Burns

Burns

Definition

Burns are injuries to the tissues caused by heat, friction, electricity, radiation, or chemicals. Such injuries cause the breakdown of body proteins, death of cells, loss of body fluids, and edema .

Description

Burns vary depending on the cause, the intensity, and the body parts involved. They are classified by degree, based on the severity of the tissue damage: A first-degree burn causes redness and swelling in the outermost layers of skin called the epidermis. A second-degree burn involves redness, swelling, and blistering. The damage extends beneath the epidermis to the deeper layers of skin, the dermis. A third-degree burn, also called a full-thickness burn, destroys the entire depth of skin, causing significant scarring. Damage also may extend to the underlying fat, muscle, or bone. Third-degree burns require immediate medical attention. Burns are the third leading cause of accidental death in North America.

The severity of a burn is judged by the amount of body surface area (BSA) involved as well as the depth of the burn. A burn is considered to be critical, or major, if a person has third-degree burns on more than 10% of the BSA or second-degree burns covering more than 25% of an adult's BSA, and more than 20% of a child's BSA. Such burns are serious and should be treated in a specialized hospital burn unit. Burns involving the hands, feet, face, eyes, ears, or genitals are considered critical, as well. Moderate burns are defined as first- or second-degree burns covering 15%-25% of an adult's body or 10%-20% of a child's body, or a third-degree burn on 2%-10% BSA. These burns also require medical attention.

Causes & symptoms

Burns may be caused by any encounter, however brief, with heat greater than 120°F (49°C). The source of this heat may be the sun, hot liquids, steam, fire, electricity, friction (rug burns and rope burns,) and chemicals. Signs that the skin has been burned are localized redness, swelling, and pain . A blister may develop. The skin may peel, appear white or charred, and feel numb. A burn may trigger a headache or fever , and extensive burns may induce shock.

Thermal burns are caused by heat sources such as fire, hot liquids, gases or other objects. Radiation burns are usually due to excess exposure to the sun's rays, tanning beds, or x rays. Chemical burns are most likely to come from strong acids, alkalis, phenols, or phosphorus . Electrical burns may be quite severe due to the high heat generated by electric currents.

Diagnosis

A physician will diagnose a burn based upon visual examination, and will ask questions to determine the history of contact with possible sources of damage. Depending on the circumstances, there should be an evaluation of the condition of the lungs and breathing, related injuries, evidence of any suspected child abuse, and the extent and location of the burn. Shock and infection are

often the results of moderate and major burns, and should be included in any evaluation.

Treatment

A number of herbal remedies, applied topically, can help mild burns heal. These include aloe (Aloe barbadensis or Aloe vera ), St. John's wort ,(Hypericum perforatum) Calendula officinalis, comfrey root (Symphytum officinale), and tea tree oil (Melaleuca spp.)

Nutritional support is particularly important for burn victims. Supplementing the diet with vitamins A, C, and E, zinc and B-complex, essential fatty acids (omega-3 and omego-6) and eating foods high in these nutrients can be very beneficial to the healing process. Proteins and fluid intake should be increased to replace losses. The traditional Chinese medicine (TCM) approach recommends foods that remove heat and toxins, nourish yin, and promote the production of body fluids. These foods include mung beans, kidney beans, lima beans, soybeans, cucumbers, potatoes, summer squash, sweet potatoes, and barley. In addition, freshly juiced ginger , potatoes, and cucumbers can be applied to burns to reduce pain and swelling. The pulp of fresh pumpkin can be used as a poultice (soft compress applied to the affected area). Chamomile tea decreases anxiety .

Homeopathic treatment should be given as soon as possible after the onset of the burn injury. Cantharis 30c is the most noteworthy remedy for burns. It is recommended to keep blisters from forming. A dose can be taken every 15 minutes for up to six doses.

Homeopathic calendula mother tincture can be useful to promote the healing of burns. Ten drops should be added to one ounce of water and applied to the burn three times daily. Arnica montana 30c can help prevent shock. Urtica urens 6c and Causticum 6c may also be useful for burns. Urtica may be applied to the skin as an ointment as well.

Guided imagery can assist with pain control.

Allopathic treatment

Burn treatment usually consists of relieving pain, preventing infection, and maintaining body fluids, electrolytes, and calorie intake while the body heals. Children and the elderly are more vulnerable to complications from burn injuries and require more intensive care. Other factors that influence treatment include associated injuries such as bone fractures and smoke inhalation, presence of a chronic disease, a history of abuse, and the occurrence of shock or infection. Moderate and major burns should always be treated by a medical practitioner.

