A burn is a type of injury to the skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are caused by heat from hot liquids, solids, or flames. While similar rates for men and women the underlying causes are often different. Among women in some areas, risks are associated with the use of open cooking fires or unsafe cooking stoves. Among men, the risks associated with the work environment. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence among people.
Burns that only affect the superficial skin layers are known as superficial or first-degree burns. They look red without blisters and the pain usually lasts about three days. When the injury extends to some of the underlying skin layers, it is a partial-thickness or second-degree wound. Blisters often appear and are often very painful. Healing can take up to eight weeks and scarring may occur. In burns with full thickness or level three, injury extends to all layers of the skin. Often there is no pain and the area is burning stiff. Healing usually does not happen by itself. Fourth-degree burns also involve injuries to deeper tissues, such as muscles, tendons, or bones. Burns are often black and often cause loss of burned parts.
Burns are usually preventable. Treatment depends on the severity of the burn. Superficial burns can be managed with little more than simple pain medications, while major burns may require long treatment at a special burn center. Cooling with tap water can help with pain and reduce damage; However, prolonged cooling can cause low body temperature. Burns with partial thickness may need to be cleaned with soap and water, followed by dressing. It is not clear how to manage blisters, but it might make sense to leave them intact if small and drain if large. Full-thickness burns usually require surgical treatment, such as skin grafts. Widespread burns often require large amounts of intravenous fluids, due to leakage of capillary fluid and tissue swelling. The most common complication of burns is infection. Tetanus toxin should be given if it is not up to date.
By 2015, fires and heat generated 67 million injuries. This resulted in approximately 2.9 million hospitalizations and 176,000 deaths. Most deaths from burns occur in developing countries, particularly in Southeast Asia. While large burns can be fatal, treatments developed since 1960 have improved results, especially in children and young adults. In the United States, about 96% of those treated at the burn center survive from their injuries. Long-term outcomes are related to the size of the burn and age of the affected person.
Video Burn
Signs and symptoms
The characteristic of the burn depends on its depth. Superficial burns cause pain lasting two or three days, followed by exfoliation over the next few days. Individuals suffering from more severe burns may show discomfort or complain of feeling pressure rather than pain. Full-thickness burns may be completely insensitive to light touch or puncture. While superficial burns are usually red, severe burns may be pink, white or black. Burns around the mouth or scorched hair in the nose may indicate that burns to the airways have occurred, but these findings are not definitive. More alarming signs include: shortness of breath, hoarseness, and stridor or wheezing. Itching usually occurs during the healing process, occurring in up to 90% of adults and almost all children. Numbness or tingling may persist for long periods after electrical injury. Burns can also produce emotional and psychological distress.
Maps Burn
Cause
Burns are caused by a variety of external sources that are classified as thermal (heat related), chemical, electrical, and radiation. In the United States, the most common causes of burns are: fire or flame (44%), burns (33%), hot objects (9%), electricity (4%), and chemicals (3%). Most (69%) of burns occurred at home or at work (9%), and most of the accidents, with 2% due to attacks by others, and 1-2% as a result of suicide attempts. These sources can cause an inhalation injury to the airway and/or lung, occurring in about 6%.
Burns occur more frequently among the poor. Smoking and alcoholism are other risk factors. Fire-related burns are generally more common in colder climates. Specific risk factors in developing countries include cooking with open flames or on the floor as well as developmental defects in children and chronic diseases in adults.
Thermal
In the United States, fire and hot liquids are the most common cause of burns. From house fires resulting in deaths, smoking causes 25% and heating devices cause 22%. Almost half of the injuries were due to efforts to fight the fire. Scalding is caused by hot or gas liquids and most often occurs from exposure to hot drinks, high temperature tap water in baths or showers, hot cooking oil, or steam. Bruises are most common in children under the age of five and, in the United States and Australia, this population makes up about two thirds of all burns. Contact with hot objects is the cause of about 20-30% of burns in children. Generally, burns are first or second level injuries, but third-degree burns can also occur, especially with prolonged contact. Fireworks are a common cause of burns during the holiday season in many countries. This is a special risk for boys.
