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Burns

Definition:
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns only affect the skin (epidermal tissue and dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an out-of-hospital setting, or may require more specialised treatment such as those available at specialised burn centers.

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Managing burns is important because they are common, painful and can result in disfiguring and disabling scarring, amputation of affected parts or death in severe cases. Complications such as shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress may occur. The treatment of burns may include the removal of dead tissue (debridement), applying dressings to the wound, administering large volumes of intravenous fluids, administering antibiotics and skin grafting.

While large burns can be fatal, modern treatments developed in the last 60 years have significantly improved the prognosis of such burns, especially in children and young adults.  In the United States, approximately 4 out of every 100 people with injuries from burns will succumb to their injuries. The majority of these fatalities occur either at the scene or enroute to hospital.

According to the American Burn Association, an estimated 500,000 burn injuries receive medical treatment yearly in the United States.

Classification:
Burns can be classified by mechanism of injury, depth, extent and associated injuries and comorbidities.

By depth

Currently, burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third and fourth degrees. This system was devised by the French barber-surgeon Ambroise Pare and remains in use today.

Note that an alternative form of reference to burns may describe burns according to the depth of injury to the dermis.

It is often difficult to accurately determine the depth of a burn. This is especially so in the case of second degree burns, which can continue to evolve over time. As such, a second-degree partial-thickness burn can progress to a third-degree burn over time even after initial treatment. Distinguishing between the superficial-thickness burn and the partial-thickness burn is important, as the former may heal spontaneously, whereas the latter often requires surgical excision and skin grafting.

First degree burn:..
A first degree burn is superficial and causes local inflammation of the skin. Sunburns often are categorized as first degree burns. The inflammation is characterized by pain, redness, and a mild amount of swelling.

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The skin may be very tender to touch.It takes about a week’s time to heal & there is no complecation.

Second degree (superficial partial thickness):
Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin. Healing time is appx.2to 3 weeks.Complecation is  Local infection/cellulities.
click to see the picture
Third Degree:
Third degree burns are deeper still, involving all layers of the skin, in effect killing that area of skin. Because the nerves and blood vessels are damaged, third degree burns appear white and leathery and tend to be relatively painless. It needs  excision. It is scarring, contractures (may require excision and skin grafting)

click to see the pictures….....(1)...……………………………………

Fourth Degree:….CLICK & SEE
It extends through skin, subcutaneous tissue and into underlying muscle and bone.Needs excision.Complecated may need  amputation, significant functional impairment.

By severity:
In order to determine the need for referral to a specialised burn unit, the American Burn Association devised a classification system to aid in the decision-making process. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area (TBSA) burnt, the involvement of specific anatomical zones, age of the person and associated injuries.

MajorMajor burns are defined as:
*Age 10-50yrs: Partial thickness burns >25% TBSA
*Age <10 or >50: Partial thickness burns >20% TBSA
*Full thickness burns >10%
*Burns involving the hands, face, feet or perineum
*Burns that cross major joints
*Circumferential burns to any extremity
*Any burn associated with inhalational injury
*Electrical burns
*Burns associated with fractures or other trauma
*Burns in infants and the elderly
*Burns in persons at high-risk of developing complications

These burns typically require referral to a specialised burn treatment center.

Moderate:

Moderate burns are defined as:
*Age 10-50yrs: Partial thickness burns involving 15-25% TBSA
*Age <10 or >50: Partial thickness burns involving 10-20% TBSA
*Full thickness burns involving 2-10% TBSA

Persons suffering these burns often need to be hospitalised for burn care.

Minor:
Minor burns are:
*Age 10-50yrs: Partial-thickness burns <15% TBSA
*Age <10 or >50: Partial thickness burns involving <10% TBSA
*Full thickness burns <2% TBSA without associated injuries.

These burns usually do not require hospitalisation.

By surface area:
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. First degree (erythema only, no blisters) burns are not included in this estimation. The rule of nines is used as a quick and useful way to estimate the affected TBSA. More accurate estimation can be made using Lund & Browder charts which take into account the different proportions of body parts in adults and children.The size of a person’s hand print (palm and fingers) is approximately 1% of their TBSA. The actual mean surface area is 0.8% so using 1% will slightly over estimate the size.Burns of 10% in children or 15% in adults (or greater) are potentially life threatening injuries (because of the risk of hypovolaemic shock) and should have formal fluid resuscitation and monitoring in a burns unit.

 

Symptoms:
There may be obvious and immediate damage to the skin, which can be very painful.

