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Ailmemts & Remedies

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.

click to see the picture
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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Categories
Meditation

Meditation(Mental Exercise)

According to Swami Vishnu Devananda, meditation is  .a continuous flow of perception or thought, just like the flow of water in a river.” A practice wherein there is constant observation of the mind, meditation brings awareness, harmony and natural order into life. It helps you dig deep into your inner self to discover the wisdom and tranquility that lie within.

Principles of Meditation

The basic points to be kept in mind in practicing meditation are :

1.Have a special place and specific time for meditation. Try doing it daily.

2.Choose a time when your mind is not clouded with worries.

3.Sit up straight with your back, neck and head in one line. Facing north or east.

4.Condition your mind such so as to remain quiet for the duration of your meditation session.

5.Regulate your breathing. Start with 5 minutes of deep breathing. Then gradually slow it down.

6.Follow a rhythmic breathing pattern – inhale and exhale.

7.Initially let your mind wander. It grows more restless if you force to concentrate.

8.Then slowly bring it to rest on the focal point of your choice.

9.Hold your object of concentration at this focal point throughout your session.

10.Meditation happens when you reach a state of pure thought. Even while retaining an awareness of duel self.

Followed diligently you will soon be able to attain a super-conscious state.

Tips on Concentration

1.At the outset, it is hard to keep your attention to keep focussed on one object.

2.So it is better to start off by limiting your field of concentration to a category of objects.

3.Choose your objects with care e.g. any four flowers, fruits, trees…etc. You must feel at ease with what you choose.

4.After concentrating on one, you can move on to the next, if & when your mind starts wandering.

This style of meditative exercise will help you control your mind down to a finer focus, teaching you the principle of single point concentration.

Meditative Postures:-

Yoni Mudra

Yoni Mudra:…….CLICK  &  SEE

1.Close your ears with thumbs.

2.Cover your eyes with your index finger.

3.Close your nostrils with your middle fingers.

4.Press your lips together with your remaining fingers.

5.Release the middle fingers gently to inhale and exhale while you meditate
Frontal & Nasal Gazing:-

1.Gaze at a point between your eyebrows, seat of the ‘Third Eye’ or at the tip or your nose.

2.This would improve your level of concentration. At the same time, strengthening your eye muscles. Nasal gazing has a positive effect on the central nervous system.

3.Remember not to strain your eyes. Start with one minute of gazing and then slowly build it up to ten minutes.

Candle Gazing

CLICK  & SEE
1.Place a candle at eye-level in a darkened, draught-free room.

2.Close your eyes and hold an after-image of the bright flame.

3.The practice steadies the wandering mind, leading you to focus with pin-point accuracy.
Meditation is an ancient technique to revive your weary soul and help you deal effectively with stress, and helps you rediscover a sense of profound peace and inner calmness.

Meditation is a state of consciousness that can be understood only on a direct, intuitive level.

Ordinary experiences are limited by time, space, and the laws of causality, but the meditative state transcends all boundaries.

Meditation is a natural state of consciousness that isn’t learned, any more than one learns to sleep. When the mind becomes one-pointed and steady, it will naturally go beyond the normal mundane awareness into the state referred to as Meditation.

How to Meditate ?

 

Please sit down comfortably, spine erect, head straight. Hands on the top of the knees or in the lap, wherever comfortable. Eyes closed. For a few moments become aware of the whole body from the top of the head to the toes. Experience open space within the body.

Imagine the whole body to be in the form of flame. First see the symbol of the flame in front of the closed eyes; see the flame in chidakasha.

Gradually experience the radiating light of the flame spreading throughout the body, purifying the body, illuminating each and every part of the body. The whole body becomes one with the light. Each and every cell of the body becomes one with the light. There is no part of the physical body where darkness can exist. Each and every cell of the body is infused with the light. Experience the whole body in the form of pure light.

At first this is a process of imagination, but with concentration, the feeling develops. The body then responds to that feeling and one can actually see the radiance internally. Try to experience and feel that radiance now within yourself. See yourself filled with light internally and surrounded by light externally. Continue to observe yourself in the form of light and mentally repeat the mantra OM with every inhalation and exhalation. With total awareness repeat the mantra internally. Do not miss a single breath and repeat the mantra OM with every inhalation and exhalation. Merge yourself completely in the repetition of the mantra and the experience of light within. Now inhale deeply and chant OM three times.

Source:www.allayurveda.com