Chemistry
Chemicals cause 2 to 11% of all burns and contribute up to 30% of deaths associated with burns. Chemical burns can be caused by more than 25,000 substances, most of which are strong bases (55%) or strong acids (26%). Most of the deaths from chemical combustion are secondary to consumption. Common agents include: sulfuric acid as found in toilet cleaners, sodium hypochlorite as found in bleach, and halogenated hydrocarbons such as those found in paint erasers, among others. Hydrofluoric acid can cause very deep burns that may not be symptomatic until some time after exposure. Formic acid can cause breakdown of large amounts of red blood cells.
Electricity
Electrical or injury burns are classified as high voltage (greater than or equal to 1000 volts), low voltage (less than 1000 volts), or as a secondary fuel flash due to an electric arc. The most common cause of electric burns in children is electrical wiring (60%) followed by electrical outlets (14%). Lightning can also cause electrical burns. Risk factors for beating include involvement in outdoor activities such as mountain climbing, golf and field sports, and work out. The death from lightning strikes is about 10%.
While electrical injuries primarily result in burns, they can also cause fractures or secondary dislocations due to blunt trauma or muscle contraction. In high-voltage injuries, most of the damage can occur internally and thus the level of injury can not be assessed by skin examination alone. Low voltage or high voltage contact can result in cardiac arrhythmias or cardiac arrest.
Radiation
Radiation burns may be caused by exposure to protracted ultraviolet light (such as from sun, tanning booth or arc welding) or from ionizing radiation (such as from radiation therapy, X-ray or radioactive fallout). Sun exposure is the most common cause of radiation burns and the most common cause of superficial burns overall. There are significant variations in how people burn easily in sunlight based on their skin type. The skin effect of ionizing radiation depends on the amount of exposure to the area, with hair loss seen after 3 Gy, redness seen after 10 Gy, wet peeling after 20 Gy, and necrosis after 30 Gy. Redness, if it occurs, may not appear until some time after exposure. Radiation burns are treated just like any other burn. Microwave burns occur through thermal heating caused by microwaves. While exposures as short as two seconds can cause injury, overall this is an unusual occurrence.
Unintentional
In those hospitalized from burns or burns, 3-10% are from assault. Reasons include: child abuse, personal strife, husband and wife abuse, elderly abuse, and business disputes. Immersion injury or immersion immersion may indicate child abuse. It is made when the extremities, or sometimes the buttocks are held beneath the surface of hot water. This usually produces a sharp and often symmetrical upper limit, known as "sock burns", "burn gloves", or "zebra lines" - where the folds have prevented certain areas from burning. Deliberate cigarette burns are preferably found on the face, or behind the hands and feet. Other signs of potentially improper risk include: circular burns, absence of splashes, uniform burns, and association with other signs of neglect or abuse.
Bride burning, a form of domestic violence, occurs in several cultures, such as India where women have been burned in retaliation for what their husbands or families consider as inadequate dowry. In Pakistan, acid burns represent 13% of intentional burns, and are often associated with domestic violence. Self-burning (self-burning) is also used as a form of protest in different parts of the world.
Pathophysiology
At temperatures greater than 44 ° C (111 ° F), the protein begins to lose its three dimensional shape and begins to break down. It produces cell and tissue damage. Many of the immediate health effects of burns are secondary to impaired normal skin function. They include skin sensation disorders, the ability to prevent water loss through evaporation, and the ability to control body temperature. The cell membrane disorder causes the cell to lose potassium to the space outside the cell and take water and sodium.
In large burns (over 30% of the total body surface area), there is a significant inflammatory response. This results in increased leakage of fluid from the capillaries, and subsequent tissue edema. This results in a loss of blood volume overall, with the remaining blood suffering significant plasma loss, making the blood more concentrated. Poor blood flow to organs such as the kidneys and gastrointestinal tract can cause kidney failure and ulcer disease.
An increase in catecholamine and cortisol levels can lead to a hypermetabolic state that can last for years. This is associated with increased cardiac output, metabolism, rapid heart rate, and poor immune function.