With partial thickness burns, the skin may be pink, red or mottled. Blistering may also be seen.

With full thickness burns, the top layer of skin is destroyed and may look white or black, and charred. Full thickness burns are painless, as the nerves carrying pain signals have been destroyed.
Causes:
Burns are caused by a wide variety of substances and external sources such as exposure to chemicals, friction, electricity, radiation, and heat.

Chemical:
Most chemicals that cause chemical burns are strong acids or bases.[11] Chemical burns can be caused by caustic chemical compounds such as sodium hydroxide or silver nitrate, and acids such as sulfuric acid.Hydrofluoric acid can cause damage down to the bone and its burns are sometimes not immediately evident.

Electrical
Electrical burns are caused by either an electric shock or an uncontrolled short circuit. (A burn from a hot, electrified heating element is not considered an electrical burn.) Common occurrences of electrical burns include workplace injuries, or being defibrillated or cardioverted without a conductive gel. Lightning is also a rare cause of electrical burns.

Since normal physiology involves a vast number of applications of electrical forces, ranging from neuromuscular signaling to coordination of wound healing, biological systems are very vulnerable to application of supraphysiologic electric fields. Some electrocutions produce no external burns at all, as very little current is required to cause fibrillation of the heart muscle. Therefore, even when the injury does not involve any visible tissue damage, electrical shock survivors may experience significant internal injury. The internal injuries sustained may be disproportionate to the size of the burns seen (if any), 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 or dislocations.

The true incidence of electrical burn injury is unknown. In one study of 220 deaths due to electrical injury, 40% of those associated with low-voltage (<1000 AC volts) injury demonstrated no skin burns or marks whatsoever. Most household electrical burns occur at 110 AC volts. This is sufficient to cause cardiac arrest and ventricular fibrillation but generates relatively low heat energy deposit into skin, thus producing few or no burn marks at all.

Radiation:
Radiation burns are caused by protracted exposure to UV light (as from the sun), tanning booths, radiation therapy (in people undergoing cancer therapy), sunlamps, radioactive fallout, 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 or “heatstroke”. Microwave burns are caused by the thermal effects of microwave radiation.

Scalding :.…CLICK & SEE

Two-day-old scald caused by boiling radiator fluid.Scalding (from the Latin word calidus, meaning hot  is caused by hot liquids (water or oil) or gases (steam), most commonly occurring from exposure to high temperature tap water in baths or showers or spilled hot drinks. A so called immersion scald is created when an extremity is held under the surface of hot water, and is a common form of burn seen in child abuse.[19] A blister is a “bubble” in the skin filled with serous fluid as part of the body’s reaction to the heat and the subsequent inflammatory reaction. The blister “roof” is dead and the blister fluid contains toxic inflammatory mediators. Scald burns are more common in children, especially “spill scalds” from hot drinks and bath water scalds.

Treatment:
Cool small burns immediately under cold running water for at least ten minutes. Rinse chemical burns for 20 minutes.

Briefly rinse larger burns, avoiding excessive cooling.

Remove clothes in the area of the burn where possible, without causing further damage to the skin. Then either wrap the burned area in a clean clear plastic bag or place a clean smooth material, such as cling film, over the burn to prevent infection.

Minor burns can be treated at home with painkillers and sterile dressings (don’t pop blisters). Deep or extensive burns, or burns to the face, hands or across joints, need to be assessed and treated in hospital.

The extent of burns can be estimated using special charts. More than ten per cent burns need hospital treatment (including intravenous fluids). Burns to more than 50 per cent of the body’s surface carry a poor chance of survival.

Severe burns need specialised long-term management, which may include skin grafts or treatments to prevent contractures, as well as psychological support to deal with scarring.

Pathophysiology:
Following a major burn injury, heart rate and peripheral vascular resistance increase. This is due to the release of catecholamines from injured tissues, and the relative hypovolemia that occurs from fluid volume shifts. Initially cardiac output decreases. At approximately 24 hours after burn injuries, cardiac output returns to normal if adequate fluid resuscitation has been given. Following this, cardiac output increases to meet the hypermetabolic needs of the body.

Management:
The resuscitation and stabilisation phase begins with the reassessment of the injured person’s airway, breathing and circulatory state. Appropriate interventions should be initiated to stabilise these. This may involve aggressive fluid resuscitation and, if inhalation injury is suspected, intubation. Once the injured person is stabilised, attention is turned to the care of the burn wound itself. Until then, it is advisable to cover the burn wound with a clean and dry sheet or dressing.

