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Burns

Burns

Definition

Burns are injuries to tissues that are caused by heat, friction, electricity, radiation, or chemicals.

Description

Burns are characterized by degree, based on the severity of the tissue damage. A first-degree burn causes redness and swelling in the outermost layers of skin (epidermis). A second-degree burn involves redness, swelling and blistering, and the damage may extend beneath the epidermis to deeper layers of skin (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.

Demographics

The severity of the burn is also judged by the amount of body surface area (BSA) involved. Healthcare workers use the "rule of nines" to determine the percentage of BSA affected in people more than 9 years of age: each arm with its hand is 9 percent of BSA; each leg with its foot is 18 percent; the front of the torso is 18 percent; the back of the torso, including the buttocks, is 18 percent; the head and neck are 9 percent; and the genital area (perineum) is 1 percent. This rule cannot be applied to a young child's body proportions, so BSA is estimated using the palm of a person's hand as a measure of 1 percent area.

The severity of the burn determines the type of treatment and also where the burned person should receive treatment. Minor burns may be treated at home or in a doctor's office. These are defined as first- or second-degree burns covering less than 15 percent of an adult's body or less than 10 percent of a child's body, or a third-degree burn on less than 2 percent BSA. Moderate burns should be treated at a hospital. These are defined as first- or second-degree burns covering 15 percent to 25 percent of an adult's body or 10 percent to 20 percent of a child's body, or a third-degree burn on 2 percent to 10 percent BSA. Critical, or major, burns are the most serious and should be treated in a specialized burn unit of a hospital. These are defined as first- or second-degree burns covering more than 25 percent of an adult's body or more than 20 percent of a child's body, or a third-degree burn on more than 10 percent BSA. In addition, burns involving the hands, feet, face, eyes, ears, or genitals are considered critical. Other factors influence the level of treatment needed, including associated injuries such as bone fractures and smoke inhalation , presence of a chronic disease, or a history of abuse. Also, children and the elderly are more vulnerable to complications from burn injuries and require more intensive care.

Causes and symptoms

Burns may be caused by even a brief encounter with heat greater than 120°F (49°C). The source of this heat may be the sun (causing a sunburn ), hot liquids, steam, fire, electricity, friction (causing rug burns and rope burns), and chemicals (causing caustic burn upon contact).

Signs of a burn are localized redness, swelling, and pain . A severe burn will also blister. The skin may also peel, appear white or charred, and feel numb. A burn may trigger a headache and fever . Extensive burns may induce shock, the symptoms of which are faintness, weakness, rapid pulse and breathing, pale and clammy skin, and bluish lips and fingernails.

When to call the doctor

A physician or healthcare professional should be consulted whenever first or second degree burns cover more than 15 percent of a person's body surface area (BSA) or third degree burns involve more than 2 percent of a victim's BSA.

Diagnosis

A physician will diagnose a burn based on visual examination and will also ask the burned person or family members questions to determine the best treatment. He or she may also check for smoke inhalation, carbon monoxide poisoning , cyanide poisoning , other event-related trauma, or, if suspected, evidence of child abuse .

Treatment

Burn treatment consists of relieving pain, preventing infection, and maintaining body fluids, electrolytes, and calorie intake while the body heals. Treatment of chemical or electrical burns is slightly different from the treatment of thermal burns but the objectives are the same.

Thermal burn treatment

The first act of thermal burn treatment is to stop the burning process. This may be accomplished by letting cool water run over the burned area or by soaking it in cool (not cold) water. Ice should never be applied to a burn. Cool (not cold) wet compresses may provide some pain relief when applied to small areas of first- and second-degree burns. Butter, shortening, or similar salve should never be applied to the burn because these prevent heat from escaping and drive the burning process deeper into the skin.

If the burn is minor, it may be cleaned gently with soap and water. Blisters should not be broken. If the skin of the burned area is unbroken and it is not likely to be further irritated by pressure or friction, the burn should be left exposed to the air to promote healing. 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. Aspirin, acetaminophen , or ibuprofen may be taken to ease pain and relieve inflammation. A doctor should be consulted if these signs of infection appear: increased warmth, redness, pain, or swelling; pus or similar drainage from the wound; swollen lymph nodes; or red streaks spreading away from the burn.

