Burns

Burns are a common type of injury that can occur in various settings, from the home to the workplace. They can be caused by a wide range of factors, including heat, chemicals, electricity, radiation, and the sun. While some burns are minor and can be treated at home, others can be severe and require immediate medical attention. In this article, we will explore the different types of burns, their causes, and the appropriate first aid measures.

What is a Burn?

A burn is an injury to the skin or other tissues resulting from exposure to heat, cold, electricity, chemicals, or radiation. The severity of a burn depends on its depth (the number of skin layers affected) and its size. Burns can cause pain, redness, swelling, blistering, and, in severe cases, charring of the skin. Burns can range from minor medical problems to life-threatening emergencies, and, it is essential to seek appropriate medical care depending on the severity of the burn.

Burns are classified into four degrees based on their severity and depth of skin damage, including:

• First-degree burns: These burns affect only the epidermis, the outermost layer of the skin. The burn site appears red, painful, and dry, without any blisters. A mild sunburn is a common example of a first-degree burn. Long-term tissue damage is rare, and the skin may experience a change in colour.

• Second-degree burns: These burns involve both the epidermis and a portion of the dermis, the lower layer of the skin. The burn site appears red, blistered, swollen, and painful.

• Third-degree burns: These burns destroy both the epidermis and dermis, potentially extending into the subcutaneous tissue, the innermost layer of the skin. The burn site may appear white or blackened and charred.

• Fourth-degree burns: These burns penetrate through both skin layers and underlying tissues, possibly affecting muscles and bones. The burn site lacks sensation due to the destruction of nerve endings.

The symptoms of burns can vary depending on the severity and depth of the injury. Some of the common symptoms include:

• Redness: Superficial burns, like first-degree burns, typically cause the skin to appear red and inflamed. This redness occurs due to increased blood flow to the area as the body responds to the injury.

• Blisters: In second-degree burns, fluid-filled blisters often develop on the skin's surface. These blisters can vary in size and may be painful. They serve to protect the underlying skin during the healing process, and it’s important not to pop them to prevent infection.

• Swelling: Swelling can develop around the burn area, affecting both the skin and underlying tissues. This indicates that the body is increasing blood flow and supplying essential nutrients to support the healing process.

• Peeling skin: As burns heal, especially in second-degree and deeper injuries, the outer layer of skin may begin to peel. This peeling is part of the natural healing process, but keeping the area clean and moisturised is essential during recovery.

• Pain: The level of pain associated with burns can vary significantly. First-degree burns might cause mild discomfort, while deeper burns, such as second and third-degree, can lead to severe pain due to nerve damage. Pain is an important indicator of burn severity and may require medical treatment for relief.

• White or charred skin: In cases of third-degree burns, the skin may appear white, leathery, or charred. This indicates damage to all layers of the skin and may affect underlying tissues. Such severe injuries require immediate medical attention due to the risk of complications like infection and scarring.

• Systemic reactions: Severe burns can also lead to systemic reactions, including fever, chills, and shock, indicating a serious condition that requires urgent medical care.

Burns can result from various sources, each with its own set of risks and potential complications. These include:

• Thermal burns: Exposure to heat sources such as hot metals, scalding liquids, steam, or flames can cause thermal burns. These burns are the most common type and can occur in various settings, from domestic accidents to industrial incidents.

• Radiation burns: Prolonged exposure to ultraviolet rays from the sun or other sources of radiation, such as X-rays, can lead to radiation burns. These burns often affect the skin and eyes, causing symptoms like redness, pain, and, in severe cases, blistering.

• Chemical burns: Contact with strong acids, alkalis, or other corrosive substances can cause chemical burns. These burns can be particularly dangerous as the chemicals may continue to damage the skin even after initial contact.

• Electrical burns: Exposure to electrical currents can cause electrical burns, which can be severe and may affect internal organs. These burns often occur in occupational settings or as a result of faulty electrical equipment.

• Friction burns: Prolonged or intense rubbing of the skin against a surface can cause friction burns. These burns are common in sports activities or accidents involving contact with rough surfaces, such as road rash from a bicycle fall.

Burns can lead to various complications, some of which can be life-threatening. The risk of complications increases with the severity and extent of the burn. Some common complications include:

• Infection: Burns compromise the skin's protective barrier, making it more susceptible to bacterial infections. Signs of infection include increased pain, redness, swelling, and discharge.

• Dehydration: Fluid loss through the burnt skin can lead to dehydration, which can cause organ damage if left untreated.

• Hypothermia: Extensive burning can disrupt the body's ability to regulate temperature, leading to hypothermia.

• Scarring: Deep burns can result in significant scarring, which may cause physical and psychological distress. Contractures (tightening of the skin) can limit movement and function.

• Breathing problems: Burns to the face, neck, or chest can cause swelling and inflammation in the airways, leading to difficulty breathing.

• Sepsis: Severe infections can lead to sepsis, a life-threatening condition characterised by widespread inflammation and organ dysfunction.

• Psychological trauma: The physical and emotional impact of burns can lead to psychological complications such as anxiety, depression, and post-traumatic stress disorder (PTSD).

Preventing burns is crucial to avoid the pain, suffering, and potential complications associated with these injuries. Some key steps to prevent burns include:

• Keep hot liquids and food out of reach of children, and use caution when handling them.

• Install smoke alarms and regularly check their batteries to ensure they are functioning properly.

• Keep matches, lighters, and other flammable materials out of reach of children.

• Use caution when handling hot objects such as curling irons, hair straighteners, and cooking equipment.

• Ensure electrical outlets are not overloaded and replace any frayed or damaged electrical cords.

