BURN

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 burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn In a full-thickness or third-degree burn, the injury extends to all layers of the skin A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone.

 Partial-thickness burns may require cleaning with soap and water, followed by dressingsIt is not clear how to manage blisters, but it is probably reasonable to leave them intact. Full-thickness burns usually require surgical treatments, such as skin grafting. Extensive burns often require large amounts of intravenous fluids because the subsequent inflammatory response will result in significant capillary fluid leakage and edema.

most common complications of burns are related to infection.

Degree

Layers involved

Appearance

Texture Sensation Healing Time

Prognosis

Heals well; Repeated Superficial (First degree)

Epidermis

Red without blisters

Dry

Painful

510 days

sunburns increase the risk of skin cancer later in life

Superficial partial thickness (Second degree)

Extends into superficial (papillary) dermis

Redness with clearblister. Blanches with pressure.

Local infection/ Moist Very painful less than 23 cellulitis but no weeks scarring typically

Superficial (First degree)

Superficial partial thickness (Second degree)

Degree

Layers involved

Appearance

Texture

Sensation Healing Time

Prognosis

Deep partial thickness (Second degree)

Extends into deep (reticular) dermis

Yellow or white. Less blanching. Fairly dry May be blistering.

Pressure and 38 weeks discomfort

Scarring, contractures (may require excision and skin grafting)

Extends Stiff and Full thickness through entire white/brown No Leathery (Third degree) dermis blanching

Painless

Scarring, Prolonged contractures, (months) and amputation incomplete (early excision recommended)

Deep partial thickness (Second degree)

Full thickness (Third degree)

Degre e

Layers involved

Appearance Texture

Sensation

Healing Time

Prognosis

Extends through entire skin, Fourth and into degree underlying fat, muscle and bone

Black; charred Dry with eschar

Painless

Amputation , significant functional Requires impairment excision and, in some cases, death.

Fourth degree

Mechanisim of burn injury

Scalds-these types of burns result when skin comes in contact with hot liquids(spilled liquids or food, hot bathwater). Contact Burns- these burns result from contact of the skin with hot items, including flames.

Chemical Burn- these burns result from contact of the skin with chemicals, or by ingestion of chemicals.
Electrical Burn- these types of burns result when a person comes into contact with a source of electrical energy; includes burns caused by electrocution and lightning strike. Radiation Burns- these types of burns result from conact with source of radiation; may include overexposure i.e. sunburn.

Burn severity is determined though among other things the size of the skin affected. The image shows the makeup of different body parts which is needed to assess burn size.

 The size of a burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full thickness burns. The size of a person's handprint (including the palm and fingers) is approximately 1% of their TBSA. 5% of tbsa requires hospital admission

American Burn Association severity classification[36] Minor Adult <10% TBSA Moderate Adult 10-20% TBSA Major Adult >20% TBSA

Young or old < 5% TBSA Young or old 5-10% TBSA Young or old >10% TBSA <2% full thickness burn 2-5% full thickness burn High voltage injury >5% full thickness burn High voltage burn

Possible inhalation injury Known inhalation injury Circumferential burn Other health problems Significant burn to face, joints, hands or feet Associated injuries

TBSA <10%

Mortality 0.6%

10-20%
20-30% 30-40% 40-50% 50-60% 60-70% 70-80%

2.9%
8.6% 16% 25% 37% 43% 57%

80-90%
>90%

73%
85%

Management
Managing burn injuries properly is essential because they are commonly painful and can result in difiguring and disabling scarring, amputation of affected parts or death in severe cases. Complication such as shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress may occur. Treatment of burns may include the removal of dead tissue(debridement), applying dressing to the wound, fluid resuscitation, administering antibiotics and skin grafting.

Amputation skin grafting administering antibiotics applying dressing to the wound

Intravenous fluids In those with poor tissue perfusion, boluses of isotonic crystalloid solution should be given. Wound care Early cooling (within 30 minutes of the burn) reduces burn depth and pain, but care must be taken as over-cooling can result in hypothermia. removal of dead tissue, and application of dressings are important aspects of wound care.

antibiotics
Benzodiazepines may be used in addition to analgesics to help with anxiety During the healing process, antihistamines, massage, or transcutaneous nerve stimulation may be used to aid with itching.

 escharotomy.-Circumferential burns of the limbs or chest may need urgent surgical release of the skin. This is done to treat or prevent problems with distal circulation, or ventilation Fasciotomies-Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle.[1] Fasciotomy is a limb-saving procedure when used to treat acutecompartment syndrome. It is also sometimes used to treat chronic compartment stress syndrome. The procedure has a very high rate of success, with the most common problem being accidental damage to a nearby nerve.

TRIVIA
Honey has been used since ancient times to aid wound healing and may be beneficial in first and second degree burns The evidence for aloe vera is of poor quality While it might be beneficial in reducing pain. and a review from 2007 found tentative evidence of improved healing times a subsequent review from 2012 did not find improved healing over silver sulfadiazine.