In situations in which a person has received moderate or critical burns, lifesaving measures take precedence over burn treatment, and emergency medical assistance must be called. A person with serious burns may stop breathing, and artificial respiration (also called mouth-to-mouth resuscitation or rescue breathing) should be administered immediately. Also, a person with burns covering more than 12 percent BSA is likely to go into shock; this condition may be prevented by laying the person flat and elevating the feet about 12 inches (30 cm). Burned arms and hands should also be raised higher than the person's heart.

In rescues, a blanket may be used to smother any flames as the person is removed from danger. The person whose clothing is on fire should "stop, drop, and roll" or be assisted in lying flat on the ground and rolling to put out the fire. Afterwards, only burned clothing that comes off easily should be removed; any clothing embedded in the burn should not be disturbed. Removing any smoldering apparel and covering the person with a light, cool, wet cloth, such as a sheet but not a blanket or towel, will stop the burning process.

At the hospital, the staff provide further medical treatment. A tube to aid breathing may be inserted if the person's airways or lungs have been damaged, as can happen during an explosion or a fire in an enclosed space. Also, because burns dramatically deplete the body of fluids, replacement fluids are administered intravenously. The person is also given antibiotics intravenously to prevent infection, and he or she may also receive a tetanus shot, depending on his or her immunization history. Once the burned area is cleaned and treated with antibiotic cream or ointment, it is covered in sterile bandages, which are changed two to three times a day. Surgical removal of dead tissue (debridement) also takes place. As the burns heal, thick, taut scabs (eschar) form, which the doctor may have to cut to improve blood flow to the more elastic healthy tissue beneath. The person will also undergo physical and occupational therapy to keep the burned areas from becoming inflexible and to minimize scarring.

In cases where the skin has been so damaged that it cannot properly heal, a skin graft is usually performed. A skin graft involves taking a piece of skin from an unburned portion of the person's body (autograft) and transplanting it to the burned area. When doctors cannot immediately use the individual's own skin, a temporary graft is performed using the skin of a human donor (allograft), either alive or dead, or the skin of an animal (xenograft), usually that of a pig.

The burn victim also may be placed in a hyperbaric chamber, if one is available. In a hyperbaric chamber (which can be a specialized room or enclosed space), the person is exposed to pure oxygen under high pressure, which can aid in healing. However, for this therapy to be effective, the burned individual must be placed in a chamber within 24 hours of being burned.

Chemical burn treatment

Burns from liquid chemicals must be rinsed with cool water for at least 15 minutes to stop the burning process. Any burn to the eye must be similarly flushed with water. In cases of burns from dry chemicals such as lime, the powder should be completely brushed away before the area is washed. Any clothing which may have absorbed the chemical should be removed. The burn should then be loosely covered with a sterile gauze pad and the person taken to the hospital for further treatment. A physician may be able to neutralize the offending chemical with another before treating the burn like a thermal burn of similar severity.

Electrical burn treatment

Before electrical burns are treated at the site of the accident, the power source must be disconnected if possible and the victim moved away from it to keep the person giving aid from being electrocuted. Lifesaving measures again take priority over burn treatment, so breathing must be checked and assisted if necessary. Electrical burns should be loosely covered with sterile gauze pads and the person taken to the hospital for further treatment.

Alternative treatment

In addition to the excellent treatment of burns provided by traditional medicine, some alternative approaches may be helpful as well. (Major burns should always be treated by a medical practitioner.) The homeopathic remedies Cantharis and Causticum can assist in burn healing. A number of botanical remedies, applied topically, can also help burns heal. These include aloe (Aloe barbadensis ), oil of St. John's wort (Hypericum perforatum ), calendula (Calendula officinalis ), comfrey (Symphytum officinale ), and tea tree oil (Melaleuca spp.). Supplementing the diet with vitamin C, vitamin E, and zinc also is beneficial for wound healing.

Prognosis

The prognosis is dependent upon the degree of the burn, the amount of body surface covered, whether critical body parts were affected, any additional injuries or complications like infection, and the promptness of medical treatment. Minor burns may heal in five to ten days with no scarring. Moderate burns may heal in ten to 14 days and may leave scarring. Critical or major burns take more than 14 days to heal and leave significant scarring. Scar tissue may limit mobility and functionality, but physical therapy may overcome these limitations. In some cases, additional surgery may be advisable to remove scar tissue and restore appearance.

Prevention

Burns are commonly received in residential fires. Properly placed and working smoke detectors in combination with rapid evacuation plans 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, and cleaning fluids.

Burns by 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.

