Burns

Types of Burns

Burns can be categorized based on the extent or degree of involvement. They include: 

1. First-degree burns: These types of burns are also called superficial epidermal burns. This type of burn only affects the outer layer of the skin (epidermis). Mild sunburn is an example of this type of burn. 

2. Second-degree burns: These types of burns are also called superficial dermal burns. This type of burn affects the both outer layer and the second layer of the skin (dermis).

3. Third-degree burns: This type of burn reaches the fat layer beneath the skin. They are also called partial thickness burns or deep dermal. 

4. Fourth-degree burns: These types of burns penetrate through both layers of the skin and underlying tissue and possibly involve muscle and bone. There is no feeling of pain in the area since the nerve endings are destroyed. They are also called full-thickness burns. 

5. Inhalational burns: These types of burns can lead to airway swelling and the inability to breathe.

Symptoms Of Burns 

The symptoms of burns can vary depending on the severity or degree of the burn. Symptoms are often worse during the first few hours or days after the burn. Some of the common ones include: 

• Pain

• Redness

• Swelling 

• Blisters 

• White or black skin in the burnt area

• Peeling skin 

• Skin loss

• Numbness due to damage to the nerves

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Causes Of Burns 

1. Hot objects 

Damage to the skin caused by touching hot objects is called contact burns. In this case, the burn is usually confined to the part of the skin that touched the hot object. 

2. Ultraviolet rays (UV)

Damage to the skin caused by UV rays is called sunburn which is emitted from the sun. 

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3. Hot liquids 

A wound to the skin caused by hot liquids is called a scald. The longer it stays in contact with the skin the greater the extent of the injury. 

4. Flame burns 

The majority of burns are caused by fire. Contact with a flame can cause direct injury to the skin and tissue.

5. Electrical burns 

These types of burns are caused by currents of electricity and are usually deep and may cause severe damage to the skin and its underlying tissue.

6. Chemical burns 

Chemical burns are caused by contact with flammable gasses or liquids. Inhaling the harmful chemicals and gasses could damage the upper airways, making it difficult to breathe.

7. Friction 

When skin rubs against a surface too roughly, it can cause an abrasion (scrape) known as a friction burn. Friction burns often happen in a bicycle or motorcycle accident. 

Learn essential first-aid tips for burns to ensure quick and proper care. 
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Risk Factors For Burns

1. Gender 

According to the most recent data, females have slightly higher rates of death from burns compared to males. The higher risk for females is associated with open-fire cooking, or inherently unsafe cookstoves, which can ignite clothing. 

2. Age 

Adult women and children are particularly vulnerable to burns.

According to WHO, childhood injuries caused by burns rank as the fifth most prevalent non-fatal reasons. They are majorly due to lack of adult supervision. 

3. Socioeconomic factors

People staying in low- and middle-income countries are at higher risk for burns than people living in high-income countries. 

4. Other factors 

1. Lack of proper safety measures, poverty, and overcrowding

2. Occupations that increase the chances of burns 

3. Employing young girls in household roles such as cooking

Diagnosis Of Burns
 

The burns can be diagnosed according to severity or degree. The diagnosis involves estimating the percentage of the body affected by the burn and its depth. 

1. Physical Examination 

Burn evaluation: Minor burns can be taken care of at home. In the case of severe burn injury, an emergency evaluation is done by the doctor, which is known as an ABCDE assessment:

• A- Airway: Evaluation of blockages in the airway (airway obstruction)

• B-Breathing: Evaluation of troubled breathing and life-threatening conditions (e.g. acute severe asthma, pulmonary edema)

• C- Circulation: Evaluation of heart rate and blood pressure

• D- Disability: Evaluation of signs of brain damage

• E-Exposure: Chemical or toxins causing burns by flushing the injured area are removed. 

While doing the physical evaluation, the doctor will evaluate

• Extent of burn: It is calculated by the percentage of total body surface area burned 

• Depth of burn: The depth of burn is classified into superficial, partial thickness, or full thickness depending on the extent of injury into the epidermis or dermis.

