Burns and Scalds

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BURNS AND SCALDS

DEFINITION

Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals. Scalds are a type of burn caused by a hot liquid or steam.

DESCRIPTION

Burns are classified according to how seriously tissue has been damaged. The following system is used:

A first degree burn causes redness and swelling in the outermost layers of the skin.
A second degree burn involves redness, swelling, and blistering. The damage may extend to deeper layers of the skin.
A third degree burn destroys the entire depth of the skin. It can also damage fat, muscle, organs, or bone beneath the skin. Significant scarring is common, and death can occur in the most severe cases.

The severity of a burn is also judged by how much area it covers. Health workers express this factor in a unit known as body surface area (BSA). For example, a person with burns on one arm and hand is said to have about a 10 percent BSA burn. A burn covering one leg and foot is classified as about a 20 percent BSA burn.

CAUSES

Burns may be caused in a variety of ways. In every case, the burn results from the death of skin tissue and, in some cases, underlying tissue. Burns caused by hot objects result from the death of cells caused by heat. In many cases, contact with a very hot object can damage tissue extensively. The contact may last for no more than a second or so, but the damage still occurs.

In other cases, cells are killed by heat produced by some physical event. For example, a rope burn is caused by friction between the rope and a person's body. The rope itself is not hot, but the heat produced by friction is sufficient to cause a burn.

Chemicals can also cause burns. The chemicals attack and destroy cells in skin tissue. They produce an effect very similar to that of a heat burn.

SYMPTOMS

The major signs of a burn are redness, swelling, and pain in the affected area. A severe burn will also blister. The skin may also peel, appear white or charred (blackened), or feel numb. A burn may also trigger a headache and fever. The most serious burns may cause shock. The symptoms of shock include faintness, weakness, rapid pulse and breathing, pale and clammy skin, and bluish lips and fingernails.

Burns and Scalds: Words to Know

BSA:: A unit used in the treatment of burns to express the amount of the total body surface area covered by the burn.
Debridement:: The surgical removal of dead skin.
Scald:: A burn caused by a hot liquid or steam.
Shock:: A life-threatening condition that results from low blood volume due to loss of blood or other fluids.
Skin graft:: A surgical procedure in which dead skin is removed and replaced by healthy skin, usually taken from the patient's own body.
Thermal burns:: Burns caused by hot objects.

DIAGNOSIS

Most burn cases are easily diagnosed. Patients know that they have touched a hot object, spilled a chemical on themselves, or been hit by steam. Doctors can confirm that a burn has occurred by conducting a physical examination.

TREATMENT

The form of treatment used for a burn depends on how serious it is. Minor burns can usually be treated at home or in a doctor's office. A minor burn is defined as a first or second degree burn that covers less than 15 percent of an adult's body or 10 percent of a child's body.

Moderate burns should be treated in a hospital. Moderate burns are first or second degree burns that cover more of a patient's body or a third degree burn that covers less than 10 percent of BSA.

The most severe burns should be treated in special burn-treatment facilities. These burns are third degree burns that cover more than 10 percent of BSA. Specialized equipment and methods are used to treat these burns.

Thermal Burn Treatment

Thermal burns are burns caused by heat, hot liquids, steam, fire, or other hot objects. The first objective in treating thermal burns is to cool the burned

area. Cool water, but not very cold water or ice, should be used for the cooling process. Minor burns can also be cleaned with soap and water. Blisters should not be broken. If the skin is broken, the burned area should be covered with an antibacterial ointment and covered with a bandage to prevent infection. Aspirin, acetaminophen (pronounced uh-see-tuh-MIN-uh-fuhn, trade name Tylenol), or ibuprofen (pronounced i-byoo-PRO-fuhn, trade names Advil, Motrin) can be used to ease pain and relieve inflammation. However, children should not take aspirin due to the risk of contracting Reye's syndrome (see Reye's syndrome entry). If signs of infection appear, the patient should see a doctor.