Thermal burns are often received from electrical appliances. Care should be exercised around stoves, space heaters, irons, and curling irons.

Sunburns may be avoided by the liberal use of a sunscreen containing either an opaque active ingredient such as zinc oxide or titanium dioxide or a nonopaque active ingredient such as PABA (para-aminobenzoic acid) or benzophenone. 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 in direct sunlight.

Electrical burns may be prevented by covering unused electrical outlets with safety plugs and keeping electrical cords away from infants and toddlers who might chew on them. Persons should also seek shelter indoors during a thunderstorm to avoid being struck by lightning.

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

Nutritional concerns

Adequate nutrition , including liquids and electrolytes, is essential when recovering from burns.

Parental concerns

Parents should fire-proof their homes to protect small children. They should teach fire safety to their children from a very young age. Smoke detectors should be installed and tested at least twice each year. Parents are advised to discuss fire and escape routes (including alternates) from their home with their children. Holding a fire drill at night may be momentarily unpopular but may save lives and prevent serious injuries. Proper childproofing tools can prevent young children from being burned in the kitchen and bathroom.

KEY TERMS

Debridement The surgical removal of dead tissue and/or foreign bodies from a wound or cut.

Dermis The basal layer of skin; it contains blood and lymphatic vessels, nerves, glands, and hair follicles.

Epidermis The outermost layer of the human skin.

Shock A medical emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. This deprives the organs and tissues of oxygen and allows the build-up of waste products. Shock can be caused by certain diseases, serious injury, or blood loss.

Resources

BOOKS

Antoon, Alia Y., and Mary K. Donovan. "Burn Injuries." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 3307.

Bosworth, Chrissie. Burns Trauma: Management and Nursing Care, 2nd ed. London: Whurr Publishers, 2002.

Demling, Robert H., and Jonathon D. Gates. "Medical Aspects of Trauma and Burn Care." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman, et al. Philadelphia: Saunders, 2003, pp. 6428.

Hall, Jesse B., and Gregory Schmidt. Principles of Critical Care, 3rd ed. New York: McGraw-Hill, 2004.

PERIODICALS

Collier, M. L., et al. "Home treadmill friction injuries: a five-year review." Journal of Burn Care Rehabilitation 25, no. 5 (2004): 4414.

Patterson, D. R., et al. "Optimizing control of pain from severe burns: a literature review." American Journal of Clinical Hypnosis 47, no. 1 (2004): 4354.

Rabbitts, A., et al. "Car radiator burns: a prevention issue." Journal of Burn Care Rehabilitation 25, no. 5 (2004): 4525.

Stokes, D. J., et al. "The effect of burn injury on adolescents' autobiographical memory." Behavior Research and Therapy 42, no. 11 (2004): 135765.

ORGANIZATIONS

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 601684014. Web site: <www.aad.org/>.

American Academy of Emergency Medicine. 611 East Wells Street, Milwaukee, WI 53202. Web site: <www.aaem.org/>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 662112672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 600071098. Web site: <www.aap.org/default.htm>.

American College of Emergency Physicians. PO Box 619911, Dallas, TX 752619911. Web site: <www.acep.org/>.

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 6061132311. Web site: <www.facs.org/>.

International Shrine Headquarters. 2900 Rocky Point Dr., Tampa, FL 336071460. Web site: <www.shrinershq.org/index.html>.

WEB SITES

"Burns." KidsHealth. Available online at <http://kidshealth.org/parent/firstaid_safe/emergencies/burns.html> (accessed December 7, 2004).

"Burns." MedlinePlus. Available online at <www.nlm.nih.gov/medlineplus/burns.html> (accessed December 7, 2004).

"Burns." Merck Manual. Available online at <www.merck.com/mmhe/sec24/ch289/ch289a.html> (accessed December 7, 2004).

"Burns: Taking Care of Burns." American College of Family Physicians, September 2002. Available online at <http://familydoctor.org/x2190.xml> (accessed December 7, 2004).

"Chemical Burns to the Skin." University of Iowa Health Care. Available online at <www.uihealthcare.com/topics/prepareemergencies/prep4904.html> (accessed December 7, 2004).

L. Fleming Fallon, Jr., MD, DrPH

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"Burns." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. 18 Aug. 2017 <http://www.encyclopedia.com>.

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Burns

Burns

Definition

Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals.

Description

Burns are characterized by degree, based on the severity of the tissue damage. A first-degree burn causes redness and swelling in the outermost layers of skin (epidermis). A second-degree burn involves redness, swelling and blistering, and the damage may extend beneath the epidermis to deeper layers of skin (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.