2. Blood tests

• Complete blood count (CBC): It is conducted in burns to assess overall health, and detect anemia, infection, and blood-related complications resulting from the injury.
  
  
• Serum electrolytes: This is done to monitor and balance crucial mineral levels in the body, as burns can disrupt electrolyte equilibrium and lead to potential complications.
  
  
• Blood urea nitrogen: This test is performed in burns to assess kidney function and fluid balance, as burns can affect renal function due to dehydration and tissue breakdown.
  
  
• Serum creatinine: This is done to evaluate kidney function and monitor potential kidney damage resulting from fluid loss.
  
  
• Glucose tests: They help monitor blood sugar levels, which can be elevated due to stress response and metabolic changes caused by the burn injury.
  
  
• Carboxyhemoglobin (COHb): These levels are the most useful test for diagnosing CO (Carbon monoxide) poisoning during fire.
  
  
• Serum lactate: This test measures the amount of lactic acid in the blood and is a fairly sensitive and reliable indicator of tissue hypoxia (low oxygen in the blood). 
  
  
• Cyanide level: Exposure to high levels of cyanide can result in cyanide poisoning, with fire being the most common source of exposure. 
  
  
• Blood group mapping: This test is performed for patients with severe trauma in addition to burns who might need blood or blood products. 
  
  
• Serum creatine kinase: High levels of CK can indicate damage or disease of the skeletal muscles seen in burns.

3. Imaging tests 

• Electrocardiogram: This is a simple test that can be used to check your heart's rhythm and electrical activity. This test is done before giving fluids because big burns might cause heart rhythm problems.
  
  
• Chest X-ray: This test produces images of the heart, lungs, blood vessels, airways, and the bones of your chest and spine. A chest X-ray is conducted in burns to assess potential inhalation injury and lung complications caused by exposure to smoke or chemicals.
  
  
• Computed tomography (CT) scan: Performing a CT scan within 24 hours of burn injury is valuable for diagnosing and managing inhalation injury (ILI) caused by burns.
  
  
• Magnetic resonance imaging (MRI): Occasionally MRIs are done to assess the extent of damage, depth of burns, and potential complications in underlying tissues.
  

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Prevention Of Burns 

Here are a few tips to keep in mind to protect yourself or your loved ones from burns. These include:

1. Burn safety at homes 

• Keep electrical appliances unplugged when not in use

• Keep pot handles turned inward on the stovetop and away from the edge of the stove

• Block access to the stove, fireplace, space heaters, and radiators for kids

• Choose fire-resistant fabrics by checking the labels of the clothes 

• Stop using a table cloth if you have a child as there is a potential risk of hot objects falling on them

• Use flashlights instead of candles during a power outage.

2. Burn safety outdoors 

• Don't allow children to play with fireworks.

• Watch grills, fire pits, and campfires and never leave them unattended.

3. Fire prevention 

• Be careful with candles and extinguish candles before leaving the room

• Keep a fire extinguisher in the kitchen and garage

• Store flammable materials tightly sealed in original containers

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Doctor To Visit

The burns can range from mild to severe. Doctors who can help to diagnose and treat burns include:

• General Physician 
• Dermatologists 
• Burn specialists 
• General surgeon
• Plastic surgeon

A general physician offers initial assessment, pain management, and referral for burns. A dermatologist or skin specialist evaluates the degree of burns and offers appropriate treatment.

A burn specialist can provide expert medical care for burns, including assessing burn severity, determining appropriate treatment, and performing procedures like wound debridement and skin grafting to promote healing and minimize scarring.

A general surgeon handles various surgical needs, while a plastic surgeon specializes in procedures like grafting and reconstruction to heal burns, restore function, and reduce scarring.

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Treatment Of Burns 

Burn treatment varies depending on the cause and severity. Most minor burns can be treated at home. They usually heal within a couple of weeks or months. While serious burns are a medical emergency that after appropriate first aid and wound assessment, warrant further treatment.

