Burns
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Introduction to burns The skin has an important role to play in the fluid and temperature regulation of the body. If enough skin area is injured, the ability to maintain that control can be lost. The skin also acts as a protective barrier against the bacteria and viruses that inhabit the world outside the body. The anatomy of the skin is complex, and there are many structures within the layers of the skin. There are three layers: 1. Epidermis, the outer layer of the skin 2. Dermis, made up of collagen and elastic fibers and where nerves, blood vessels, sweat glands, and hair follicles reside. 3. Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are located. This is the layer of tissue that is most important in temperature regulation. The amount of damage that a burn can cause depends upon its location, its depth, and how much body surface area that it involves.
How are burns classified? Burns are classified based upon their depth. 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. The skin may be very tender to touch. Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin. 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. Burns are not static and may mature. Over a few hours a first degree burn may involve deeper structures and become second degree. Think of a sunburn that blisters the next day. Similarly, second degree burns may evolve into third degree burns. Regardless of the type of burn, inflammation and fluid accumulation in and around the wound occur. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. A burn is also a break in the skin, and the risk of infection exists both at the site of the injury and potentially throughout the body. Only the epidermis has the ability to regenerate itself. Burns that extend deeper may cause permanent injury and scarring and not allow the skin in that area to return to normal function.
What is the significance of the amount of body area burned? In addition to the depth of the burn, the total area of the burn is significant. Burns are measured as a percentage of total body area affected. The "rule of nines" is often used, though this measurement is adjusted for infants and children. This calculation is based upon the fact that the surface area of the following parts of an adult body each correspond to approximately 9% of total (and the total body area of 100% is achieved): •
Head = 9%
•
Chest (front) = 9%
•
Abdomen (front) = 9%
•
Upper/mid/low back and buttocks = 18%
•
Each arm = 9%
•
Each palm = 1%
•
Groin = 1%
•
Each leg = 18% total (front = 9%, back = 9%)
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
Only second and third degree burn areas are added together to measure total body burn area. While first degree burns are painful, the skin integrity is intact and it is able to do its job with fluid and temperature maintenance. If more than15%-20% of the body is involved in a burn, significant fluid may be lost. Shock may occur if inadequate fluid is not provided intravenously. The Parkland formula (named for the trauma hospital in Dallas) estimates the amount of fluid required in the first few hours of care following a burn: •
4cc/ kg of weight/% burn = initial fluid requirement in the first 24 hours, with half given in the first 8 hours.
•
As an example: A 175lb (or 80kg) patient with 25% burn will need 4cc x 80kg x 25%, or 8000cc of fluid in the first 24 hours, or more than 7 pounds of fluid.
As the percentage of burn surface area increases, the risk of death increases as well. Patients with burns involving less than 20% of their body should do well, but those with burns involving greater than 50% have a significant mortality risk, depending upon a variety of factors, including underlying medical conditions and age.
How important is the location of a burn?
Burn location is an important consideration. If the burn involves the face, nose, mouth or neck, there is a risk that there will be enough inflammation and swelling to obstruct the airway and cause breathing problems. If there are circumferential burns to the chest, as the burn progresses, the tissue involved may not allow enough motion of the chest wall to allow adequate breathing to occur. If circumferential burns occur to arms, legs, fingers, or toes, the same constriction may not allow blood flow and put the survival of the extremity at risk. Burns to areas of the body with flexion creases, like the palm of the hand, the back of the knee, the face, and the groin may need specialized care. As the burn matures, the skin may scar and shorten, preventing full range of motion of the body area.
What about electrical burns? Electrical burns may cause serious injury that is not readily apparent. Often the entry and exit points for the electrical shock may not be easily found. Electricity flows more easily through tissues in the body that are designed to deal with electricity. Nerves and muscles are "wired" for this task and often are damaged. If significant muscle damage occurs, muscle fibers and chemicals can be released into the bloodstream causing electrolyte disturbances and kidney failure.
What about chemical burns? Burns can also occur when chemicals are spilled onto the body and generate a reaction that creates heat. Chemical burns may be classified by their pH or acidity. •
Acids are those with pH less than 7 and include common household compounds like acetic acid, hydrochloric acid, or sulfuric acid.
•
Bases or alkali compounds have a pH greater than 7. Ammonia is a common alkali found in the home.
First aid for burns For major burns (second and third degree burns) 1. Remove the victim from the burning area, remembering not to put the rescuer in danger. 2. Remove any burning material from the patient. 3. Call 911 or activate the emergency response system in your area if needed. 4. Once the victim is in a safe place, keep them warm and still. Try to wrap the injured areas in a clean sheet if available. DO NOT use cold water on the victim; this may drop the body temperature and cause hypothermia.
Burns of the face, hands, and feet should always be considered a significant injury (although this may exclude sunburn. For minor burns (first degree burns or second degree burns involving a small area of the body) •
Gently clean the wound with lukewarm water.
