Any injury in which the skin is extensively damaged and may include underlying tissues can be classified as a burn.
The extent of damage caused by these injuries varies from superficial to partial thickness and full thickness.
Superficial burns cause loss of function without permanent structural change or scarring, whereas partial-thickness burns can result in morphological changes and damage of function, and full-thickness burn injuries cause destruction of epidermal, dermal tissue.
What is the treatment for a superficial partial-thickness (first degree) burn?
The treatment for first-degree burns involves cleansing with mild soap, applying over-the-counter antibiotic pastes such as silver sulfadiazine or bacitracin, followed by dressing in dry sterile gauze or cling wrap/bandage.
Adults who have a minor partial-thickness injury on hands, feet, perineum, or limbs that involve only epidermis require no surgical intervention and usually heal by epithelialization from wound edges without scar formation. These can be managed with simple wound dressing at home.
What is the treatment for a partial thickness (second degree) burn?
Partial-thickness burns are more severe than superficial first-degree burns.
Treatment involves cleansing of the wounds with mild soap and water, use of antibiotic ointment to prevent infection, covering of wounds by sterile dressing or wet saline gauze cloths, pain control with analgesics preferably non-steroidal anti-inflammatory drugs (NSAIDs), tetanus prophylaxis in all cases when the injury is not remote from prior high-risk exposure to microorganisms such as soil, sand or animal bites.
Conservative treatment can be attempted for shallow or full-thickness burn injuries (second degree) smaller than 15% TBSA, which may heal without scars and minimal tissue loss.
What is the treatment for a full-thickness (third-degree) burn?
Burns involving more than 80% TBSA are usually considered third-degree burns. These injuries must be renewed with fluid therapy and may require a blood transfusion. In addition, broad-spectrum antibiotics should be started to prevent infection of these extensive wounds. Surgery for the excision of burned tissue is followed by autografting. Covering the burned area involves taking healthy skin from areas that do not have burn injuries, such as buttocks or anterior abdominal walls. Split thickness skin grafting has better cosmetic outcomes when compared to full-thickness skin grafts in victims with large burns.
What precautions should be taken when an individual has received a burn injury?
Burn injuries are associated with multiple organ dysfunction syndromes (MODS), which can be prevented by fluid resuscitation, administration of antibiotics, and proper wound treatment. The skin over the burned areas should be kept moist with normal saline. Patients may require intubation if their airway becomes threatened following admission to the hospital. Body temperature needs to be maintained at or around 36°C to 38°C; patients must be monitored for hyperthermia or hypothermia.
Careful eye care is required because burn victims are prone to corneal damage due to environmental factors such as wind, smoke, splashing of hot liquids during fire-fighting, etc. Excised burn wounds should be covered with autografts which should be stored in saline-soaked gauze at 4°C for no more than 24 hours before their use.
Read: Most Frequent Causes of Burn Injuries and How to Claim Compensation?
What are the different types of treatment available?
Conservative Treatment:
This is suitable for burns that involve 15% or less of the TBSA. The wounds are cleaned and topically treated for infection with silver sulfadiazine, bacitracin, mafenide acetate, or a 3% hydrogen peroxide mixture. These dressings do not require removal daily and can be left undisturbed until healing occurs. Another topical antimicrobial ointment is Dakin’s solution (sodium hypochlorite), usually used with silver sulfadiazine.
Surgical Treatment:
Surgery is required for burns that involve more than 15% TBSA. The burn eschar is excised along with a generous margin of non-burned skin, and wound edges are grafted with autografts taken from uninvolved areas such as thigh, upper arm, chest, or buttocks. Split thickness grafts have better cosmetic outcomes compared to full-thickness skin grafts in victims with large burns.
What complications can result due to severe burn injuries?
Complications seen following severe burns include sepsis, pneumonia, renal failure, and catabolic state leading to death. In addition, there may be damage to the respiratory system due to inhalation injury, leading to respiratory distress. Severe renal impairment is seen in patients with burns over 20% TBSA, and fluid resuscitation with crystalloids or colloids may worsen this condition.
What is the prognosis for a severe burn injury patient?
The outcome of severe burns depends on the extent of body surface area involvement, the health of the individual, and adequacy of resuscitation with fluids and electrolytes. Patients with less than 10% TBSA tend to do better than those with extensive burns (>20% TBSA). Those burned at an early age (less than 1 year), over more than 60 years of age, resulting from electrical injuries, inhalation injuries, especially involving children, have worse outcomes.
What is the outcome in patients with severe burn injuries?
The mortality rate in individuals with large burns (20% TBSA or more) remains high. Following extensive burn injury, risk factors associated with death include male gender, age over 60 years, inhalation injury, and concomitant trauma. Infection and sepsis remain significant causes of morbidity and mortality. The risk of sepsis is higher when a patient develops renal failure secondary to fluid overload.
How can we prevent burn injuries?
There are many ways of preventing burn injuries:
- The use of protective clothing and equipment at work is essential in industries such as steel and textile mills, aluminum and magnesium plants, etc., where fire hazards exist.
- Fire extinguishers should be placed at strategic locations in factories, offices, or homes to reduce opportunities for fires to start or spread.
- All flammable materials should be removed from the vicinity of the kitchen stove, and no heating element should be left on when cooking is not taking place.
- Open flames such as gas stoves must also be extinguished after use; electrical appliances must only be used with a supply of electricity so that they do not overheat.
- Matches and lighters should be kept in a safe place where children cannot reach them.
- Children should be taught not to play with matches and lighters to prevent them from starting a fire.
- Parents should make sure that smoke detectors are fitted in their homes, and they should also know how to work these detectors.
- An adequate number of fire extinguishers should be placed in public areas such as offices, schools, and colleges.
Burns sometimes lead to death; what steps can we take at this time?
When a person suffers significant burns or dies suddenly due to burn injuries:
The possibility of the patient suffering inhalation injury must be considered and appropriate diagnostic tests (chest X-ray and blood gases) done emergently.
Family members must be informed of the critical nature of the patient’s condition. Family members need to know that there is no hope for survival if bleeding is severe or signs of shock. The prognosis may be better in cases where burns are not too extensive. Still, in which known complications such as respiratory failure, renal failure, etc., exist.
How do you estimate mortality?
Estimates of mortality depend on burn size and resuscitation, the presence of inhalation injury, and associated injuries. Other factors are essential in determining prognosis, especially if one sees patients with large burns delayed resuscitation.
What are the common complications that may occur after burn injuries?
Complications that can develop include:
Infection, sepsis, and death due to sepsis
Sepsis occurs mainly because of the absorption of bacterial products through damaged skin. Infections cause tissue damage by releasing toxins or other harmful substances into the circulation (i.e., exotoxins). Bacteria colonize on exposed burn surfaces; their adhesion leads to the release of cell wall components known as endotoxins. These toxins enter the circulation and cause fever, chills, tachycardia (rapid heart rate), blood pressure instability, decreased urine output (oliguria), etc., all of which may lead to septic shock if left untreated.
Respiratory distress syndrome
Acute respiratory distress syndrome (ARDS) is a type of acute lung injury that develops suddenly and causes severe respiratory failure. It is characterized by widespread inflammation within the lungs’ delicate air sacs. This prevents oxygen from reaching small blood vessels in the lungs to pick up carbon dioxide for removal through exhalation. These changes result in the inability of the heart to pump sufficient amounts of blood through the body, eventually leading to damage or death of other organs.
Renal failure
Burned areas may dry and cause cracks on lips and tongue, leading to renal damage due to lack of fluid intake by such patients.