Burns

• -:Abstract

Burns are local damage to the body tissues due to contact with flames, hot substances,
chemicals, electricity or radiation. Burns can be minor, or life threatening medical problems.
The severity of the burns depends on the affected amount of the body surface and the depth
of destroyed tissues. Burns has three types including first, second and third degree. Burn
.treatment depends on the severity and the location of the tissue damage

• -:Introduction

Burn is local skin or tissue injury that occurs primarily as a result of thermal factors such as dry
and moist heat, or due to contact with nuclear radiation, electricity, radioactivity, friction or
chemicals. The burns that occurs most commonly are thermal burns that occurs when the skin
touches flames, hot metals or hot liquids. Burns is a worldwide public health issue, it accounts
about 180,000 deaths per year. the most of these deaths happen in countries with low and
middle income and about two thirds of these deaths happen in WHO African and South East
Asia. (WHO. World Health Organization. Burns(2018).To a large extent, the severity of the burn
depends on the depth of tissue damage and the affected amount of the body surface. Burns
are divided into 3 types according to the severity of the skin damage. and these types are first,
second and third degree. (EKB. Britannica ACADEMIC.(2020). Burns may be mild medical
problem or emergent life threatening condition. Burns treatment is based on the severity of
.skin damage and the location of the damage (MAYO CLINIC.(2019).Burns)

• -:Objectives

To identify and explain burns, their causes and types. to provide basic principles of
management that lead to the best outcomes for patients with either small or large burns

• Definition

Burns are the damage that occurs to the skin when it comes in contact with flames, hot
 .substances, chemicals, electricity or radiations such as the rays of the sunlight and X-rays

• Causes of the burns

Thermal Burns : these burns are the most common type of burn injuries. They are caused
when an extreme heat above 115 degrees comes in contact with the skin. Thermal burns
occurs in different ways. burns caused by fire or flames accounts about 45 percent of burns.
Burns caused by touching hot objects accounts about 9 percent of burns and 33 percent of
burns are due to scalding. Thermal burns are most frequently occurs at home and at work.
And most commonly they are results from smoking or heating devices. Flash, flame, scalds,
and contact burns fall under the thermal burns category. Flash burns are burns that caused
due to an exposure to intense heat for a very short period of time such as a natural gas,
propane, gasoline, or other flammable liquids explosion. Flame burns are the burns caused
due to exposure to intense heat for a long period of time such as house fires and flammable
liquids. Scalds are the burns that occurs due to touching a hot liquid the skin such as boiling
.water or hot oil

In thermal burns, the severity of the skin damage depends on the temperature of the contact
.object and the duration of the heat exposure

The common external sources of thermal burns are flames, steam, hot objects, boiling
liquids, heaters and flammable liquids. (DAVIS SAPERSTEIN & SALOMON. (2019).Causes of
.Burns

Radiation burns: it occurs due to an exposure to Radioactive waves, ultraviolet waves,

ionizing radiation waves, and strong microwaves. A procedure like fluoroscopy can also cause
skin burn. depending on the type of radiation, the depth of burn is affected. Shallow
radiations burns occurs after exposure to beta waves. The patient skin becomes brown in
color and this called nuclear tan. Burning, itching and blisters are common present. After
days or weeks skin lesions occurs. The burns caused by gamma rays are much deeper and
more severe. Gamma rays cause radiation poisoning which known as acute radiation
.syndrome. (DAVIS SAPERSTEIN & SALOMON. (2019).Causes of Burns

Inhalation burns: It occurs from inhalation of vapors, harmful gases, smoke and smoke
.containing particulate matter. (DAVIS SAPERSTEIN & SALOMON. (2019).Causes of Burns

Electrical Burns: these burns are occurs when the electrical energy passes through the body
and generates heat that results from the body resistance against electricity. The factors that
determine the extent of the electrical buns are the voltage of the electrical source,
 resistance, the pathway that electricity takes and the duration of the contact. (DAVIS
.SAPERSTEIN & SALOMON. (2019).Causes of Burns

Chemical Burns : are the burns that occurs when a strong acid or alkaline substance comes in
contact with the body tissues. Hydrochloric acid and hydrofluoric acid are the most common
causes of acid burns. the bases substances that are commonly cause burns are sodium
hydrochlorite and calcium hrypchlorite, and phosphates and ammonia. the concentration of
the chemical substance, duration of the contact, and the amount of the tissue affected
determine the extent of the chemical burns. (DAVIS SAPERSTEIN & SALOMON. (2019).Causes
.of Burns