The severity of the burn is also judged by the amount of body surface area (BSA) involved. Health care workers use the "rule of nines" to determine the percentage of BSA affected in patients more than 9 years old: each arm with its hand is 9% of BSA; each leg with its foot is 18%; the front of the torso is 18%; the back of the torso, including the buttocks, is 18%; the head and neck are 9%; and the genital area (perineum) is 1%. This rule cannot be applied to a young child's body proportions, so BSA is estimated using the palm of the patient's hand as a measure of 1% area.

The severity of the burn will determine not only the type of treatment, but also where the burn patient should receive treatment. Minor burns may be treated at home or in a doctor's office. These are defined as first- or second-degree burns covering less than 15% of an adult's body or less than 10% of a child's body, or a third-degree burn on less than 2% BSA. Moderate burns should be treated at a hospital. These 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. Critical, or major, burns are the most serious and should be treated in a specialized burn unit of a hospital. These are defined as first- or second-degree burns covering more than 25% of an adult's body or more than 20% of a child's body, or a third-degree burn on more than 10% BSA. In addition, burns involving the hands, feet, face, eyes, ears, or genitals are considered critical. Other factors influence the level of treatment needed, including associated injuries such as bone fractures and smoke inhalation, presence of a chronic disease, or a history of being abused. Also, children and the elderly are more vulnerable to complications from burn injuries and require more intensive care.

Causes and symptoms

Burns may be caused by even a brief encounter with heat greater than 120°F (49°C). The source of this heat may be the sun (causing a sunburn ), hot liquids, steam, fire, electricity, friction (causing rug burns and rope burns), and chemicals (causing a caustic burn upon contact).

Signs of a burn are localized redness, swelling, and pain. A severe burn will also blister. The skin may also peel, appear white or charred, and feel numb. A burn may trigger a headache and fever. Extensive burns may induce shock, the symptoms of which are faintness, weakness, rapid pulse and breathing, pale and clammy skin, and bluish lips and fingernails.

Diagnosis

A physician will diagnose a burn based upon visual examination, and will also ask the patient or family members questions to determine the best treatment. He or she may also check for smoke inhalation, carbon monoxide poisoning, cyanide poisoning, other event-related trauma, or, if suspected, further evidence of child abuse.

Treatment

Burn treatment consists of relieving pain, preventing infection, and maintaining body fluids, electrolytes, and calorie intake while the body heals. Treatment of chemical or electrical burns is slightly different from the treatment of thermal burns but the objectives are the same.

Thermal burn treatment

The first act of thermal burn treatment is to stop the burning process. This may be accomplished by letting cool water run over the burned area or by soaking it in cool (not cold) water. Ice should never be applied to the burn. Cool (not cold) wet compresses may provide some pain relief when applied to small areas of first- and second-degree burns. 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.

If the burn is minor, it may be cleaned gently with soap and water. Blisters should not be broken. If the skin of the burned area is unbroken and it is not likely to be further irritated by pressure or friction, the burn should be left exposed to the air to promote healing. 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. Aspirin, acetaminophen (Tylenol), or ibuprofen (Advil) may be taken to ease pain and relieve inflammation. A doctor should be consulted if these signs of infection appear: increased warmth, redness, pain, or swelling; pus or similar drainage from the wound; swollen lymph nodes; or red streaks spreading away from the burn.

Classification Of Burns
First-Degree
(Minor)
The burned area is painful. The outer skin is
reddened. Slight swelling is present.
Second-Degree
(Moderate)
The burned area is painful. The underskin is affected.
Blisters may form. The area may have a wet, shiny
appearance because of exposed tissue.
Third-Degree
(Critical)
The burned area is insensitive due to the destruction
of nerve endings. Skin is destroyed. Muscle tissues
and bone underneath may be damaged. The area
may be charred, white, or grayish in color.

In situations where a person has received moderate or critical burns, lifesaving measures take precedence over burn treatment and emergency medical assistance must be called. A person with serious burns may stop breathing, and artificial respiration (also called mouth-to-mouth resuscitation or rescue breathing) should be administered immediately. Also, a person with burns covering more than 12% BSA is likely to go into shock; this condition may be prevented by laying the person flat and elevating the feet about 12 in (30 cm). Burned arms and hands should also be raised higher than the person's heart.