Early cooling reduces burn depth and pain, but care must be taken as uncontrolled cooling can result in hypothermia.

Intravenous fluids:
Children with TBSA >10% and adults with TBSA > 15% need formal fluid resuscitation and monitoring (blood pressure, pulse rate, temperature and urine output).Once the burning process has been stopped, the injured person should be volume resuscitated according to the Parkland formula . This formula calculates the amount of Ringer’s lactate required to be administered over the first 24hrs post-burn.

Parkland formula: 4mls x percentage total body surface area sustaining non-superficial burns x person’s weight in kgs.

Half of this total volume should be administered over the first 8hrs, with the remainder given over the following 16hrs. It is important to note that this time frame is calculated from the time at which the burn is sustained, and not the time at which fluid resuscitation is begun. Children also require the addition of maintenance fluid volume. Such injuries can disturb a person’s osmotic balance.  Inhalation injuries in conjunction with thermal burns initially require up to 40–50% more fluid.

The formula is a guide only and infusions must be tailored to the urine output and central venous pressure. Inadequate fluid resuscitation may cause renal failure and death but over-resuscitation also causes morbidity.

Wound care
Debridement cleaning and then dressings are important aspects of wound care. The wound should then be regularly re-evaluated until it is healed. In the management of first and second degree burns little quality evidence exists to determine which type of dressing should be used. Silver sulfadiazine (Flamazine) is not recommended as it potentially prolongs healing time  while biosynthetic dressings may speed healing.

Antibiotics:
Intravenous antibiotics may improve survival in those with large severe burns however due to the poor quality of the evidence routine use is not currently recommended.

Analgesics:
A number of different options are used for pain management. These include simple analgesics ( such as ibuprofen and acetaminophen ) and narcotics. A local anesthetic may help in managing pain of minor first-degree and second-degree burns.

Surgery:
Wounds requiring surgical closure with skin grafts or flaps should be dealt with as early as possible. Circumferential burns of digits, limbs or the chest may need urgent surgical release of the burnt skin (escharotomy) to prevent problems with distal circulation or ventilation.

Alternative treatments:
Hyperbaric oxygenation has not been shown to be a useful adjunct to traditional treatments. Honey has been used since ancient times to aid wound healing and may be beneficial in first and second degree burns, but may cause infection.

Home Remedy:..
One of them that is pretty popular but equally dangerous is the old, “butter on burns” procedure. Many people around the world apply butter (or margarine) to the skin to treat minor burns;
Complications:
Infection is a major complication of burns. Infection is linked to impaired resistance from disruption of the skin’s mechanical integrity and generalized immune suppression. The skin barrier is replaced by eschar. This moist, protein rich avascular environment encourages microbial growth. Migration of immune cells is hampered, and there is a release of intermediaries that impede the immune response. Eschar also restricts distribution of systemically administered antibiotics because of its avascularity.

Risk factors of burn wound infection include:

*Burn > 30% TBS
*Full-thickness burn
*Extremes in age (very young, very old)
*Preexisting disease e.g. diabetes
*Virulence and antibiotic resistance of colonizing organism
*Failed skin graft
*Improper initial burn wound care
*Prolonged open burn wound

Burn wounds are prone to tetanus. A tetanus booster shot is required if individual has not been immunized within the last 5 years.

Circumferential burns of extremities may compromise circulation. Elevation of limb may help to prevent dependent edema. An Escharotomy may be required.

Acute Tubular Necrosis of the kidneys can be caused by myoglobin and hemoglobin released from damaged muscles and red blood cells. This is common in electrical burns or crush injuries where adequate fluid resuscitation has not been achieved.

Prognosis:
The outcome of any injury or disease depends on three things: the nature of the injury, the nature of the injured or ill person and the treatment available. In terms of injury factors in burns the prognosis depends primarily on the burn surface area (% TBSA) and the age of the person. The presence of smoke inhalation injury, other significant injuries such as long bone fractures and serious co-morbidities (heart disease, diabetes, psychiatric illness, suicidal intent etc.) will also adversely influence prognosis. Advances in resuscitation, surgical management, control of infection, control of the hyper-metabolic response and rehabilitation have resulted in dramatic improvements in burn mortality and morbidity in the last 60 years.

