The Anatomy Of Burn Injuries And Their Medical Treatment

Each year in the United States more than 3 million people receive some type of burn. The majorities of burn injuries are minor and require little or no treatment. Yet, over 10 percent of the victim do require treatment and some of these, despite advanced medical technology, will die from burn injuries.

Just watch the evening news or online newspapers/channels for a week, and you will probably hear of someone being burned by a fire or an explosion. My purpose in writing this article is to present some basic facts about injuries caused by heat. By having some knowledge about this type of injury you hopefully will become more careful. One should know how to assist someone who wasn’t careful or was simply at the wrong place at the wrong time.

Main causes for burn injuries

The obvious and most common causes of burn injuries are fire, hot metal, scalding hot fluids or steam. In the hot summer months especially near the beach or large bodies of water, the ultraviolet irradiation from the sun, better known as sunburn, can cause severe skin damage.

Recently, the news media has covered stories about the concerns expressed by many scientists regarding the change in the chemical composition of the atmosphere. Some scientists believe this change is caused by the emission of ozone-destroying chlorofluorocarbons ozone, a chemical that absorbs ultraviolet radiation from the sun, is thinning. This allows for more harmful ultraviolet radiation to reach the earth. Since it is believed that the major cause of skin cancer is the ultraviolet rays of the sun, too much sunburn over a period of time could kill you.

Other burn causes

Mechanical abrasions and electrical current (these two may cause occult or hidden damage and frequently progress in severity after the initial injury. Chemicals such as acids and alkalies (alkali burns are usually more severe than acid burns due to alkali lipid penetration and rapid burn depth. This is why alkali burns are more likely to result in a full thickness burn). X-ray irradiation, nuclear radiation, dry heat and severe cold such as that from liquid nitrogen are also causes of burn injuries.

Burn injuries, especially those caused by an open flame may be associated with internal injuries not immediately apparent or suspected. Don’t fall into this trap and ignore what you can’t see. Heat and toxic fumes can burn and damage the esophagus and lungs. Various synthetics when burned give off toxic fumes. Many of your local firefighters can verify this from personal experiences.

An explosion is especially dangerous since it can cause trauma in addition to burns to organs from the combustion. Along with getting a standard medical history, ask about immunization. This is important because someone with extensive burns will need his immunization status against Clostridium tetani evaluated.

Burn injuries classification

A major factor used to determine the potential for healing of a burn is its depth. By classifying burns into three degrees of depth, you can better assess the extent of the injury and probability of recovery.

First Degree burn injuries:

This involves only the epidermis or outer layer of the skin. It is usually caused by ultraviolet damage (better known as a sunburn) or brief thermal contact as from a mild scald.

Clinical findings include erythema or red akin which is painful. This discomfort is present since the nerve elements in the dermis or liner below the epidermis are intact. Although quite painful, on many occasions, it will heal on its own without scarring. A fever or systemic symptoms are rare unless a large area of the body has been involved.

Usually, no treatment is indicated except some mild painkillers (in some cases) or various creams to ease the pain. Before taking any medication, be sure you are not allergic or have a condition that is contraindicated to the medicine.

Second Degree burn injuries:

This is also known and probably more correctly so as a partial thickness burn. The epidermis and some of the underlying dermis is destroyed.

Clinically, the skin is red as in a first-degree burn but with the addition of blister formation on the epidermis and dermis. There is also a weeping surface with swelling. Pain is present and can be slightly decreased depending on the burn’s depth. The burned area can be hypersensitive to even a light touch.

Someone with a partial thickness burn is very vulnerable to infection so try to use sterile techniques. Conversion to a full thickness burn as well as fluid and protein  losses can occur. Skin texture is normal to the firm.

Cover the entire area with sterile burn pads If not available, cover with clean dressing, one without a lot of lint that can get into the burn. If sterile water is available, moisten the dressing. Watch for shock and respiratory problems and transport the patient to a hospital for medical care.

Superficial second-degree burns may heal within two weeks with little scarring. If you were unfortunate to experience a deep partial burn, then four to six weeks may be needed for healing. Scarring here is likely to occur. The outcome is generally good provided that there is no infection to add to complications and your nutrition is adequate. Good nutrition plays an important role in wound healing. You will have a problem with any healing if you are in negative nitrogen balance. This means that your body is using more protein than it is making, a common finding in starvation. Vitamin C and zinc deficiencies along with chronic corticosteroid therapy are all implicated in impairing wound healing. Steroids reduce the inflammatory response to an initial injury which impedes the cleaning of necrotic tissue.

Third Degree burn injuries:

This is known as a full thickness burn, and it is the most serious of the three.

Clinically, the burn surface has a charred, waxen or leathery appearance. Depending on the cause of the burn, the skin may appear white, translucent and dead. The surface is usually dry instead of weeping. Since the burn is deep, the nerve elements have been destroyed, and there is no pain. There is also no sensitivity to temperature. Blisters don’t occur.