In rescues, a blanket may be used to smother any flames as the person is removed from danger. The person whose clothing is on fire should "stop, drop, and roll" or be assisted in lying flat on the ground and rolling to put out the fire. Afterwards, only burnt clothing that comes off easily should be removed; any clothing embedded in the burn should not be disturbed. Removing any smoldering apparel and covering the person with a light, cool, wet cloth, such as a sheet but not a blanket or towel, will stop the burning process.

At the hospital, the staff will provide further medical treatment. A tube to aid breathing may be inserted if the patient's airways or lungs have been damaged, as can happen during an explosion or a fire in a enclosed space. Also, because burns dramatically deplete the body of fluids, replacement fluids are administered intravenously. The patient is also given antibiotics intravenously to prevent infection, and he or she may also receive a tetanus shot, depending on his or her immunization history. Once the burned area is cleaned and treated with antibiotic cream or ointment, it is covered in sterile bandages, which are changed two to three times a day. Surgical removal of dead tissue (debridement ) also takes place. As the burns heal, thick, taut scabs (eschar) form, which the doctor may have to cut to improve blood flow to the more elastic healthy tissue beneath. The patient will also undergo physical and occupational therapy to keep the burned areas from becoming inflexible and to minimize scarring.

In cases where the skin has been so damaged that it cannot properly heal, a skin graft is usually performed. A skin graft involves taking a piece of skin from an unburned portion of the patient's body (autograft) and transplanting it to the burned area. When doctors cannot immediately use the patient's own skin, a temporary graft is performed using the skin of a human donor (allograft), either alive or dead, or the skin of an animal (xenograft), usually that of a pig.

The burn victim also may be placed in a hyperbaric chamber, if one is available. In a hyperbaric chamber (which can be a specialized room or enclosed space), the patient is exposed to pure oxygen under high pressure, which can aid in healing. However, for this therapy to be effective, the patient must be placed in a chamber within 24 hours of being burned.

Chemical burn treatment

Burns from liquid chemicals must be rinsed with cool water for at least 15 minutes to stop the burning process. Any burn to the eye must be similarly flushed with water. In cases of burns from dry chemicals such as lime, the powder should be completely brushed away before the area is washed. Any clothing which may have absorbed the chemical should be removed. The burn should then be loosely covered with a sterile gauze pad and the person taken to the hospital for further treatment. A physician may be able to neutralize the offending chemical with another before treating the burn like a thermal burn of similar severity.

Electrical burn treatment

Before electrical burns are treated at the site of the accident, the power source must be disconnected if possible and the victim moved away from it to keep the person giving aid from being electrocuted. Lifesaving measures again take priority over burn treatment, so breathing must be checked and assisted if necessary. Electrical burns should be loosely covered with sterile gauze pads and the person taken to the hospital for further treatment.

Alternative treatment

In addition to the excellent treatment of burns provided by traditional medicine, some alternative approaches may be helpful as well. (Major burns should always be treated by a medical practitioner.) The homeopathic remedies Cantharis and Causticum can assist in burn healing. A number of botanical remedies, applied topically, can also help burns heal. These include aloe (Aloe barbadensis ), oil of St.-John's-wort (Hypericum perforatum ), calendula (Calendula officinalis ), comfrey (Symphytum officinale ), and tea tree oil (Melaleuca spp.). Supplementing the diet with vitamin C, vitamin E, and zinc also is beneficial for wound healing.

KEY TERMS

Debridement The surgical removal of dead tissue.

Dermis The basal layer of skin; it contains blood and lymphatic vessels, nerves, glands, and hair follicles.

Epidermis The outer portion of skin, made up of four or five superficial layers.

Shock An abnormal condition resulting from low blood volume due to hemorrhage or dehydration. Signs of shock include rapid pulse and breathing, and cool, moist, pale skin.

Prognosis

The prognosis is dependent upon the degree of the burn, the amount of body surface covered, whether critical body parts were affected, any additional injuries or complications like infection, and the promptness of medical treatment. Minor burns may heal in five to 10 days with no scarring. Moderate burns may heal in 10-14 days and may leave scarring. Critical or major burns take more than 14 days to heal and will leave significant scarring. Scar tissue may limit mobility and functionality, but physical therapy may overcome these limitations. In some cases, additional surgery may be advisable to remove scar tissue and restore appearance.

Prevention

Burns are commonly received in residential fires. 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, and cleaning fluids.

Burns by 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.

