Burns

Gender

Recent data shows that women have slightly higher burn-related mortality rates than men. This is primarily due to risks associated with open-fire cooking or unsafe cooking stoves, which can ignite clothing.

Age

Children and adult women are particularly vulnerable to burns. According to the WHO, childhood burns rank as the fifth most common non-fatal injury, often due to lack of supervision.

Socioeconomic Status

Individuals in low- and middle-income countries are at a higher risk of burns compared to those in wealthier nations.

Other Contributing Factors

Factors such as insufficient safety measures, poverty, overcrowding, and occupations that increase burn risk, such as young girls working in cooking-related household roles, contribute to the likelihood of burns.

Burns are diagnosed based on their severity or degree. The assessment involves determining the extent of the burn on the body and its depth.

Physical Examination

When evaluating burns, minor injuries can often be treated at home. However, severe burns require emergency evaluation by a doctor, following the ABCDE method:

• A - Airway: Assess for any blockages in the airway (airway obstruction).
• B - Breathing: Examine for breathing issues or life-threatening conditions (e.g., acute asthma or pulmonary edema).
• C - Circulation: Check heart rate and blood pressure.
• D - Disability: Evaluate for signs of brain damage.
• E - Exposure: Remove any chemicals or toxins causing burns by flushing the injured area.

During the physical evaluation, the doctor will assess:

• Extent of the Burn: This is calculated by the percentage of the body affected by the burn.
• Depth of the Burn: Burns are classified into superficial, partial thickness, or full thickness, depending on how deeply the injury penetrates the epidermis or dermis.

Blood Tests

• Complete Blood Count (CBC): This test checks overall health, detects anemia, infection, and blood-related complications from the injury.
• Serum Electrolytes: Helps monitor and balance vital mineral levels in the body, as burns can disrupt electrolyte balance and lead to complications.
• Blood Urea Nitrogen (BUN): Assesses kidney function and fluid balance, as burns can affect renal function due to dehydration and tissue breakdown.
• Serum Creatinine: Evaluates kidney function and monitors potential kidney damage resulting from fluid loss.
• Glucose Tests: Monitors blood sugar levels, which may rise due to stress response and metabolic changes after a burn injury.
• Carboxyhemoglobin (COHb): This test helps detect carbon monoxide poisoning, which is common during fire-related burns.
• Serum Lactate: Measures lactic acid in the blood, indicating potential tissue hypoxia (low oxygen levels in the blood).
• Cyanide Level: High cyanide levels indicate poisoning, which can result from fire exposure.
• Blood Group Mapping: This test is performed on severely injured patients who may require blood or blood products.
• Serum Creatine Kinase (CK): Elevated CK levels may indicate muscle damage from the burn injury.

Imaging Tests

• Electrocardiogram (ECG): Checks heart rhythm and electrical activity. This is done before administering fluids, as large burns can cause heart rhythm disturbances.
• Chest X-ray: Provides images of the chest area to assess potential lung complications from smoke or chemical exposure.
• Computed Tomography (CT) Scan: Conducted within 24 hours of the burn injury to diagnose inhalation injuries (ILI) caused by smoke or fumes.
• Magnetic Resonance Imaging (MRI): Occasionally used to assess the extent of burn damage, the depth of the injury, and complications in underlying tissues.

To protect yourself and others from burns, follow these guidelines:

Burn Safety at Home

• Unplug electrical appliances when not in use.
• Keep pot handles turned inward and away from the stove’s edge.
• Keep stoves, fireplaces, space heaters, and radiators out of children’s reach.
• Choose fire-resistant clothing fabrics and check labels.
• Avoid using tablecloths if you have young children, as they can pull down hot items.
• Use flashlights instead of candles during power outages.

Burn Safety Outdoors

• Do not allow children to play with fireworks.
• Always supervise grills, fire pits, and campfires, never leaving them unattended.

Fire Prevention

• Extinguish candles before leaving a room.
• Keep a fire extinguisher in the kitchen and garage.
• Store flammable materials in tightly sealed original containers.

Doctors to Consult

Burn severity can range from mild to severe. Doctors who specialize in treating burns include:

• General Physician: Provides initial assessment, pain management, and referrals.
• Dermatologists: Evaluate the degree of burns and offer appropriate treatments.
• Burn Specialists: Expert in burn care, including burn severity assessment, treatment, and procedures like wound debridement and skin grafts to aid healing and reduce scarring.
• General Surgeons: Handle surgical needs related to burns.
• Plastic Surgeons: Specialize in reconstructive procedures, skin grafting, and minimizing scarring to restore function and appearance.

Burn treatment varies depending on the cause and severity of the injury. Minor burns can generally be treated at home and usually heal within a few weeks or months. In contrast, severe burns are considered a medical emergency and require proper first aid and further treatment after a wound assessment.

Treatment of Minor Burns (First or Second Degree)

• Cool the Burn: Immediately immerse the affected area in cool or room temperature water for about 10 minutes, or until the pain lessens.

(Note: Avoid applying ice, greasy substances like butter, egg whites, honey, toothpaste, or steroid creams such as hydrocortisone.)

• Remove Tight Items: Take off rings or tight clothing from the burned area as quickly as possible, before swelling occurs.

• Apply Cooling Gel: For sunburns, use a cooling agent such as aloe vera gel to prevent dryness and alleviate pain.

• Use Antibiotic Ointments: Apply over-the-counter ointments such as:

1. Silver sulfadiazine
2. Bacitracin
3. Polysporin
4. Neosporin

• Cover with a Clean Dressing: Protect the burn by loosely wrapping it with a clean gauze, non-stick bandage, or cloth to prevent infection.