Diagnosis
Burns can be classified based on depth, injury mechanisms, extent, and related injuries. The most commonly used classification is based on the depth of injury. Burn depth is usually determined by examination, although biopsy may also be used. It may be difficult to accurately determine the depth of burn on a single examination and multiple re-examinations for several days may be required. In those who have headaches or dizziness and have burns associated with fire, carbon monoxide poisoning should be considered. Cyanide poisoning should also be considered.
Size
The size of the burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full-thickness burns. A single, red-colored burn is not included in this estimate. Most burns (70%) involve less than 10% of TBSA.
There are a number of methods for determining TBSA, including Wallace's rule of nine, Lund and Browder charts, and estimates based on the size of a person's palm. Rule nine is very easy to remember but only accurate in people over the age of 16. More accurate estimates can be made using Lund and Browder charts, which take into account the proportions of different body parts in adults and children. The size of a person's handprint (including the palms and fingers) is roughly 1% of their TBSA.
Severity
To determine the need for reference to a special fuel unit, the American Burn Association develops a classification system. Under this system, burns can be classified as large, medium and small. It is assessed based on a number of factors, including the affected body surface area, the involvement of a specific anatomical zone, the age of the person, and related injury. Mild burns can usually be handled at home, moderate burns are often hospitalized, and large burns are managed by a burn center.
Prevention
Historically, about half of all burns were thought to be preventable. The burn prevention program has significantly reduced serious burns. Precautions include: limiting hot water temperatures, smoke alarms, sprinkler systems, precise building construction, and fire retardant clothing. Experts recommend setting water heaters below 48.8 Â ° C (119.8 Â ° F). Other measures to prevent burns include using a thermometer to measure the temperature of the bath water, and spark guards on the stove. Although the effects of fireworks settings are unclear, there is tentative evidence of benefits with recommendations including limiting the sale of fireworks to children.
Management
Resuscitation begins with the assessment and stabilization of the airway, breathing, and circulation of the person. If an inhalation injury is suspected, premature intubation may be necessary. This is followed by the treatment of the burn itself. People with extensive burns can be wrapped in clean sheets until they arrive at the hospital. Because burns are susceptible to infection, tetanus booster injections should be given if a person has not been immunized in the past five years. In the United States, 95% of burns present in the emergency department are treated and dismissed; 5% require hospitalization. With severe burns, early feeding is very important. Hyperbaric oxygenation may be useful in addition to traditional treatments.
Intravenous fluid
In those with poor tissue perfusion, an isotonic crystalloid solution bolus should be administered. In children with more than 10-20% of TBSA burns, and adults with more than 15% of TBSA burns, formal fluid resuscitation and monitoring should follow. It should be initiated pre-hospital if possible in those with burns greater than 25% TBSA. The Parkland formula can help determine the required intravenous fluid volume during the first 24 hours. The formula is based on TBSA and its affected body weight. Half of the liquid is given for the first 8 hours, and the rest for the next 16 hours. Time is calculated from when the burn occurs, and not since fluid resuscitation begins. Children need additional fluid treatment that contains glucose. In addition, those with inhaled injuries need more fluids. Although inadequate fluid resuscitation may cause problems, excessive resuscitation can also be detrimental. The formula is just a guide, with an ideal infusion tailored to urine output & gt; 30Ã, mL/hour in adults or & gt; 1mL/kg in children and mean arterial pressure greater than 60 mmHg.
While Ringer's lactate solution is often used, there is no evidence that it is better than regular salt. The crystalloid fluid looks as good as the colloidal fluid, and because colloid is more expensive it is not recommended. Blood transfusion is rarely needed. They are usually only recommended when the hemoglobin level falls below 60-80 g/L (6-8 g/dL) due to the risk of related complications. Intravenous catheters may be placed through the burning skin if necessary or an intraosseous infusion may be used.