Thermal burns are often received from electrical appliances. Care should be exercised around stoves, space heaters, irons, and curling irons.

Sunburns may be avoided by the liberal use of a sunscreen containing either an opaque active ingredient such as zinc oxide or titanium dioxide or a nonopaque active ingredient such as PABA (para-aminobenzoic acid) or benzophenone. 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 in direct sunlight.

Electrical burns may be prevented by covering unused electrical outlets with safety plugs and keeping electrical cords away from infants and toddlers who might chew on them. Persons should also seek shelter indoors during a thunderstorm to avoid being struck by lightning.

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

Resources

ORGANIZATIONS

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

OTHER

HealthAnswers.com. http://www.healthanswers.com.

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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

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Burns

Burns

Why are Burns a Hot Topic?

What are the Three Classes of Burns?

How Do Doctors Treat Burns?

Resources

Burns are tissue injuries caused by fire, sun, steam, hot fluids, heated objects, electricity, lightning, radiation, and other things. Burns may cause a variety of problems ranging from minor discomfort to serious life-threatening conditions.

KEYWORDS

for searching the Internet and other reference sources

Dermatology

Epithelium

Rehabilitation

Trauma

Wounds

Why are Burns a Hot Topic?

The skin is the protective outer surface of the body. Its outer layer is the epidermis, comprising several layers of epithelial cells arranged like shingles on a roof. Its inner layer is the dermis, which contains many types of nerves that sense touch, pain, heat, and cold. Healthy skin renews itself and helps keep body fluids in and unwanted bacteria out. When burns injure the skin, they upset these processes. All burns result in skin cell injury. The most serious burns can result in death.

Did You Know?

The U.S. National Institute of General Medical Sciences reports that there are more than 2 million burn injuries requiring medical attention each year. Among people with burn injuries:

  • 70,000 require hospitalization
  • 20,000 require treatment in special burn units
  • 10,000 die of burn-related infections
  • burn research and burn treatments are improving survival rates even among people with burns covering more than 90% of their bodies.

What are the Three Classes of Burns?

First degree burns

These burns are the least severe. They affect only the top layer of skin, the epidermis, which turns red at the burn site and hurts when it is touched. First degree burns sometimescause small blisters and mild swelling, but they usually heal rapidly on their own.

Second degree burns

These burns affect both the dermis and the epidermis. They often cause pain, fever, swelling, chills, and blisters,

which may be reddish or whitish in color. Severe sunburns often are second degree burns, and it is important to see a doctor about them.

Sunburns

These things can help ease the discomfort of sunburns:

  • cool baths or cool compresses
  • soothing lotions
  • over-the-counter pain medications such as acetaminophen.

These things can make sunburns worse:

  • petroleum jelly
  • butter
  • harsh soaps
  • over-the-counter sprays containing benzocaine.

Severe sunburn should be treated by a doctor.

Third degree burns

These are the most serious burns and require immediate medical treatment. They affect all layers of skin and cause damage and cell death to all kinds of tissues, including nerves, sweat glands, fat, and hair follicles. The burn area itself may be free from pain if its nerve endings have been damaged, but the area around the burn will often be extremely painful. The whitish or reddish blisters of second degree burns usually will not be present, but the skin may be blackened or charred. Other complications of third degree burns may include:

  • loss of body fluids (dehydration)
  • respiratory (breathing) problems
  • bacterial infections and pneumonia
  • shock.

How Do Doctors Treat Burns?

Treatment depends on how large the burn is and how deeply it has injured skin tissue and underlying organs. Mild burns usually heal on their own when the injured area is kept clean and dry. More serious burns often require treatment in a hospital. The most serious burns may require treatment in a hospitals specialized burn unit or in an intensive care unit. These burns often require skin graft surgery to replace the damaged tissue followed by a long healing period and physical therapy for the injured area. Fire safety, awareness, and prevention are the best defenses against burns.

See also

Skin Conditions

Shock

Trauma

Resources

U.S. National Institute of General Medical Sciences, 45 Center Drive, MSC 6200, Bethesda, MD 20892-6200. The NIGMS posts resource lists and fact sheets about burns and other injuries at its website. http://www.nih.gov/nigms

American Burn Association, 625 North Michigan Avenue, Suite 1530, Chicago, IL 60611. The ABA publishes a Journal of Burn Care and Rehabilitation and posts burn statistics and a reference bibliography at its website. http://ameriburn.org

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Burns

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