Care is the same as for second-degree burn injuries, and transport. This is a true life-threatening emergency. Transportation to a burn center is highly recommended. By knowing what is available in your area before an emergency arises, you are better able to pick the best facility.

Since all skin layers have been destroyed in third-degree burns, there is no chance for regeneration. Grafting is therefore mandatory.

Skin

Since skin, the largest body organ, is so important to and the main structure compromised in a burn, some space should be devoted to this important structure which performs the following functions:

1. Provides protection in preventing fluid Ioss and as a protective barrier against infections from microorganisms. In a burn, this protection is gone; therefore, this fluid loss and infection is a serious problem for those with burns.
2. Enables secretions through sweat glands, which help control temperatures
3. Maintains temperature control aside from sweating, by regulating blood flow through the skin’s capillary beds.
4. Promotes hair growth to follicles contained in the dermis.
5. Induces sensations to pain, touch, and temperature
6. Provides identification as from fingerprints and looks.
7. Acts as a synthesizer for vitamin D to the body.

The skin’s three layers of tissue:

Epidermis:

The outer layer which is made up of stratified squamous epithelium. It provides protection and does not contain blood vessels or lymphatics. Its thickness varies depending on the region of the body. It is thickest on the soles of the feet and palms of the hands

Dermis:

This irregularly arranged connective tissue contains nerves and nerve ending, blood vessels, lymphatics sebum and sweat glands, hair follicles, and mammary glands.

Subcutaneous tissue:

This layer is not really part of the skin. It contains fibroelastic tissue and fat. It attaches the skin to the muscles and bones

To quickly help the examiner in estimating and assessing the extent of the body area involved you should be familiar with the standard “rule of nines.” This system divides the body’s surface area into anatomic percentage areas, each of which is 9 percent or a multiple of 9 as 18.

Adult:

9 percent for face, scalp, and neck; 9 percent for each arm; 18 percent for each leg, anterior (front), front and back or posterior; 18 percent for chest or back; 1 percent reserved for the perineum.

Child:

18 percent for the face, scalp, and neck; 14 percent for each leg

General First Aid Treatment of burn injuries

Considerations for partial and full thickness burns:

1. Burns are serious. First aid doesn’t encompass n treatment but provides for stabilization until proper medical help can be obtained, preferably in a medical facility with a burn center.
2. Carefully remove the victim from any danger, mindful of injuries that may involve the vertebrae.
3. Remove contaminated and burning clothing. Synthetics melt and hold heat which produces deep injuries.
4. Cover burns with sterile pads soaked with sterile water if available.
5. Do not cover burns with gauzes that may stick to the burn and contaminate it. A clean sheet may be better as a temporal treatment.
6. Do not use ointments and sprays on burned areas since the hospital physician will only have to clean this off. Don’t complicate his job.
7. In chemical burns, use continuous cold water irrigation of the injury until medical care is obtained or contacted. An exception is alkali burns caused by dry lime. When water mixes with lime, you get a corrosive mixture that burns. If dry, brush it off unless a lot of water is available for rapid and thorough irrigation.
8. The danger in electrical burns is that they may not appear severe on the surface, and the patient may have extensive internal injuries. Heart damage may or may not be apparent, so EKG monitoring by medical personnel is critical.
9. Look for associated injuries. In an explosion, look for fractures and lacerations. Stop the bleeding and immobilize the fracture as though no burn were present. Be careful in checking the status of the vertebrae before moving the victim. If in doubt, wait until medical help arrives so the victim can be safely moved.
10. Treat for shock.
11. Transport the victim lying flat.

Related reading: Learn To Treat Burns During A Crisis

General hospital measures

Some of which may be controversial:

1. Medications for pain.

2. IV fluids to replace those lost. In any person with partial or full thickness burns greater than 20 percent of the body surface area, IV fluid replacement with isotonic solutions as lactated Ringer’s or normal saline is necessary.

3. Sterile dressings with topical ointments end/or antibiotics.

4. IV antibiotics for prophylaxis (controversial) and if an infection is present cultures should be done before antibiotics are started.

5 Tetanus prophylaxis: it is important that you keep your immunizations updated. You, as well as your doctor,  should have a record and be responsible for getting immunizations when scheduled.

6. Antacids to prevent Curling’s stress ulcers of the duodenum.

7. Proper nutrition. More protein and calories oil are needed

8. Surgical grafts and plastic surgery may be required.

9. Debridement of loose dead tissues.

10. Counseling.

Conclusion

The best treatment is prevention. For most, sunburns are the worst that will ever be experienced. For those unfortunate to experience a partial or full thickness burn, their lives could be at stake if they are not treated at a medical facility, preferably one with a recognized burn center. In burns, you can’t do much to treat. But in the meet of occult injuries, first aid is important, especially in surveying the victim before transport.

Visit your local fire company or ambulance association and inquire about taking a first aid or EMT course. Learn how to properly assist or treat, and not maim a victim due to ignorance.

This article has been written by James H. Redford MD for Prepper’s Will.

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