• Types of Burns

The classification of burns depends on the depth and severity of the burn penetration of the
surface of the skin. Burns comprise three types, and they are the first, second , and third
.burns

First degree: (superficial burns) this degree damages only the outer layer of the skin
(epidermis), the symptoms that appears at the site of burn are redness, painful, dryness, and
no blisters. An example of this degree is mild sunburn. At this degree the long term damage
to the tissues is rare. And usually involves increases or decrease in the color of the skin.
.Healing time is about from 3 to 4 days. No scars appear

Second degree: (Partial thickness) The outer layer of the skin (epidermis) and part of the skin
layer of the dermis are involved in the second degree of burns. the symptoms appears at the
site of the burn are redness, blisters, and swollen. Due to damage to the nerves endings the
site of burns in extremely painful. Healing and recovery time is about from 7 to 28 days.
.Some scarring at the site of burn

Third degree : (full thickness) at this degree, both layer of the skin (epidermis and dermis )
are destroyed. also it may extend and damage the bones, muscles, and tendons. The
appearance of the burn site is whitish or charred and the tough, leathery feeling at the site of
burn. The sensation at the site of burn is diminished due to destruction of the nerves
.endings. skin grafting is required at this degree of burn

Fourth degree: it refers to the burns that damaged the underlying structures as tendons,
muscles, or bones. This degree of burn is often lead to loss of muscle and bone and requires
amputation. The appearance of the burn site is white or charred. Frequent burns at this
degree are electrical burns. for the healing of this degree, surgical intervention is required.
 .(INTEGRIS.(2020). Types of Burns) / (Stanford Heath Care.(2020). Burn Stages)

• Rule of Nine

The first step in the assessment of burn and resurrection planning involves a careful
examination of the all surfaces of the body. Rule of nine is a way of assessing the extent of
the burns, this role is expressed as a percentage of the total surface of the body. This rule is
used for quickly estimated the size of burn. it divides the surface arena of the body into
.percentages

The head and the neck front and back equals 9 percent of the Total body surface area. Each
arm and hand front and back equals 9 percent of the total body surface area. The chest equal
9 percent of the total body surface area. The stomach equals 9 percent of the total body
surface. The upper of the back equals 9 percent and the lower of the back equals 9 percent
of the total body surface area. Each leg and foot front and back equals 18 percent of the total
body surface area. The area of genital equals 1 percent of the total body surface area.
(Alberta.(2019). Rule of nines for burns.) / (UWHealth.(2019). Assessing Burns and Planning
.Resuscitation: The Rule of Nines)

•Management of Burns

Immediate management includes Prioritization of ABCs ( Airway, Breathing, and -1

.Circulation)

Airways: upper airway obstruction is the primary airway concern. in cases of massive burns,
the airways can swell and can leads to total obstruction. So it's important to assessing patient
.airway and make endotracheal intubation before the airways is lost

Breathing: patients with burns caused by flames, flames consume the oxygen which results
in low levels of oxygen and leads to severe hypoxemia. Also hypoxemia can be caused by high
levels of carbon monoxide. Carbon monoxide is elevated in patients with prolonged smoke
exposure. In case of severe exposure to carbon monoxide. The treatment in this case
includes administrating 100% oxygen. In case of chest and abdominal burns, it may develop
compartment syndrome that requires a surgical procedure called escharotomies (incisions
through the burn to relieve the pressure). In cases of acute respiratory distress syndrome
.that may develops in patients with burns. it should be treated with low tidal volumes
 Circulation : cases with major extensive burns requires large resuscitation volume. The best
formula for burn resuscitation is the Parkland formula, Estimates a fluid resuscitation rate of
4 ml per kilogram of body weight percent of the total body-surface area burned during the
first 24 hours, with 50% of the volume of fluids supplied in the first 8 hr. and 50% is given in
the next 16 hrs. After the initial fluid resuscitation rate has been determined, fluids should be
.adjusted according to the urine output

Traditionally, balanced isotonic crystalloids were used for the resuscitation. And now many
burn center are using oncotic fluids (plasma and albumin) for resuscitation in cases of burns.
.(Dan.L. and Longo,M, (The New England Journal of Medicine.(2019)

Wound Care -2

Estimating the depth of the burn is important for assessing its severity and for planning future
.wound care

