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 symptoms 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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1. Hot objects: Damage to the skin caused by touching hot objects is known as contact burns. The burn is usually confined to the area of skin that made contact with the hot object.
2. Ultraviolet rays (UV): Damage to the skin caused by UV rays is referred to as sunburn, which is emitted from the sun. Protect your skin from sunburns with our well-curated range of sunscreens. Shop Now
3. Hot liquids: A wound to the skin caused by hot liquids is called a scald. The longer the liquid 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 lead to direct injury to the skin and underlying tissue.
5. Electrical burns: These burns are caused by currents of electricity and are usually deep, potentially causing severe damage to the skin and its underlying tissue.
6. Chemical burns: Chemical burns occur due to contact with flammable gases or liquids. Inhaling harmful chemicals and gases can 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 occur in bicycle or motorcycle accidents.

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 primarily due to a lack of adult supervision.
3. Socioeconomic factors
   Individuals living in low- and middle-income countries are at higher risk for burns than those residing in high-income countries.
4. Other factors
   
   • Lack of proper safety measures, poverty, and overcrowding
   • Occupations that increase the chances of burns
   • Employing young girls in household roles such as cooking

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 managed at home. In cases of severe burn injury, an emergency evaluation is performed by the doctor, 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: Removal of chemicals or toxins causing burns by flushing the injured area.

During the physical evaluation, the doctor will assess:

• Extent of burn: Calculated by the percentage of total body surface area burned.
• Depth of burn: Classified into superficial, partial thickness, or full thickness, depending on the extent of injury to the epidermis or dermis.

2. Blood Tests

• Complete blood count (CBC): Conducted to assess overall health, detect anemia, infection, and blood-related complications from the injury.
• Serum electrolytes: Monitors and balances crucial mineral levels, as burns can disrupt electrolyte equilibrium and lead to complications.
• Blood urea nitrogen: 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 from fluid loss.
• Glucose tests: Monitors blood sugar levels, which can be elevated due to stress response and metabolic changes from the burn injury.
• Carboxyhemoglobin (COHb): Useful for diagnosing carbon monoxide poisoning during fire incidents.
• Serum lactate: Measures lactic acid in the blood, serving as a sensitive indicator of tissue hypoxia.
• Cyanide level: High levels indicate cyanide poisoning, commonly from fire exposure.
• Blood group mapping: Performed for patients with severe trauma in addition to burns who may require blood or blood products.
• Serum creatine kinase: High levels indicate damage or disease of skeletal muscles associated with burns.

3. Imaging Tests

• Electrocardiogram: Checks heart rhythm and electrical activity, performed before administering fluids due to potential heart rhythm issues from large burns.
• Chest X-ray: Produces images of the heart, lungs, blood vessels, airways, and chest bones, assessing potential inhalation injury and lung complications from smoke or chemicals.
• Computed tomography (CT) scan: Valuable for diagnosing and managing inhalation injury when performed within 24 hours of burn injury.
• Magnetic resonance imaging (MRI): Occasionally done to assess damage, depth of burns, and potential complications in underlying tissues.

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

1. Burn safety at home

• 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 tablecloth 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.

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

Treatment of Minor (First or Second Degree) Burns

• Cool the Burn: Immediately immerse the burn in cool or room temperature running water 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: Try to do this quickly before the area swells.
• Apply a Cooling Gel: For sunburns, apply a cooling agent like aloe vera gel to help prevent drying and provide relief.
• Use Antibiotic Ointments: For thermal burns, apply over-the-counter ointments such as:
  • Silver sulfadiazine
  • Bacitracin
  • Polysporin
  • Neosporin
• Loosely Wrap with a Clean Dressing: Cover the burn with a clean gauze, nonstick bandage, or cloth to protect the burn and prevent infection.
• Special Dressings: Advanced dressings are pads or strips that have wound-healing products built into them. Examples include:
  • Hydrogels
  • Silver impregnated dressings
  • 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 significantly in the first 48 hours. If you notice signs of infection such as 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.