1. Treatment of Minor (First or second degree) Burns 

• Cool the Burn: Immediately immerse the burn in cool or room temperature running water. Do this for about 10 minutes or until the pain subsides.
  
  (Note: Never apply ice, greasy substances like butter, egg whites, honey, toothpaste or creams containing steroids like hydrocortisone.)
  
  
• Remove rings or tight items from the burned area: Try to make this fast, before the areas swell. 
  
  
• Apply a cooling gel: For sunburns, you can apply a cooling agent like an aloe vera gel. This will help prevent drying and provide relief.
  
  
• Use Antibiotic Ointments: In the case of thermal burns you can apply, over-the-counter ointments like:

  1. Silver sulfadiazine

  2. Bacitracin 

  3. Polysporin

  4. Neosporin
     
     
     

• Loosely wrap with a clean dressing: Cover the burn with a clean gauze, nonstick bandage or a cloth to protect the burn and prevent any infection.

• Special dressings: Advanced dressings are pads or strips that have wound-healing products built into them. With these dressings, the person doesn’t have to apply an ointment before adding a dressing. Examples include: 
  1. Hydrogels
  2. Silver impregnated dressings
  3. Hydrocolloids

• Take over-the-counter pain medications: Pain from a minor burn can be managed with pain relievers like paracetamol and ibuprofen. 

• Keep a close watch on the burn:  Burns can change a lot in the first 48 hours. If you see some signs of infection like redness or swelling contact a doctor immediately. 

        Note: Do not pop the blisters.

• Protect the area from the sun: Once the burn heals, protect the area from the sun by wearing protective clothing or applying sunscreen with an SPF of 30 or higher. 

2. Treatment of Major (Third or Fourth degree) Burns 

Until emergency help arrives:

• Safeguard the burnt person from further harm: Make sure that the person that you are helping is not in contact with the source of light. 
  
  
• Make sure the burned person is breathing normally: If the burnt person requires rescue breathing, start that immediately. 
  
  
• Remove any ornaments and tight clothing: Try to remove the tight clothing from the burnt area, especially from the neck. 
  
  
• Elevate the burnt area: Try to lift the wound area above the heart level, if possible. 
  
  
• Cover the burnt person: Cover the person with loose clothing or a bandage gauge. 
  
  
• Calm the person: Try to pacify the person to avoid a case of shock. 

3. After a major burn accident, the person is admitted to the hospital, and emergency medical help is given which may include: 

• Water-based treatment: This treatment, called MIST therapy, uses a mist with gentle ultrasound to help wounds heal faster, clean them, and make them less likely to get infected.
  
  
• I.V. fluids: Intravenous (IV) fluids are given to keep blood pressure steady and prevent shock and dehydration.
  
  
• Dressing: For the wounds to dry, the person needs to be wrapped in dry gauze to prevent further infections. 
  
  
• Pain relievers: The burns can be highly painful and the person may require high doses of pain relievers like morphine for dressing wounds. 
  
  
• Antibiotics: Burns can increase the risk of developing severe infections. The antibiotics used included : Cefotaxime,  trimethoprim, penicillin V
  
  
• Anabolic steroids: Such as oxandrolone, may be used for severe burns to help decrease wound healing time.
  
  
• Thromboprophylaxis: It is the prevention of blood clots through methods like medications or compression devices, which can be a risk due to the body's response to burn injuries.

4. Surgical procedures

Surgical procedures might be required in severe cases to assist in the healing of wounds:

• Skin grafts: This is a skin surgery where a patch of skin is removed by surgery from one area of the body and transplanted, or attached, to another area. Donor skin can also be used as a temporary solution to replace the scar tissue caused by deep burns.
  
  
• Reconstruction: This procedure is also known as plastic surgery. This can help in improving the appearance of burn scars and increase the flexibility of joints affected by scarring.

Home Care For Burns 

Most superficial or first-degree burns can be managed at home with several home remedies. These include:

1. Use cool water

The first thing to be kept in mind in the case of minor burns is washing the wounds with cool (not cold) water for about 15 minutes and then washing the affected area with mild soap and water. 