You may Click to see :List of Burn Centers in  US

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.umm.edu/imagepages/1078.htm
http://en.wikipedia.org/wiki/Burn
http://www.bbc.co.uk/health/physical_health/conditions/burns2.shtml
http://www.doctorsatyourhome.com/blog/?p=77

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Burns and Scalds

Scalding caused by a radiator explosion. Pictu...Image via Wikipedia

Definition:
Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals. Scalds are a type of burn caused by a hot liquid or steam....CLICK & SEE
Description:
Burns are classified according to how seriously tissue has been damaged. The following system is used:

* A first degree burn causes redness and swelling in the outermost layers of the skin.
* A second degree burn involves redness, swelling, and blistering. The damage may extend to deeper layers of the skin.
* A third degree burn destroys the entire depth of the skin. It can also damage fat, muscle, organs, or bone beneath the skin. Significant scarring is common, and death can occur in the most severe cases.

The severity of a burn is also judged by how much area it covers. Health workers express this factor in a unit known as body surface area (BSA). For example, a person with burns on one arm and hand is said to have about a 10 percent BSA burn. A burn covering one leg and foot is classified as about a 20 percent BSA burn.


Causes :

Burns may be caused in a variety of ways. In every case, the burn results from the death of skin tissue and, in some cases, underlying tissue. Burns caused by hot objects result from the death of cells caused by heat. In many cases, contact with a very hot object can damage tissue extensively. The contact may last for no more than a second or so, but the damage still occurs.

In other cases, cells are killed by heat produced by some physical event. For example, a rope burn is caused by friction between the rope and a person’s body. The rope itself is not hot, but the heat produced by friction is sufficient to cause a burn.

Chemicals can also cause burns. The chemicals attack and destroy cells in skin tissue. They produce an effect very similar to that of a heat burn.

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Symptoms:
The major signs of a burn are redness, swelling, and pain in the affected area. A severe burn will also blister. The skin may also peel, appear white or charred (blackened), or feel numb. A burn may also trigger a headache and fever. The most serious burns may cause shock. The symptoms of shock include faintness, weakness, rapid pulse and breathing, pale and clammy skin, and bluish lips and fingernails.
Burns and Scalds: Words to Know

Burns and Scalds: Words to Know

BSA:
A unit used in the treatment of burns to express the amount of the total body surface area covered by the burn.
Debridement:
The surgical removal of dead skin.
Scald:
A burn caused by a hot liquid or steam.
Shock:
A life-threatening condition that results from low blood volume due to loss of blood or other fluids.
Skin graft:
A surgical procedure in which dead skin is removed and replaced by healthy skin, usually taken from the patient’s own body.
Thermal burns:
Burns caused by hot objects.

Diagnosis:

Most burn cases are easily diagnosed. Patients know that they have touched a hot object, spilled a chemical on themselves, or been hit by steam. Doctors can confirm that a burn has occurred by conducting a physical examination.
Treatment:
The form of treatment used for a burn depends on how serious it is. Minor burns can usually be treated at home or in a doctor’s office. A minor burn is defined as a first or second degree burn that covers less than 15 percent of an adult’s body or 10 percent of a child’s body.

Moderate burns should be treated in a hospital. Moderate burns are first or second degree burns that cover more of a patient’s body or a third degree burn that covers less than 10 percent of BSA.

The most severe burns should be treated in special burn-treatment facilities. These burns are third degree burns that cover more than 10 percent of BSA. Specialized equipment and methods are used to treat these burns.

Thermal Burn Treatment:
Thermal burns are burns caused by heat, hot liquids, steam, fire, or other hot objects. The first objective in treating thermal burns is to cool the burned area. Cool water, but not very cold water or ice, should be used for the cooling process. Minor burns can also be cleaned with soap and water.

A burn victim receiving debridement treatment, or removal of dead skin, for severe burns.

Blisters should not be broken. If the skin is broken, the burned area should be covered with an antibacterial ointment and covered with a bandage to prevent infection. Aspirin, acetaminophen (pronounced uh-see-tuh-MIN-uh-fuhn, trade name Tylenol), or ibuprofen (pronounced i-byoo-PRO-fuhn, trade names Advil, Motrin) can be used to ease pain and relieve inflammation. However, children should not take aspirin due to the risk of contracting Reye’s syndrome (see Reye’s syndrome entry). If signs of infection appear, the patient should see a doctor.

More serious burns may require another approach. A burn may be so severe that it causes life-threatening symptoms. The patient may stop breathing or go into shock. In such cases, the first goal of treatment is to save the patient’s life, not treat the burns. The patient may require mouth-to-mouth resuscitation or artificial respiration.

There are three classifications of burns based on how deeply the skin has been damaged: first degree, second degree, and third degree.

