Burn

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Burn is an injury to the skin and other tissues caused by contact to extreme heat, electricity, friction, radiation, or chemicals.

Contents

Types and causes

Direct contact with burn-inducing substances or surfaces is the most common cause of burn injuries. Also known as thermal burn, this can occur upon contact with hot liquids, steam, fire and hot surfaces. This usually happens in the home.

Contact with household or industrial chemicals causes chemical burn. This type of burn injury is common in the workplace, particularly in manufacturing plants that use large quantities of chemicals in solid, liquid, or gas form.

Radiation burn is caused by exposure to radio frequency energy or ionizing radiation. The most common is sunburn which is a result of overexposure to the sun’s ultraviolet rays or tanning salons. Extreme exposure to X-rays can also cause radiation burn. Cancer patients undergoing radiation therapy are at risk of incurring radiation burn injuries.

Electrical burn occurs upon contact with electrical sources, either alternating current (AC) or direct current (DC), or lightning.

Friction burn is a result of the skin rubbing against abrasive surfaces. It is commonly referred to as ‘chafing’ or the surface which caused the burn, such as ‘carpet burn’, ‘rope burn’, or ‘road rash’.

Classification

According to degree

  • First degree refers to burn injury only to the outer layer of the skin. The skin is red and swelling. Minor pain is felt by the victim.
  • Second degree refers to burn injury that reaches the dermis, which is the second layer of the skin. Skin becomes red and splotchy. Blisters are present. Moderate to severe pain is felt by the victim.
  • Third degree refers to burn injury to all layers of the skin, which are the epidermis, dermis, and hypodermis. Injured areas may be numb, but the victim may complain of pain because of the first and second degree burns surrounding the third degree burn.
  • Fourth degree refers to burn injury to all layers of the skin, including tendons, bone, ligament, and muscle. Nerve endings are destroyed resulting to lack of sensation for the victim. This type of burn is life-threatening and may result to permanent disability, even death.

According to its depth

  • Superficial burns affect only the epidermal skin layer. Injury is erythematous, with minimal swelling and light to moderate pain. Blisters do not develop and the skin’s functions remain normal after healing.
  • Superficial partial-thickness burns affect the epidermis and the superficial portion of the dermis. Blister formation is present within 24 hours. This type of burn injury heals in 1 to 3 weeks.
  • Deep partial-thickness burns reach the second or lower half of the dermis. Blisters may develop but injury is often dry caused by the destruction of sweat glands. Nerve damage is extensive and may require skin grafting.
  • Full thickness burns involve the entire dermis and the underlying fat or subcutaneous tissue. Hair follicles and sweat glands are also destroyed. Burns may be black, brown, white, or bright red. Blisters do not develop and the victim may feel little to no pain. A full thickness burn may also be classified as a fourth degree burn when damage involves deep tissues and the bone. Skin is tough and leathery and it may be black, white, or brown in appearance. Charring may be present. Hospital admission and skin grafting are mandatory.

According to severity

  • Minor burns include first and second-degree burns that involve less than 10% of the body surface.
  • Moderate and severe burns involve the hands, feet, face, or genitals. Second-degree burns covering more than 10% of the body surface or third-degree burns covering more than 1% of the body are also classified as moderate or severe.

Treatment

For first degree or superficial burns, holding the affected area under cool running water or soaking it in a cool, but not iced, water bath is recommended. A clean, cold towel may also be applied on the burn. Over-the-counter pain medications, burn creams, and ointments may be used to relieve pain. Healing is quick and no professional medical attention is usually required unless the affected areas include substantial portions of the hands, feet, face, groin, buttocks, and/or a major joint.

For second degree or superficial partial-thickness burn, submerging the affected area in cold water for at least five minutes is suggested. Ice should not be applied on the burn as this may cause further damage. Butter or ointment may not be used to avoid infection. Blisters and dead skin should remain untouched.

Third degree or deep partial-thickness and full thickness burns require immediate medical attention. Severe burns must not be immersed in cold water nor applied with a cold compress as this may lead to shock. Burned clothing must not be removed but tight clothing or jewelry that are not on the burned area may be removed in case of swelling. The patient's breathing should be checked. Otherwise, cardiopulmonary resuscitation (CPR) must be performed. Burned body parts must be raised above heart level.

Skin grafting may be needed to replace burned skin and to serve as a temporary covering and protection while the skin heals. Meanwhile, physical and occupational therapy can help the victim function if burn injury leads to immobility or a limit in joint function.

Possible Complications

  • Post-burn infection is a common, yet serious, complication. Also known as sepsis, it results to 50-60% of deaths in burn patients. The use of antibiotics and topical agents assist in the microbial control of the burn wound.
  • Dehydration may be a result of the fluid being lost through the skin. Signs of dehydration include thirst, dizziness, weakness, dry skin, and less urination. A doctor will treat dehydration with the administration of intravenous (IV) fluids.
  • Post-burn seizures occur in children as a result of an electrolyte imbalance, an abnormally low level of oxygen in the blood, infection or drugs.
  • Post-burn hypertension also occur in children and is speculated to be a result of the release of catecholamines and other stress hormones.
  • Hypertrophic scars and [keloid|keloids]] are overgrown scar tissues. Mobility may be affected. These scars are usually treated with pressure garments or steroid injections. Surgery or skin grafts may be administered to treat extensive scars.
  • Respiratory complications occur in almost 41% of burn victims. This complication arises within the first 48 hours of post-burn injury and may lead to death. Respiratory complications include inhalation injuries, aspiration of fluids by unconscious patients, bacterial pneumonia, pulmonary edema, obstruction of pulmonary arteries, and post-injury respiratory failure. Direct inhalation injuries, which may be a result of carbon monoxide poisoning, or inhalation of smoke, dry heat, and soot, may also lead to respiratory complications. A doctor will order oxygen delivery, assessment of carbon monoxide and cyanide toxicity, visualization of the airway, and repeated evaluation of the need for intubation in the early phase. Long-term respiratory dysfunction may occur months to years post-burn injury in severe cases.

Philippine scenario

Most burn cases in the Philippines involve chemical and electrical burns. Firecrackers are also another major cause of burn incidents. Medical experts report an increase in burn cases, but the Philippines only has four hospitals with burn units, each with 35 beds. The hospitals with burn units are the Philippine General Hospital in Manila, East Avenue Medical Center in Quezon City, Jose Reyes Memorial Medical Center in Manila, and Davao Medical Center in Davao City.

Miriam Defensor Santiago noted that the government lacks facilities to treat burn patients. She has sought a Senate inquiry thru Resolution 813, which called for a probe on government hospitals’ capacity to respond to burn cases and a study on an upgrade of burn units that will enable hospitals to respond to mass burn injuries.

References