•
Though butter has been used as a home remedy, it should NOT be used on any burn.
•
Rings, bracelets, and other potentially constricting articles should be removed (edema, or swelling from inflammation may occur and the item may cut into the skin).
•
The burn may be dressed with a topical antibiotic ointment like Bacitracin or Neosporin.
•
If there is concern that the burn is deeper and may be second or third degree in nature, medical care should be accessed.
•
Tetanus immunization should be updated if needed.
For electrical burns Victims of electrical burns should always seek medical care. For chemical burns 1. Identify the chemical that was involved. 2. Contact the Poison Control Center in your area or your local hospital's Emergency Department. The United States National Poison Hotline is 1800-222-1222. You will be automatically linked to the nearest poison control center. Many chemical burns may be treated with local wound care. Some chemicals can cause life- and limb-threatening injuries and need emergent intervention. 3. Victims with chemical burns to their eyes should always seek emergency care. http://www.medicinenet.com/burns/article.htm#tocb The incidence of burns in developing countries is not precisely known due to unavailability or incompleteness of death registration and disease reporting.A scar prevalence of 6 per cent was found.No sex differences were foundHowever, significant differences were found among age groups, with children aged 18–23 .(months having the highest incidence (57.4 per 1000 person-years http://books.google.com/books?id=m_QnStA_JPsC&pg=PA788&lpg=PA788&dq=in +cidence+and++prevalence BurnRx is 100% botanical oils: essential & carrier plant oils formulated to stop burn pain fast
Burn Types First Degree Burn Superficial - First degree burns typically take 3 to 6 days to heal. The superficial or first layer of skin is damaged. Examples of a superficial - First degree burn are: mild sunburns, contact burn injuries, or heat burns. Second Degree Burn Superficial - Second degree burns usually heal in less than 3 weeks depending on severity. The deeper or thicker the burned skin the longer the injury make take to heal. Third Degree Burn Deep - Third degree burns are severe and may require skin graphs and a protracted recovery period - more than 3 weeks. Full-thickness burns, without skin grafts, heal only at the edges by scarring. A skin graft is a very thin layer of skin that is cut from an unburned area on the body and put on a badly burned area. Step 3. Treatment What can I do? Minor Burn Injury 1. Soak the burn in cool water for 15 minutes. 2. Apply cool cloth to the burn for a few minutes each day. 3. Apply BurnRx (see below) to the burn and cover it with a dressing or bandage. 4. Re-apply burn with BurnRx to promote healing. 5. Apply topical antibiotic to the burn to prevent infection if necessary. 6. If necessary, take over-the-counter pain medication to control pain. 7. If burn pain, redness, swelling persists or if there are signs of infection see a physician.
How are burns classified? Burns are classified based upon their depth. 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. The skin may be very tender to touch. Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin. 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. Burns are not static and may mature. Over a few hours a first degree burn may involve deeper structures and become second degree. Think of a sunburn that blisters the next day. Similarly, second degree burns may evolve into third degree burns. Regardless of the type of burn, inflammation and fluid accumulation in and around the wound occur. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. A burn is also a break in the skin, and the risk of infection exists both at the site of the injury and potentially throughout the body. Only the epidermis has the ability to regenerate itself. Burns that extend deeper may cause permanent injury and scarring and not allow the skin in that area to return to normal function.
What is the significance of the amount of body area burned? In addition to the depth of the burn, the total area of the burn is significant. Burns are measured as a percentage of total body area affected. The "rule of nines" is often used, though this measurement is adjusted for infants and children. This calculation is based upon the fact that the surface area of the following parts of an adult body each correspond to approximately 9% of total (and the total body area of 100% is achieved): •
Head = 9%
•
Chest (front) = 9%
•
Abdomen (front) = 9%
•
Upper/mid/low back and buttocks = 18%
•
Each arm = 9%
•
Each palm = 1%
•
Groin = 1%
•
Each leg = 18% total (front = 9%, back = 9%)
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
Only second and third degree burn areas are added together to measure total body burn area. While first degree burns are painful, the skin integrity is intact and it is able to do its job with fluid and temperature maintenance. If more than15%-20% of the body is involved in a burn, significant fluid may be lost. Shock may occur if inadequate fluid is not provided intravenously. The Parkland formula (named for the trauma hospital in Dallas) estimates the amount of fluid required in the first few hours of care following a burn: •
4cc/ kg of weight/% burn = initial fluid requirement in the first 24 hours, with half given in the first 8 hours.
•
As an example: A 175lb (or 80kg) patient with 25% burn will need 4cc x 80kg x 25%, or 8000cc of fluid in the first 24 hours, or more than 7 pounds of fluid.