The first act of treating a burn is to stop the burning process. Small thermal burns should be immediately placed in cold water if possible. To avoid infection, the wound should be cleaned with soap and water, and all dirt should be carefully removed. Butter, shortening, or similar salve should never be applied to the burn since it prevents heat from escaping and drives the burning process deeper into the skin. Minor burns should be cleaned gently with soap and water. If the skin is broken or apt to be disturbed, the burned area should be coated lightly with an antibacterial ointment and covered with a sterile bandage. Pain relievers such as aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) may be used as needed. A doctor should be consulted if signs of infection appear: increased warmth, redness, pain, or swelling; pus or similar drainage from the wound; swollen lymph nodes; or red streaks spreading from the burn.

At an accident site, the victim should be immediately removed from the burning process. Clothing should be removed from all affected areas. Any clothing embedded in the burn should not be disturbed. Dry chemicals should be brushed from the skin; burns caused by acids, alkalis, phosphorus, or organic compounds, such as phenols and cresols, should be flushed with water continuously over an extended time.

In cases of moderate and major burn damage, further medical treatment may include assessment of breathing and treatment if the patient's airways or lungs have been damaged; a flush of any chemicals; and the administering of intravenous fluids, since burns may dramatically deplete body fluids. Antibiotic ointments are usually applied to burns, and the patient is also given antibiotics intravenously to prevent infection. A tetanus shot may also be given. Dead tissue is surgically removed, or debrided. Once the burned area is cleaned and treated, it is usually covered with sterile bandages. Oral narcotics such as codeine may be required for pain relief. The burn patient may have to undergo physical and occupational therapy. If there is extensive scarring, a skin graft is usually performed.

Expected results

Prognosis is dependent upon the degree of the burn, the amount of body surface covered, whether critical body parts are affected, any additional injuries or complications, and the promptness of medical treatment. The epidermis in first-degree burns regenerates rapidly; not much scarring results unless infection develops. With deeper burns, the process of healing is slow, and scars often develop. This may limit mobility and function, making physical therapy necessary. In some cases, surgery may be advisable to remove scar tissue and restore appearance. Some people, especially young women and people with dark skin, may develop keloids.

Secondary infections are common, and may be a major cause of loss of function, disfigurement, and death. Patients with burns over more than 40% BSA, those older than 60 years old, and those with inhalation injuries are at risk for burn injuries that result in death.

Prevention

Burns are commonly received from fires in the home. Properly placed and working smoke detectors in combination with rapid evacuation plans will minimize a person's exposure to smoke and flames in the event of a fire. Children must be taught never to play with matches, lighters, fireworks, gasoline or cleaning fluids.

Burns from scalding with hot water or other liquids may be prevented by setting the water heater thermostat no higher than 120°F (49°C), checking the temperature of bath water before getting into the tub, and turning pot handles on the stove out of the reach of children. Care should be used when removing covers from pans of steaming foods and when uncovering or opening foods heated in a microwave oven.

Sunburns may be avoided by the liberal use of sunscreen. Hats, loose clothing, and umbrellas also provide protection, especially between 10 a.m. and 3 p.m., when the most damaging ultraviolet rays are present.

Burns are often received from electrical appliances. Care should be exercised around stoves, space heaters, irons, and curling irons. Electrical burns may be prevented by covering unused outlets with safety plugs and keeping electrical cords away from infants and toddlers who might chew on them.

Chemical burns may be prevented by wearing protective clothing, including gloves and eye shields. Chemicals should always be used according to the manufacturer's instructions and properly stored when not in use.

Resources

BOOKS

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Washington: Future Medicine Publishing, 1995.

Lininger, D.C., Skye, editor-in-chief, et al. The Natural Pharmacy. California: Prima Health, 1998.

Lockie, Dr. Andrew and Dr. Nicola Geddes. The Complete Guide to homeopathy: The principles and Practice of Treatment with a Comprehensive Range of Self-Help Remedies for Common Ailments. London: Dorling Kindersley, Ltd., 1995.

ORGANIZATIONS

Shriners Hospitals for Children. 2900 Rocky Point Drive, Tampa, FL 33607-1435.

OTHER

Health Answers. http://www.healthanswers.com (January 17, 2001).

The Merck Manual. http://www.merck.com/pubs/mmanual/section20/chapter276/276a.htm (January 17, 2001).

Patience Paradox