to scarring and deformity.

Classification
By degree
•First-degree burns- are usually limited to redness (erythema), a white
plaque and minor pain at the site of injury.

•Second-degree burns - manifest as erythema with superficial blistering of

the skin, and can involve more or less pain depending on the level of nerve
involvement.

•Third-degree burns - occur when the epidermis is lost with damage to the
subcutaneous tissue. Burn victims will exhibit charring and extreme damage
of the epidermis, and sometimes hard eschar will be present.

•.Fourth-degree burns- damage muscle, tendon, and ligament tissue, thus

result in charring and catastrophic damage of the hypodermis. In some
instances the hypodermis tissue may be partially or completely burned away
as well as this may result in a condition called compartment syndrome,
which threatens both the life and the limb of the patient.

♦ Burns can also be assessed in terms of total body surface area (TBSA),
which is the percentage, affected by partial thickness or full thickness burns
(superficial thickness burns are not counted). The rule of nines is used as a
quick and useful way to estimate the affected TBSA.
Causes
•Chemical burn-Most chemicals that cause severe chemical burns
are strong acids or bases. Chemical burns are usually caused
by caustic chemical compounds, such as sodium
hydroxide, silver nitrate, and more serious compounds (such
as sulphuric acid and Nitric acid). Hydrofluoric acid can
cause damage down to the bone and its burns are sometimes
not immediately evident.

•Electrical burn- Electrical burns are caused by an exogenous

electric shock. The internal injuries sustained may be
disproportionate to the size of the burns seen, and the extent of
the damage is not always obvious. Such injuries may lead to
cardiac arrhythmias, cardiac arrest, and unexpected falls
with resultant fractures.

•Radiation burn- are caused by protracted exposure to UV light (as

from the sun), tanning booths, radiation therapy (as patients
who are undergoing cancer therapy), sunlamps, and X-rays.

• By far the most common burn associated with radiation is sun

exposure, specifically two wavelengths of light UVA, and UVB,
the latter being more dangerous.

•Tanning booths also emit these wavelengths and may cause similar
damage to the skin such as irritation, redness, swelling, and
inflammation. More severe cases of sun burn result in what is
known as sun poisoning.

•Scalding- is caused by hot liquids or gases, most commonly

occurring from exposure to high temperature tap water. Usually
forms a blister; Steam is a common gas that causes scalds.
The injury is usually regional and usually does not cause death.
Management
If the patient was involved in a:

•Fire accident - then it must be assumed that he or she has sustained an

inhalation injury until proven otherwise, and treatment should be
managed accordingly. At this stage of management, it is also critical to
assess the airway status. Any hint of burn injury to the lungs (e.g.
through smoke inhalation) is considered a medical emergency.

♦Regardless of the cause, the first step in managing a person with a burn is
to stop the burning process at the source, and cool the burn wound.

•With dry powder burns- the powder should be brushed off first. With
other burns the affected area should be rinsed thoroughly with a large
amount of clean water.

♦Cold water should not be applied to a person with extensive burns,

however, as it may result in hypothermia.

♦To help ease the suffering of a burn victim, they may be placed in a special
burn recovery bed which evenly distributes body weight and helps to
prevent painful pressure points and bed sores. Survival and outcome of
severe burn injuries is remarkably improved if the patient is treated in a
specialized burn center/unit rather than a hospital.

Alternative treatments
♦Honey has been used since ancient times to aid wound healing and may be
beneficial in first and second degree burns