• Use sunscreen with an appropriate SPF and wear protective clothing when exposed to the sun to prevent sunburns.

• Store chemicals and flammable liquids in a secure location away from heat sources.

• Teach children about fire safety and create an escape plan in case of a fire.

Diagnosing burns involves a thorough assessment of the injury's severity and extent to determine the appropriate level of care. The following factors are considered during the diagnostic process:

• Visual examination: The size, depth, and location of the burn are carefully assessed. First-degree burns are characterised by redness and minor swelling, while second-degree burns present with blisters and more intense redness. Third-degree burns appear waxy, white, charred, or dark brown, with a raised and leathery texture.

• Estimating the percentage of body surface area (BSA) affected: The "rule of nines" is often used to estimate the percentage of BSA affected in adults, while specialised charts are used for children. Burns covering more than 10% of the BSA are considered severe and require immediate medical attention.

• Assessing the burn depth: The depth of the burn is determined by examining the skin's appearance and sensation. First-degree burns affect only the epidermis, while second-degree burns extend into the dermis. Third-degree burns damage all layers of the skin and may appear leathery or charred.

• Evaluating other injuries: Burns can be accompanied by other injuries, such as fractures, inhalation injuries, or head trauma. A comprehensive evaluation is essential to identify and address any additional complications.

• Medical history: Preexisting medical conditions, allergies, and current medications are considered when developing a treatment plan.

The management and treatment of burns vary significantly depending on the severity and type of the burn. The treatment options include:

• Initial care: For minor burns, the first step is to cool the affected area by running cool (not cold) water over the burn for 10 to 20 minutes. Avoid using ice, as it can further damage the skin. After cooling, gently clean the burn with mild soap and water to remove any debris.

• Pain management: Pain relief is crucial for burn treatment. Over-the-counter pain relievers such as paracetamol and ibuprofen can help alleviate pain and reduce inflammation. For more severe pain, stronger medications like morphine may be prescribed by a doctor.

• Wound care: For burns with blisters, it's important to leave the blisters intact to protect the underlying skin. If blisters break, gently clean the area and apply an antibiotic ointment such as bacitracin or silver sulfadiazine to prevent infection. Cover the burn with a sterile, non-stick bandage to keep it clean and protected.

• Medications: In addition to topical ointments, antibiotics like cefotaxime, trimethoprim, and penicillin V may be prescribed to prevent or treat infections, especially in deeper burns. Anabolic steroids, such as oxandrolone, may also be utilised in some cases to promote healing and muscle recovery.

• Thromboprophylaxis: For patients with extensive burns, thromboprophylaxis may be necessary to prevent blood clots, particularly during prolonged immobility.

• Surgery: In cases of severe burns, surgical intervention may be required. Skin grafts and reconstruction surgeries can help restore skin integrity and improve function, especially in cases of significant tissue loss.

• Hydration: Maintaining hydration is essential, especially for more extensive burns. Drinking plenty of fluids supports the healing process and helps manage fluid loss.

• Monitoring for infection: Watch for signs of infection, such as increased redness, swelling, pus, or fever. If any of these symptoms occur, seek medical attention promptly, as infections can complicate healing.

• Physical rehabilitation: In cases of severe burns, physical therapy may be required to restore mobility and function. This helps prevent contractures (tightening of the skin) and improves overall recovery.

While prevention is key, living with the aftermath of a burn injury requires careful management to promote healing and prevent further complications. Here are some pointers to keep in mind:

• Follow your doctor's instructions for wound care, including regular dressing changes and the application of prescribed ointments or creams.

• Keep the burnt area clean and dry to prevent infection and avoid scratching or picking at the wound.

• Protect the burnt area from direct sunlight, as it can cause further damage and discolouration to the healing skin.

• Wear loose, comfortable clothing that doesn't rub against the burnt area, and opt for natural, breathable fabrics like cotton.

• Stay hydrated and maintain a balanced diet rich in nutrients that support wound healing, such as vitamin C, zinc, and protein.

• Attend follow-up appointments with your doctor to monitor the healing process and address any concerns or complications.

• Consider seeking support from a burn survivor support group or mental health professional to cope with the emotional impact of the injury.

While minor burns can often be treated at home, certain situations require immediate medical attention. If you experience any of the following symptoms or circumstances, it's essential to call your doctor or seek emergency care:

• The burn is larger than the size of the palm of your hand, or it covers a sensitive area like the face, hands, feet, or genitals.

• The burn is deep, causing the skin to appear white, brown, or charred, or if it results in blistering.

• You experience signs of infection, such as increased pain, redness, swelling, or discharge from the burn site.

• You develop fever, chills, or other systemic symptoms following burn injury.

• The burn was caused by electricity, chemicals, or an explosion, as these types of burns may cause internal damage not immediately visible on the skin.

• Burns are a common injury that can range from mild to life-threatening, depending on the extent and depth of the damage.

• Scald burns from hot liquids, flame burns, and contact with hot objects are the most common types of burns.

• Symptoms of burns include pain, redness, swelling, blistering, and, in severe cases, charring of the skin.

• Treatment for burns depends on the severity and may include cooling the burn, applying topical treatments, taking pain medication, and, in severe cases, hospitalisation and skin grafting.

• Preventing burns involves a combination of awareness, safety measures, and cautious behaviours in various settings, such as the kitchen, around fires, and when handling chemicals.

• Living with burns requires diligent wound care, pain management, sun protection, rehabilitation, and emotional support.

• Seek medical attention for deep, large, or infected burns or if the pain is severe and unmanageable at home.