Specialized treatment for severe burn cases may also include:

* Installation of a breathing tube if the patient’s airways or lungs have been damaged
* Administration of fluids through an intravenous tube
* Immunization with tetanus vaccine to prevent infection
* Covering the burned area with antibiotic ointments and bandages
* Debridement, or removal of dead tissue
* Removal of scars as healing occurs in order to improve blood flow
* Physical and occupational therapy to keep burn areas flexible and prevent scarring

Sometimes skin tissue is damaged so badly that it cannot heal properly. In that case, a skin graft may be required. In a skin graft, a doctor removes a section of healthy skin from an area of the patient’s body that has not been burned. The tissue scarred by the burn is also removed. The healthy tissue is then put into place where the damaged tissue was removed. Over a period of time, the healthy tissue begins to grow and replace the damaged tissue.

Chemical Burn Treatment:
The first step in treating a chemical burn is to remove the material causing the burn. If the material is a dry powder, it can be brushed off. If the material is a liquid, it can be flushed away with water. If the chemical that caused the burn is known, it may be neutralized with some other chemical. For example, if the burn is caused by an acid, a weak base can be used to neutralize the acid. The burned area can then be covered with a clean gauze and, if necessary, treated further by a doctor.
Electrical Burn Treatment

As with severe thermal burns, the first step in treating electrical burns usually involves saving the patient’s life. An electrical charge large enough to burn the skin may also produce life-threatening symptoms. The source of electricity must be removed and life support treatment provided to the patient. When the patient’s condition is stable, the burn can be covered with a clean gauze and medical treatment sought.

Alternative Treatment:
Serious burns should always be treated by a modern medical doctor. Less serious burns may benefit from a variety of alternative treatments. Some herbs that can be used to treat burns include aloe, oil of St. John’s wort, calendula (pronounced KUH-len-juh-luh), comfrey, and tea tree oil. Supplementing one’s diet with vitamins C and E and the mineral zinc may help a wound to heal faster.

Prognosis:
The prognosis for burns depends on many factors. These factors include the degree of the burn, the amount of skin affected by the burn, what parts of the body were affected, and any additional complications that might have developed.

In general, minor burns heal in five to ten days with few or no complications or scarring. Moderate burns heal in ten to fourteen days and may leave scarring. Major burns take more than fourteen days to heal and can leave significant scarring or, in the most severe cases, can be fatal.

Prevention:
Most thermal burns are caused by fires in the home. Every family member should be aware of basic safety rules that can reduce the risk of such fires. The single most important safety device is a smoke detector. The installation of smoke detectors throughout a house can greatly reduce the chance that injuries will result if a fire breaks out. Children should also be taught not to play with matches, lighters, fireworks, gasoline, cleaning fluids, or other materials that could burn them.

Burns from scalding water can be prevented by monitoring the temperature in the home hot water heater. That temperature should never be set higher than about 120°F (49°C). Taking care when working in the kitchen can also prevent scalds. For instance, be cautious when removing the tops from pans of hot foods and when uncovering foods heated in a microwave oven.

Sunburns can be prevented by limiting the time spent in the sun each day. The use of sunscreens can also reduce exposure to the ultraviolet radiation that causes sunburns.

Electrical burns can be prevented by covering unused electrical outlets with safety plugs. Electrical cords should also be kept out of the reach of infants who may chew on them. People should seek shelter indoors during thunderstorms in order to avoid being struck by lightning or coming in contact with fallen electrical wires.

Chemical burns may be prevented by wearing protective clothing, including gloves and eyeshields. Individuals should also be familiar with the chemicals they handle and know which ones are likely to pose a risk for burns.

For More Information:

Books
Munster, Andrew M., and Glorya Hale. Severe Burns: A Family Guide to Medical and Emotional Recovery. Baltimore: Johns Hopkins University Press, 1993.
Organizations

American Burn Association. 625 North Michigan Avenue, Suite 1530, Chicago, IL 60611. http://www.ameriburn.org.

Shriners Hospitals for Children. 2900 Rocky Point Drive, Tampa, FL 33607–1435. (813) 281–0300. http://www.shriners.org.
Web sites

“Cool the Burn: A Site for Children Touched by a Burn.” [Online] http://www.cooltheburn.com (accessed on October 11, 1999).

You may also click to learn more about Burns & Scalda:->..(1)……..(2)…...(3)…..(4)…….(5)

Sources: http://www.faqs.org/health/Sick-V1/Burns-and-Scalds.html

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