2. Reduce sun exposure 

Avoid exposing the burn to direct sunlight as the burned skin will be highly sensitive to the sun. Keep it covered with clothing or in the case of very minor burns apply sunscreen lotions. 

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3. Try cool compressions

A cool or clean wet cloth placed over the burn area can help relieve pain and swelling by placing it at an interval of 5-15 minutes. 

4. Give natural ingredients a chance

The following home remedies can be tried for mild or superficial burns. However, make sure to consult your doctor before trying them:

1. Aloe vera (Ghritkumari): Aloe vera is instilled with anti-inflammatory, antimicrobial properties and promotes circulation.

How to use it?

Apply a layer of aloe vera gel to the affected area to soothe the wound.

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2. Coconut oil (Nariyal tel): It can provide a soothing effect on minor burns due to its moisturizing properties.

How to use it?

Apply coconut oil topically to recondition and moisturize the skin.

3. Onion (Pyaz): Onions are rich in sulfur compounds that can heal superficial burns.

How to use it?

Both onion juice and paste are effective in relieving pain and irritation and also lower the occurrence of blisters.

Know more about natural home remedies for minor skin burns 
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Complications Of Burns 

Burns can lead to some further complications like: 

• Scarring: When the skin is damaged, the body forms scar tissue as part of the healing process. The severity and extent of scarring can vary depending on factors like the depth and size of the burn.

• Infection: Wounds can become infected if bacteria get into them. If a burn blister breaks out it may become infected if it's not kept clean.

• Shock: Shock is a life-threatening condition that occurs when there's an insufficient supply of oxygen to the body seen after severe burns.

• Heat stroke and heat exhaustion: These can occur as a result of burns when the body's ability to regulate temperature is compromised due to extensive tissue damage. 

• Arrhythmia: Also called an irregular heartbeat, is a problem with the rate or rhythm of the heartbeat which is usually caused by electrical burns. 

• Psychological impact: Severe burns can cause long-lasting distress like feelings of anxiety and stress, low mood and depression, and lack of confidence and self-esteem. 
  
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• Sepsis: In rare cases, the infected burn can cause blood poisoning also called sepsis. This condition can be fatal if not treated immediately. 

Alternative Therapies For Burns 

There are certain therapies that have shown promising results when given with conservative treatment in alleviation of the symptoms. These include:

1. Acupuncture

This technique involves inserting needles into the body to stimulate sensory nerves in the skin and muscles. Studies suggest that certain acupoints may relieve pain for people with burns.

2. Physiotherapy

This therapy begins very early for people who are hospitalized for burns. Physiotherapists use several techniques to improve the movement and functioning of the areas affected by a burn. 

3. Massage therapy 

People suffer from pain, and itching, from the burn itself and during the healing of wounds. Some studies suggest that massage may help in alleviating the symptoms in both the emergency and recovery phases. 

4. Hypnosis 

Hypnosis, also called hypnotherapy, is a state of deep relaxation and focused concentration. Much evidence suggests hypnosis focuses on patients’ psychological health as well as pain reduction that can help with managing severe burn pains.

Living With Burns

Recovering from burns requires resilience, adapting to challenges, and comprehensive support to regain physical and emotional well-being. Some things to keep in mind include:

1. Supportive care 

Supportive critical care that promotes optimal conditions for wound healing should be the clear focus of post-engraftment care. It includes 

• Hemodynamic (related to the flow of blood) support in the early phases

• Nutritional support while promoting healing

• Adequate pain control with the appropriate use of painkillers. 

2. Rehabilitation 

Rehabilitation is the care that can help you get back, keep, or improve abilities that are required for daily life. Exercise and physical therapy should be initiated as early as possible and mobilization should be started immediately. 

The ultimate goal of rehabilitation following a burn injury is reintegration into society and gaining enough confidence to attain the position again including well-paid employment. 

3. Psychological aspect 

Giving psychological support to the burned individual should be an early and routine component of management. Therapeutic interventions in recovery following a major burn injury include;

• Meeting people

• Expressing feelings

• Medical counselling therapies. etc.

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