As the percentage of burn surface area increases, the risk of death increases as well. Patients with burns involving less than 20% of their body should do well, but those with burns involving greater than 50% have a significant mortality risk, depending upon a variety of factors, including underlying medical conditions and age.
How important is the location of a burn?
Burn location is an important consideration. If the burn involves the face, nose, mouth or neck, there is a risk that there will be enough inflammation and swelling to obstruct the airway and cause breathing problems. If there are circumferential burns to the chest, as the burn progresses, the tissue involved may not allow enough motion of the chest wall to allow adequate breathing to occur. If circumferential burns occur to arms, legs, fingers, or toes, the same constriction may not allow blood flow and put the survival of the extremity at risk. Burns to areas of the body with flexion creases, like the palm of the hand, the back of the knee, the face, and the groin may need specialized care. As the burn matures, the skin may scar and shorten, preventing full range of motion of the body area.
What about electrical burns? Electrical burns may cause serious injury that is not readily apparent. Often the entry and exit points for the electrical shock may not be easily found. Electricity flows more easily through tissues in the body that are designed to deal with electricity. Nerves and muscles are "wired" for this task and often are damaged. If significant muscle damage occurs, muscle fibers and chemicals can be released into the bloodstream causing electrolyte disturbances and kidney failure.
What about chemical burns? Burns can also occur when chemicals are spilled onto the body and generate a reaction that creates heat. Chemical burns may be classified by their pH or acidity. •
Acids are those with pH less than 7 and include common household compounds like acetic acid, hydrochloric acid, or sulfuric acid.
•
Bases or alkali compounds have a pH greater than 7. Ammonia is a common alkali found in the home.
First aid for burns For major burns (second and third degree burns) 1. Remove the victim from the burning area, remembering not to put the rescuer in danger. 2. Remove any burning material from the patient. 3. Call 911 or activate the emergency response system in your area if needed. 4. Once the victim is in a safe place, keep them warm and still. Try to wrap the injured areas in a clean sheet if available. DO NOT use cold water on the victim; this may drop the body temperature and cause hypothermia.
Burns of the face, hands, and feet should always be considered a significant injury (although this may exclude sunburn. For minor burns (first degree burns or second degree burns involving a small area of the body) •
Gently clean the wound with lukewarm water.
•
Though butter has been used as a home remedy, it should NOT be used on any burn.
•
Rings, bracelets, and other potentially constricting articles should be removed (edema, or swelling from inflammation may occur and the item may cut into the skin).
•
The burn may be dressed with a topical antibiotic ointment like Bacitracin or Neosporin.
•
If there is concern that the burn is deeper and may be second or third degree in nature, medical care should be accessed.
•
Tetanus immunization should be updated if needed.
For electrical burns Victims of electrical burns should always seek medical care. For chemical burns 1. Identify the chemical that was involved. 2. Contact the Poison Control Center in your area or your local hospital's Emergency Department. The United States National Poison Hotline is 1800-222-1222. You will be automatically linked to the nearest poison control center. Many chemical burns may be treated with local wound care. Some chemicals can cause life- and limb-threatening injuries and need emergent intervention. 3. Victims with chemical burns to their eyes should always seek emergency care. http://www.medicinenet.com/burns/article.htm#tocb The incidence of burns in developing countries is not precisely known due to unavailability or incompleteness of death registration and disease reporting.A scar prevalence of 6 per cent was found.No sex differences were foundHowever, significant differences were found among age groups, with children aged 18–23 .(months having the highest incidence (57.4 per 1000 person-years http://books.google.com/books?id=m_QnStA_JPsC&pg=PA788&lpg=PA788&dq=in +cidence+and++prevalence BurnRx is 100% botanical oils: essential & carrier plant oils formulated to stop burn pain fast
Burn Types First Degree Burn Superficial - First degree burns typically take 3 to 6 days to heal. The superficial or first layer of skin is damaged. Examples of a superficial - First degree burn are: mild sunburns, contact burn injuries, or heat burns. Second Degree Burn Superficial - Second degree burns usually heal in less than 3 weeks depending on severity. The deeper or thicker the burned skin the longer the injury make take to heal. Third Degree Burn Deep - Third degree burns are severe and may require skin graphs and a protracted recovery period - more than 3 weeks. Full-thickness burns, without skin grafts, heal only at the edges by scarring. A skin graft is a very thin layer of skin that is cut from an unburned area on the body and put on a badly burned area. Step 3. Treatment What can I do? Minor Burn Injury 1. Soak the burn in cool water for 15 minutes. 2. Apply cool cloth to the burn for a few minutes each day. 3. Apply BurnRx (see below) to the burn and cover it with a dressing or bandage. 4. Re-apply burn with BurnRx to promote healing. 5. Apply topical antibiotic to the burn to prevent infection if necessary. 6. If necessary, take over-the-counter pain medication to control pain. 7. If burn pain, redness, swelling persists or if there are signs of infection see a physician.