Treatment of Major (Third or Fourth Degree) Burns

Until emergency help arrives:

• Safeguard the Burnt Person: Ensure that the person you are helping is not in contact with the source of the burn.
• Ensure Normal Breathing: If the burnt person requires rescue breathing, start immediately.
• Remove Ornaments and Tight Clothing: Try to remove tight clothing from the burnt area, especially from the neck.
• Elevate the Burnt Area: Lift the wound area above heart level, if possible.
• Cover the Burnt Person: Use loose clothing or a bandage gauze to cover the person.
• Calm the Person: Try to pacify the person to avoid shock.

Major Burn Accident

The person is admitted to the hospital, and emergency medical help may include:

• Water-Based Treatment: This treatment, called MIST therapy, uses a mist with gentle ultrasound to help wounds heal faster, clean them, and reduce the likelihood of infection.
• I.V. Fluids: Intravenous (IV) fluids are given to maintain blood pressure and prevent shock and dehydration.
• Dressing: The person needs to be wrapped in dry gauze to prevent further infections.
• Pain Relievers: Burns can be highly painful, and the person may require high doses of pain relievers like morphine for dressing changes.
• Antibiotics: Burns can increase the risk of severe infections. Antibiotics used may include:
  • Cefotaxime
  • Trimethoprim
  • Penicillin V
• Anabolic Steroids: Such as oxandrolone, may be used for severe burns to help decrease wound healing time.
• Thromboprophylaxis: This 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.

Surgical Procedures

Surgical procedures may be required in severe cases to assist in wound healing:

• Skin Grafts: This surgery involves removing a patch of skin from one area of the body and transplanting it to another area. Donor skin can also be used temporarily to replace scar tissue caused by deep burns.
• Reconstruction: Also known as plastic surgery, this procedure can improve the appearance of burn scars and increase the flexibility of joints affected by scarring.

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

• Use cool water: The first step in treating minor burns is to wash the wound with cool (not cold) water for about 15 minutes, followed by washing the affected area with mild soap and water.
• Reduce sun exposure: Avoid exposing the burn to direct sunlight, as the burned skin will be highly sensitive. Keep it covered with clothing or, in the case of very minor burns, apply sunscreen lotions.
• Try cool compressions: A cool, clean wet cloth placed over the burn area can help relieve pain and swelling. Apply it at intervals of 5-15 minutes.
• 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:
  • Aloe vera (Ghritkumari): Aloe vera is rich in anti-inflammatory and antimicrobial properties and promotes circulation.
    How to use it? Apply a layer of aloe vera gel to the affected area to soothe the wound.
  • Coconut oil (Nariyal tel): It provides 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.
  • 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 reduce the occurrence of blisters.

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Burns can lead to several complications, including:

• 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 such as the depth and size of the burn.
• Infection: Wounds can become infected if bacteria enter them. A burn blister may become infected if it is not kept clean.
• Shock: Shock is a life-threatening condition that occurs when there is an insufficient supply of oxygen to the body, commonly seen after severe burns.
• Heat stroke and heat exhaustion: These conditions can occur as a result of burns when the body's ability to regulate temperature is compromised due to extensive tissue damage.
• Arrhythmia: Also known as an irregular heartbeat, arrhythmia is a problem with the rate or rhythm of the heartbeat, which is usually caused by electrical burns.
• Psychological impact: Severe burns can lead to long-lasting distress, including feelings of anxiety, low mood, depression, and a lack of confidence and self-esteem. Consider trying relaxation techniques to manage stress.
• Sepsis: In rare cases, an infected burn can lead to blood poisoning, also known as sepsis. This condition can be fatal if not treated immediately.

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

• 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.
• 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.
• 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.
• 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, which can help with managing severe burn pains.

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 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 regain, maintain, or improve abilities required for daily life. Exercise and physical therapy should be initiated as early as possible, and mobilization should begin immediately. The ultimate goal of rehabilitation following a burn injury is reintegration into society and gaining enough confidence to attain a well-paid position.
3. Psychological aspect
   Providing 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

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