Wound care
Initial cooling (within 30 minutes of burns) reduces the depth of burns and pain, but care should be taken because excessive cooling can lead to hypothermia. This should be done with cold water 10-25Ã, Â ° C (50.0-77.0Ã, Â ° F) and not ice water because the latter can cause further injury. Chemical burns may require extensive irrigation. Cleaning with soap and water, lifting dead tissue, and applying pads are important aspects of wound care. If a full blister is present, it is unclear what to do with them. Some tentative evidence supports leaving them intact. Second-degree burns should be re-evaluated after two days.
In first and second level burn management, there is little evidence of the quality available to determine the type of dressing used. It makes sense to manage first-degree burns without dressing. While topical antibiotics are often recommended, there is little evidence to support their use. Sulfadiazine silver (a type of antibiotic) is not recommended because of the potential to prolong the healing time. There is insufficient evidence to support the use of silver-containing dressings or negative pressure wound therapy.
Drugs
Burns can be very painful and a number of different options can be used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and opioids such as morphine. Benzodiazepines may be used in addition to analgesics to aid anxiety. During the healing process, antihistamines, massage, or transcutaneous nerve stimulation can be used to help with itching. However, antihistamines are only effective for this purpose in 20% of people. There is tentative evidence supporting the use of gabapentin and its use may make sense to those who do not improve with antihistamines. Intravenous lidocaine requires more research before it can be recommended for pain.
Intravenous antibiotics are recommended prior to surgery for those with extensive burns (& gt; 60% TBSA). In 2008, the guidelines did not recommend their general use due to concerns about antibiotic resistance and increased risk of fungal infections. The provisional evidence, however, suggests that they can improve survival rates in those with severe and severe burns. Erythropoietin has not been found effective to prevent or treat anemia in cases of burns. In burns caused by hydrofluoric acid, calcium gluconate is a special antidote and can be used intravenously and/or topically. Recombinant human growth hormone (rhGH) in those with burns involving more than 40% of their bodies seem to speed healing without affecting the risk of death.
Surgery
Wounds that require surgical closure with a skin graft or flap (usually more than a full thick burn) should be treated as early as possible. Circumferential burns on the limbs or chest may require immediate surgery of the skin, known as escharotomy. This is done to treat or prevent problems with distal circulation, or ventilation. It is uncertain whether it is useful for neck or scald burns. Fasciotomies may be necessary for electric burns.
Alternative medicine
Honey has been used since ancient times to aid wound healing and may be beneficial in first and second degree burns. There is tentative evidence that honey helps heal partial burns. Evidence for aloe vera is of poor quality. Although it may be beneficial in relieving pain, and a review of 2007 found tentative evidence of increased healing time, the next review of 2012 did not find better healing than silver sulfadiazine. There were only three randomized controlled trials for the use of plants for burns, two for aloe vera and one for oatmeal.
There is little evidence that vitamin E helps with keloid or scar tissue. Butter is not recommended. In low-income countries, burns are treated up to a third of the time with traditional medicine, which may include application of eggs, mud, leaves or cow dung. Surgical management is limited in some cases due to insufficient financial resources and availability. There are a number of other methods that can be used in addition to drugs to alleviate procedural pain and anxiety including: virtual reality therapy, hypnosis, and behavioral approaches such as disorder techniques.
Prognosis
The prognosis is worse for those with larger burns, older people, and those who are women. The presence of smoke inhalation injury, other significant injuries such as long fractures, and serious comorbidities (eg heart disease, diabetes, psychiatric illness, and suicidal intent) also affect the prognosis. On average, of those treated at US burn centers, 4% die, with results for individuals depending on the extent of burns. For example, admittees with burns area less than 10% TBSA have a mortality rate of less than 1%, while admittees with more than 90% TBSA have an 85% mortality rate. In Afghanistan, people with more than 60% of TBSA burns rarely survive. Baux scores have historically been used to determine the prognosis of major burns. However, with improved care, it is no longer very accurate. The score is determined by adding the burn size (% TBSA) to the person's age, and taking it becomes more or less equal to the risk of death. Burns in 2013 produce 1.2 million years of life with disabilities and 12.3 million years of customized disability lives.