First Aid for wound care : Thoroughly drench the burn with cool water for 20 minutes to
prevent further damage and remove any burned clothes. When the area of the burn is
limited, the burn should be placed under cool water for 30 minutes for reducing pain ,edema
and to minimizing damage of the tissues. When the burn area is large, apply clean covers
about the burned area after it has been doused with cool water in order to limit heat loss and
evaporation. Ice or ice slush should not be applied on the burn wound because it will cause
additional damage to the tissues. Hydrogel burn products should not be used as a first aid
step unless there is no available source of water. Any burns caused due to chemicals, they
should be irrigated with copious amount of water. Copious volume of water should be
irrigated early in case of eye burns. as soon as possible transfer the patient with severe burns
.to the hospital

Initial Management -3

The treatment of burns should be focused on fast healing and prevention of infection.
Administrate tetanus prophylaxis in all burn cases. Start removing the adherent dead tissues
from the burn initially and start debridging all the necrotic tissues over the first several days.
Start to gently cleaning the burn with 0.25% chlorhexidine solution or anther mild water based
antiseptic. Alcohol based solutions should not be used. Began to gently scrubbing the burn to
remove the loose dead tissues. A thin layer of antibiotic cream should be applied like silver
.sulfadiazine. Then cover the burn area with petroleum gauze and dry gauze

Pain relief : immediately providing an effective analgesia, the route and the choice of analgesia
is determined according the patient condition. An appropriate analgesia and sedation should
be applied during dressing changing. (RCH. The Royal Children's Hospital Melbourne.(2019)
.Management of burn wounds)

Burn Daily Treatment -4

The dressing should be changed twice daily or as necessary to prevent seepage within the
dressing. Any visible loose tissue should be removed on each dressing change. The wound
should be observed for discoloration or hemorrhage which indicates infection developing.
Cellulites in the surrounding tissue of the burn, it indicates infection. In cases of hemolytic
streptococcal wound infection or septicemia, administrate systemic antibiotic. Pseudomonas
aeruginosa infection is often leads to septicemia and death. Topical antibiotic chemotherapy
should be administrated daily. Special care for treating burned hands to preserve function.
Apply silver sulfadiazine on your hands and put your hands in loose gloves or bag secured at
the wrist. Elevate your hands for the first 48 hrs, then start making hand exercises. For only
once a day, remove gloves or the bag, wash your hand, observe the site of burn and then
reapply silver sulfadiazine and the gloves again. ( WHO. World Health Organization.
(2007).Management of Burns)./ (RCH. The Royal Children's Hospital Melbourne.(2019)
.Management of burn wounds)

References

WHO. World Health Organiztion.(2018)Burns. Available at -1

.https://www.who.int/news-room/fact-sheets/detail/burns . Retrieved on 23/5/2020

EKB. Britannica Academic, Encyclopædia Britannica.(2020)Burn. Available at -2

https://06107y08m-1105-y-https-academic-eb-com.mplbci.ekb.eg/levels/collegiate/article/
burn/18190 . Retrieved on 23/5/2020

MAYO CLINIC.(2019).Burns. Available at -3

https://www.mayoclinic.org/diseases-conditions/burns/symptoms-causes/syc-20370539 .
.Retrieved on 23/5/2020

DAVIS SAPERSTEIN & SALOMON. (2019).Causes of Burns. Available at -4

https://www.dsslaw.com/personal-injury-attorney/burn-injury/causes-of-burns/ . Retrieved on
.)23/5/2020

INTEGRIS.(2020). Types of Burns. Available at https://integrisok.com/resources/articles/types-of--5

burns. Retrieved on 23/5/2020
Stanford Heath Care.(2020). Burn Stages. Available at https://stanfordhealthcare.org/medical--6
.)conditions/skin-hair-and-nails/burns/stages.html . Retrieved on 23/5/2020

Alberta.(2019). Rule of nines for burns. Available at -7

https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw262650 . Retrieved on
.23/5/2020

UWHealth.(2019). Assessing Burns and Planning Resuscitation: The Rule of Nines. Available -8
at https://www.uwhealth.org/emergency-room/assessing-burns-and-planning-resuscitation-
.the-rule-of-nines/12698 . Retrieved on 24/5/2020

Dan.L. and Longo,M, (The New England Journal of Medicine.(2019).Management of Burns. (-9
Available at https://www.nejm.org/doi/full/10.1056/NEJMra1807442 . Retrieved on
.24/5/2020)

WHO. World Health Organization.(2007).Management of Burns. Available at -10

.http://www.who.int/surgery/publications/Burns_management.pdf . Retrieved on 24/5/2020

RCH. The Royal Children's Hospital Melbourne.(2019) Management of burn wounds. -11
Available at https://www.rch.org.au/clinicalguide/guideline_index/Burns/ . Retrieved on
.24/5/2020