Burns

Burns

Many thermal injuries can damage the skin. Burns include injuries caused by scalding, fire, radiation, caustic chemicals, and electricity. Although each type of burn requires individualized treatment, some generalizations are appropriate. Classification of burns is important to determine their severity, as well as to gauge the response to treatment. Traditionally, the extent is described by degrees. A first-degree burn involves the superficial layers of the skin only, and manifests itself in reddening. The most common type is sunburn. Prolonged use of heating pads or split-second exposure to a fire may also produce this self-limited, but occasionally painful type of burn. Second degree or “partial thickness” burns also involve the skin surface or epidermis. This burn, however, transfers sufficient heat to the skin to produce blistering. These deeper types are more painful. Second degree burns of babies or small children are especially likely to become infected. If extensive, they may result in dehydration or shock.

The deepest burn, called third degree or “full thickness” involves both layers of skin, epidermis, and dermis. These may extend into the subcutaneous fat and muscle, destroying both blood vessels and nerves that supply the skin.Small full thickness burns may be produced by electricity, although more commonly they are caused by fire or chemicals. Remember that a deep partial thickness burn may become badly infected, with extension of the burn to involve all the skin layers. In contrast to first and second-degree burns that heal rapidly, the deeper full thickness variety is very slow to heal. The skin forms granulation tissue, with gradual progression to skin renewal, or grafting may be necessary.

TREATMENT
Immediate first aid in the case of burns requires the application of cold.Often a potential third degree burn can be converted to a second degree or a second degree to a first-degree burn by the immediate use of ice or other application of cold to counteract the thermal injury. This should be prolonged for thirty to sixty minutes, unless the burn is extensive enough to necessitate immediate emergency medical care.

A second way to classify burns is according to the extent of skin involvement. The “rule of nines” has commonly been used to approximate the burn area. The accompanying diagram helps illustrate how these burned areas can be calculated. Because of the ever-present danger of contracture or scarring, burns involving the face or hands are especially serious.Unless superficial, most burns can be treated like abrasions, with appropriate cleansing and protection against infection. Sterile dressings can be used to relieve pain and prevent the entrance of germs. Small burns are more amenable to the “open technique” than are extensive injuries. In this approach, the burn is cleansed and left open to the air to dry. Rapid formation of a crust seals off the burn, functioning like a scab to prevent infection while healing occurs beneath.

Many preparations have been advocated for the relief of pain from burns. And they may be used in a home setting. The mucilaginous gel from the aloe vera plant is immediately applied to burns in many countries. A portion of the plant is broken and the juice squeezed onto the affected skin. Pain is relieved, and the gel forms a soothing protective coating. Vitamin E oils may also be used. These seem to reduce the likelihood of scarring. The oil can be used directly over the burn and applied several times daily until the skin is healed. Petroleum jelly (Vaseline) and fine mesh gauze can also be beneficial. They are quite easily applied to larger burned areas. A fluffy gauze dressing is used to cover the tine mesh. If no infection or drainage is present, this bandage can be left on several days until the burn is healed, at which time it will be dry and peeling. Daily dressing changes provide an opportunity to see the burn in the healing state. Whirlpool baths with disinfectants can be used when necessary for debridement. This term describes the peeling of dead skin or removal of crusts, thus allowing more freedom of motion around affected joints. The entrance of air exerts a drying effect. Treatment should always be continued until healing is complete.