More serious burns may require another approach. A burn may be so severe that it causes life-threatening symptoms. The patient may stop breathing or go into shock. In such cases, the first goal of treatment is to save the patient's life, not treat the burns. The patient may require mouth-to-mouth resuscitation or artificial respiration.

Specialized treatment for severe burn cases may also include:

Installation of a breathing tube if the patient's airways or lungs have been damaged
Administration of fluids through an intravenous tube
Immunization with tetanus vaccine to prevent infection
Covering the burned area with antibiotic ointments and bandages
Debridement, or removal of dead tissue
Removal of scars as healing occurs in order to improve blood flow
Physical and occupational therapy to keep burn areas flexible and prevent scarring

Sometimes skin tissue is damaged so badly that it cannot heal properly. In that case, a skin graft may be required. In a skin graft, a doctor removes a section of healthy skin from an area of the patient's body that has not been burned. The tissue scarred by the burn is also removed. The healthy tissue is then put into place where the damaged tissue was removed. Over a period of time, the healthy tissue begins to grow and replace the damaged tissue.

Chemical Burn Treatment

The first step in treating a chemical burn is to remove the material causing the burn. If the material is a dry powder, it can be brushed off. If the material is a liquid, it can be flushed away with water. If the chemical that caused the burn is known, it may be neutralized with some other chemical. For example, if the burn is caused by an acid, a weak base can be used to neutralize the acid. The burned area can then be covered with a clean gauze and, if necessary, treated further by a doctor.

Electrical Burn Treatment

As with severe thermal burns, the first step in treating electrical burns usually involves saving the patient's life. An electrical charge large enough to burn the skin may also produce life-threatening symptoms. The source of electricity must be removed and life support treatment provided to the patient. When the patient's condition is stable, the burn can be covered with a clean gauze and medical treatment sought.

Alternative Treatment

Serious burns should always be treated by a medical doctor. Less serious burns may benefit from a variety of alternative treatments. Some herbs that can be used to treat burns include aloe, oil of St. John's wort, calendula (pronounced KUH-len-juh-luh), comfrey, and tea tree oil. Supplementing one's diet with vitamins C and E and the mineral zinc may help a wound to heal faster.

PROGNOSIS

The prognosis for burns depends on many factors. These factors include the degree of the burn, the amount of skin affected by the burn, what parts of the body were affected, and any additional complications that might have developed.

In general, minor burns heal in five to ten days with few or no complications or scarring. Moderate burns heal in ten to fourteen days and may leave scarring. Major burns take more than fourteen days to heal and can leave significant scarring or, in the most severe cases, can be fatal.

PREVENTION

Most thermal burns are caused by fires in the home. Every family member should be aware of basic safety rules that can reduce the risk of such fires. The single most important safety device is a smoke detector. The installation of smoke detectors throughout a house can greatly reduce the chance that injuries will result if a fire breaks out. Children should also be taught not to play with matches, lighters, fireworks, gasoline, cleaning fluids, or other materials that could burn them.

Burns from scalding water can be prevented by monitoring the temperature in the home hot water heater. That temperature should never be set higher than about 120°F (49°C). Taking care when working in the kitchen can also prevent scalds. For instance, be cautious when removing the tops from pans of hot foods and when uncovering foods heated in a microwave oven.

Sunburns can be prevented by limiting the time spent in the sun each day. The use of sunscreens can also reduce exposure to the ultraviolet radiation that causes sunburns.

Electrical burns can be prevented by covering unused electrical outlets with safety plugs. Electrical cords should also be kept out of the reach of infants who may chew on them. People should seek shelter indoors during thunderstorms in order to avoid being struck by lightning or coming in contact with fallen electrical wires.

Chemical burns may be prevented by wearing protective clothing, including gloves and eyeshields. Individuals should also be familiar with the chemicals they handle and know which ones are likely to pose a risk for burns.

FOR MORE INFORMATION

Books

Munster, Andrew M., and Glorya Hale. Severe Burns: A Family Guide to Medical and Emotional Recovery. Baltimore: Johns Hopkins University Press, 1993.