• Special Dressings: Advanced dressings like hydrogels, silver-impregnated dressings, and hydrocolloids can be used to speed up healing without the need for additional ointments.

• Take Pain Relievers: Over-the-counter pain medications like paracetamol or ibuprofen can help manage pain from a minor burn.

• Monitor the Burn: Burns can change significantly in the first 48 hours. If signs of infection such as redness or swelling appear, consult a doctor immediately.

(Note: Do not burst blisters.)

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

Treatment of Major Burns (Third or Fourth Degree)

• Until Emergency Help Arrives:
• Protect the Person: Ensure the individual is no longer in contact with the source of the burn.
• Ensure Breathing: If needed, begin rescue breathing right away.
• Remove Tight Clothing: Carefully remove tight clothing from the burned area, especially around the neck.
• Elevate the Burned Area: If possible, elevate the burned area above heart level to reduce swelling.
• Cover the Person: Cover the person with loose clothing or a clean bandage.
• Calm the Person: Help prevent shock by reassuring and calming the individual.

Treatment in a Major Burn Accident

Once admitted to the hospital, emergency treatment may include:

• Water-Based Therapy: MIST therapy uses a gentle ultrasound mist to promote wound healing, clean wounds, and reduce infection risk.
• Intravenous (IV) Fluids: IV fluids are administered to maintain blood pressure and prevent shock or dehydration.
• Dressing: The affected areas may be wrapped in dry gauze to protect wounds and prevent infection.
• Pain Management: Strong pain relievers like morphine may be necessary to manage severe pain during dressing changes.
• Antibiotics: To prevent infection, antibiotics like Cefotaxime, Trimethoprim, and Penicillin V may be prescribed.
• Anabolic Steroids: Medications like oxandrolone may be used to speed up wound healing in severe burns.
• Thromboprophylaxis: Methods such as medication or compression devices may be used to prevent blood clots, which can arise as a complication of burn injuries.

Surgical Procedures

Severe burns may require surgical interventions to aid in the healing process:

• Skin Grafts: Skin from a donor site or another part of the body is transplanted to cover burn wounds and reduce scar tissue formation.
• Reconstructive Surgery: Plastic surgery can improve the appearance of burn scars and increase the flexibility of joints affected by scarring.

Burns can lead to various complications, including:

• Scarring: When the skin is damaged, scar tissue forms during the healing process. The extent and severity of scarring depend on the depth and size of the burn.

• Infection: Burns are susceptible to infections, especially if bacteria enter through the wounds. Burn blisters that rupture can also become infected if not properly cared for.

• Shock: A life-threatening condition, shock occurs when there is not enough oxygen circulating in the body, typically after severe burns.

• Heat Stroke and Heat Exhaustion: These conditions can result from burns that disrupt the body’s ability to regulate temperature, due to extensive tissue damage.

• Arrhythmia: An irregular heartbeat, often caused by electrical burns, is known as arrhythmia and can be a serious complication.

• Psychological Impact: Severe burns can have a long-lasting emotional toll, including anxiety, depression, stress, and a decrease in self-esteem and confidence.

• Sepsis: In rare instances, an infected burn can lead to sepsis, a severe blood infection. If left untreated, sepsis can be fatal.

Certain complementary therapies may help relieve symptoms when used alongside conventional treatments:

Acupuncture:

Inserting needles into specific acupoints in the skin and muscles may help alleviate burn pain, as suggested by some studies.

Physiotherapy:

This treatment starts early for burn victims in hospitals. Physiotherapists work to improve the movement and functionality of the affected areas through various techniques.

Massage Therapy:

Massage can relieve pain, itching, and discomfort from burns and their healing stages. Studies suggest that it may be beneficial during both the acute and recovery phases.

Hypnosis:

Also known as hypnotherapy, hypnosis involves deep relaxation and focused concentration. Research suggests that it can help reduce pain and improve psychological well-being for burn patients.

Superficial or first-degree burns can generally be treated at home using the following remedies:

Use Cool Water:

For minor burns, rinse the area with cool (not cold) water for about 15 minutes, then wash the affected area with mild soap.

Limit Sun Exposure:

Avoid exposing the burn to direct sunlight, as the affected skin will be more sensitive. Cover it with clothing or apply sunscreen if necessary.

Apply Cool Compresses:

A cool, wet cloth applied to the burn for 5–15-minute intervals can help alleviate pain and reduce swelling.

Natural Remedies:

The following home treatments can be considered for minor burns, though it's important to consult a doctor beforehand:

• Aloe Vera: Aloe vera has anti-inflammatory and antimicrobial properties, promoting circulation and soothing the burn.

How to use: Apply aloe vera gel directly to the affected area.

• Coconut Oil: Coconut oil's moisturizing properties can help soothe minor burns.

How to use: Gently apply coconut oil to the burn to rehydrate and protect the skin.

• Onion: Onions contain sulfur compounds that may assist in healing superficial burns.

How to use: Apply onion juice or paste to the burn to relieve pain and prevent blisters from forming.

Recovery from burns requires resilience, support, and a focus on both physical and emotional healing. Key considerations include:

Supportive Care:

The focus during post-engraftment care should be on creating optimal conditions for healing, which involves:

• Hemodynamic support in the early recovery stages
• Nutritional support to promote healing
• Proper pain management through the use of appropriate medications

Rehabilitation:

Rehabilitation aims to restore the individual’s ability to perform daily tasks. Early exercise and physical therapy are crucial, as is immediate mobilization. The ultimate goal is to reintegrate the person into society and help them regain confidence, including the ability to return to work.

Psychological Support:

Psychological care should be a routine part of burn recovery. This includes offering therapeutic interventions that help individuals express their feelings, meet others in similar situations, and receive medical counseling during recovery.