Burns information and treatment

The effects of burns

Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals.

Burns cause varying degrees of pain, blisters, swelling, and skin loss.

Deep, extensive burns can cause serious complications, such as  

shock and severe infections.

Small, shallow burns may need only to be kept clean and to have an 

antibiotic cream applied.

People with deep or extensive burns may require intravenous fluids, 

surgery, and rehabilitation, often at a burn center.

Burns are usually caused by heat (thermal burns), such as fire, steam, tar,

or hot liquids. Burns caused by chemicals are similar to thermal burns, whereas burns caused by radiation (see Radiation Injury), sunlight (see Sunlight and Skin Damage:

Introduction), and electricity (see Electrical and Lightning Injuries: Electrical

Injuries) differ significantly. Events associated with a burn, such as jumping from a burning building, being struck by debris, or being in a motor vehicle crash, may cause other injuries.

Thermal and chemical burns usually occur because heat or chemicals contact part of the body's surface, most often the skin. Thus, the skin usually sustains most of the damage. However, severe surface burns may penetrate to deeper body structures, such as fat, muscle, or bone.   When tissues are burned, fluid leaks into them from the blood vessels, causing swelling. In addition, damaged skin and other body surfaces are easily infected because they can no longer act as a barrier against invading microorganisms.

 Older people and  young children are particularly vulnerable. In those age groups, abuse must be considered.  Doctors classify burns according to strict, widely accepted definitions. The definitions classify the burn's depth and the extent of tissue damage.  

Burn Depth: The depth of injury from a burn is described as first, second, or third degree:

First-degree (superficial)burns are the most shallow. They affect only the top layer of skin (epidermis).

Second-degree burns (also called partial-thickness burns) extend into the middle layer of skin (dermis). Second-degree burns are sometimes further described as superficial (involving the more superficial part of the dermis) or deep (involving both the superficial and the deep parts of the dermis).

Third-degree burns (also called full-thickness) involve all three layers of skin (epidermis,dermis, and fat layer). Usually, the sweat glands, hair follicles, and nerve endings are destroyed as well.

  

Treatment

Before burns are treated, the burning agent must be stopped from inflicting

further damage. For example, fires are extinguished. Clothing—especially any that is smoldering (such as melted synthetic shirts), covered with a hot substance

(for example, tar), or soaked with chemicals—is immediately removed.  Hospitalization is sometimes necessary for optimal care of burns. For example, elevating a severely burned arm or leg above the level of the heart to prevent swelling is more easily accommodated in a hospital. In addition, burns that prevent people from carrying out essential daily functions, such as walking or eating, make hospitalization necessary. Severe burns, deep second- and third-degree burns, burns occurring in the very young or the very old, and burns involving the hands, feet, face, or genitals are usually best treated at burn centers. Burn centers are hospitals that are specially equipped and staffed to care for burn victims.

Superficial Minor Burns: 

Superficial minor burns are immersed immediately in cool water if possible. The burn is carefully cleaned to prevent infection. If dirt is deeply embedded, doctors can give analgesics or numb the area by injecting a local anesthetic and then scrub the burn with a brush.  Often, the only treatment required is application of an antibiotic cream, such as silver sulfadiazine Some Trade Names 
SILVADENE
. The cream prevents infection and forms a seal to prevent further bacteria from entering the wound. A sterile bandage is then applied to protect the burned area from dirt and further injury. A tetanus vaccination is given if needed (see Immunization: Tetanus).

Care at home includes keeping the burn clean to prevent infection. In addition, many people are given analgesics, often opioids for at least a few days. The burn can be covered with a nonstick bandage or with sterile gauze. The gauze can be removed without sticking by first being soaked in water.

Small, Shallow Burns

Most people who sustain small burns attempt to treat them at home rather than visit the doctor. Indeed, simple first-aid measures may be all that is necessary to treat small, shallow burns that are clean. In general, a clean burn is one that affects only clean skin and that does not contain any dirt particles or food. Running cold water over the burn can help relieve pain. Covering the burn with an over-the-counter antibiotic ointment and a nonstick, sterile bandage can help prevent infection.

Generally, a doctor's examination and treatment are recommended if a tetanus vaccination is needed. Likewise, a doctor should examine a burn if it has any of the following characteristics:

Is larger than the size of the person's open hand

Contains blisters

Darkens or breaks the skin

Involves the face, hand, foot, genitals, or skinfolds

Is not completely clean

Causes pain that is not relieved by acetaminophen Some Trade Names 
TYLENOL

Causes pain that does not improve within one day after the burn was sustained.

Deep Minor Burns:

As with more superficial burns, deep minor burns are treated with antibiotic cream. Any dead skin and broken blisters should be removed by a health care practitioner before the antibiotic cream is applied.  In addition, keeping a deeply burned arm or leg elevated above the heart for the first few days reduces swelling and pain. The burn may require admission to a hospital or frequent re-examination at a hospital or doctor's office, possibly as often as daily for the first few days.