BURNS




Burnt is defined as a wound in whichnecrosis of wound occurs.
There are various types of burns:

1.Ordinary Burns- this is caused by dry heat, or flame, hotmetal, etc.
2.Scald- this is caused by moist heat like steam or hotliquid.
3.Electric Burns- this is caused by high voltage electriccurrent. This type of burn causes more damage to deep tissues and organs thanskin.
4.Chemical Burns- this is caused by strong acid like sulphuricburn or base like ammonia that come in contact with skin or other tissues.
5.Radiation Burns- this is caused by excessive exposure toirradiations like X- rays or radium.
6.Cold Burns- this is caused by exposure to cold. Thisincludes frostbite, chilblains, and trench foot.


Burns are classified in three grades:
1.First Degree Burns- these are superficial burns involvedonly epidermis. These are characterized itself by redness and swelling ofaffected part.
2.Second Degree Burn- in this whole epidermis gets destroyed.This is representing itself by formation of blisters.
3.Third Degree Burns- in this complete irreversible destructionof epidermis and dermis of skin is occurred. Because of destruction of bloodvessels and nerves, these types of burns are usually painless.

Importance to know the extent of burns:
It is measured as a percentage of total body area affected.This can be estimated with the help of 'RULE OF NINE'.


ANATOMICALAREA                                  PERCENTAGE OF BODY SURFACE
Head, Face andNeck                                                           9%
Right UpperExtremity                                                           9%
Left upperExtremity                                                              9%
Right Lower Extremity (thigh 9%, leg and foot9%)                   18%
Left Lower Extremity (thigh 9%, leg and foot9%)                     18%
Anterior Trunk (chest 9%, abdomen9%)                                 18%
Posterior Trunk (upper half 9% and lower half9%)                    18%
ExternalGenitalia                                                                  1%

This rule is applicable to adults only. In infants andchildren the surface area of head, face and neck is more than 9%.
         

Location of burn:
If the affected area is
1.Head, neck, face, nose and mouth- Airways could beobstructed resulting in breathlessness.
2.Extremities- Destruction of blood vessels may result inimpaired healing.
3.Chest- Adequate movement is not possible due to scarformation resulting in impaired breathing process,
4.Flexors Area- Impaired movement due to scar formation.Example- palmar surface, area behind knee joints, groins, etc.


Infection:
The affected area must be sterilized immediately. In cases ofdeep burns formation of crust will help in preventing infection. Those personswho are malnourished or suffering from anaemia, immuno-compromised diseases andsystemic diseases like diabetes mellitus are more to infection than others.

Treatment:
In cases of mild first degree burn cases, proper first aid isrequired in the assistance of a specialist.
In cases of severe cases with complications like shock,hospitalization is required to support the patient health.


General Treatment:
1.Removal of crust in cases of third degree full thicknessburns as it may compresses the adjacent blood vessels leading to cyanosis,paraesthesia, and etc. Sometimes, this crust present on the chest wall mayimpair breathing due to restricted movement of it so it become necessary toremove them.
2.Tetanus Prophylaxis- it must be given to a patient havingburn injury.
3.Nutritional support.
4.Treatment of other complaints of patient like GITdisturbances.    


Local Treatment:
1.First- Aid- The patient should be removed from source ofheat. Cold water must be applied on the affected area for atleast 5 mins. Avoidexcessive exposure to cold water as it may lead to hypothermia.
2.Burn- wound care- It should be cleaned properly and anyantimicrobial agent must be applied topically.
3.Skin Grafting.
4.Physical Therapy and Rehabilitation.


Treatment of Shock:
1.Sedation- in order to palliate pain.
2.Fluid Resuscitation and Blood transfusion.
3.Maintenance of airways. 



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