Complications
A number of complications can occur, with infection being the most common. In the frequency sequence, potential complications include: pneumonia, cellulitis, urinary tract infections and respiratory failure. Risk factors for infection include: burns of more than 30% TBSA, full-thickness burns, age extremes (old or young), or burns involving the feet or perineum. Pneumonia occurs primarily in those with inhaled injuries.
Secondary anemia for full-thickness burns of more than 10% TBSA is common. Electrical burns can cause compartment syndrome or rhabdomyolysis due to muscle damage. Blood clots in the leg veins are estimated to occur in 6 to 25% of people. A hypermetabolic state that can persist for many years after large burns can lead to decreased bone density and loss of muscle mass. Keloids can form after burns, especially in young and dark-skinned people. After burns, children may experience significant psychological trauma and post-traumatic stress disorder. Scarring can also cause disturbances in body image. In developing countries, significant burns can result in social isolation, extreme poverty and neglect of children.
Epidemiology
By 2015 fires and heat have resulted in 67 million injured. This resulted in approximately 2.9 million hospitalizations and 238,000 people died. This figure fell from 300,000 deaths in 1990. This makes it the fourth leading cause of injury after a motor vehicle crash, a fall, and violence. About 90% of burns occur in developing countries. This is partly due to unsafe density and cooking situations. Overall, nearly 60% of fatal burns occur in Southeast Asia at a rate of 11.6 per 100,000. The number of fatal burns has changed from 280,000 in 1990 to 176,000 by 2015.
In developed countries, adult males have twice as much mortality as women of burns. This is most likely due to high-risk jobs and greater risk-taking activities. In many countries in the developing world, however, women have twice the risk of men. This is often associated with accidents in the kitchen or domestic violence. In children, burnout deaths occur at more than ten times the rate in developing countries than in developed countries. Overall, in children it is one of the fifteen major causes of death. From the 1980s to 2004, many countries have seen declining levels of fatal burns and burns in general.
Developed countries
An estimated 500,000 burns receive medical care each year in the United States. They produced about 3,300 deaths in 2008. Most of the burns (70%) and deaths from burns occur in males. The highest incidence of fire fires occurs in those aged 18-35 years, while the highest incidence occurs in children less than five years and adults over 65 years. Electrical burns generate about 1,000 deaths per year. The result of lightning in the death of about 60 people per year. In Europe, deliberate burns are most common in middle-aged men.
Developing country
In India, about 700,000 to 800,000 people per year suffer significant burns, although very few are treated in specialist units of burns. The highest number occurred in women aged 16-35 years. Part of this high level is linked to the unsafe kitchen and loose clothes that are typical to India. It is estimated that one-third of all burns in India are due to clothing being burned from open flames. Deliberate burns are also a common cause and occur at a high level in young women, secondary to domestic violence and self-harm.
History
The cave paintings of over 3,500 years ago documented burns and their management. The earliest Egyptian records on wound care illustrate a dressing prepared with milk from a baby boy's mother, and 1500 BC Edwin Smith Papyrus describes treatment using honey and resin ointment. Many other treatments have been used for centuries, including the use of Chinese tea leaves documented to 600 BC, lard and vinegar by Hippocrates documented to 400 BC, and wine and nuts by Celsus documented to 100Ã, CE. The French barber surgeon Ambroise ParÃÆ' © was the first to describe the degree of different burns in the 1500s. Guillaume Dupuytren expanded this degree to six different severity levels in 1832.
The first hospital to treat burns was opened in 1843 in London, England and the development of modern burn care began in the late 1800s and early 1900s. During World War I, Henry D. Dakin and Alexis Carrel developed standards for cleaning and disinfecting burns and wounds using sodium hypochlorite solution, which significantly reduced mortality. In the 1940s, the importance of early excision and skin grafting was recognized, and around the same time, fluid resuscitation and formulas to guide it developed. In the 1970s, researchers pointed out the importance of hypermetabolic conditions that follow large burns.
References
Note
- National Burn Repository (PDF) . American Burn Association. 2012.
External links
directory
- Burned in Curlie (based on DMOZ)
- Parkland Formula
Source of the article : Wikipedia
0 Comments