Contents
A burn is an injury to the skin, mucous membranes, and sometimes deeper tissues, such as muscles and bones, caused by the action of high temperatures, electricity and corrosive chemicals such as acids and bases. Thus, burns can be experienced in many ways, e.g. when staying in the sun for too long.
A few words about burns …
Burns injure both the skin and mucous membranes, and sometimes deeper tissues (e.g. muscles). It is the body’s reaction to the direct influence of the following factors (perpetrators):
- contact burns – e.g. touching the hot surface of devices,
- burns with boiling water or other hot liquids – most often occur in young children,
- electric burns,
- burns from hot air or hot steam; flame,
- frostbite – as a consequence of the impact of cold,
- chemical burns – caused by e.g. acids,
- radiation burns – tissues can be damaged, e.g. by UV radiation.
The detrimental effect of temperature on the skin begins at 42 ° C. At this temperature, the epidermis undergoes necrosis after 6 hours, at 55 ° C it takes 3 minutes of operation, and at 70 ° C only 1 second. The threshold temperature above which tissue protein is irreversibly damaged is 55 ° C. Any higher temperature affecting the surface of the body causes damage to the skin and deeper tissues, they are usually irreversible, i.e. they end in necrosis. Depending on the amount of temperature that affects the human body and the duration of its action, local or systemic damage may occur.
Classification of thermal burns due to the depth of damage
The type and extent of the burn depends largely on the time of exposure to the harmful factor as well as its temperature and intensity. Also, the effects of the implemented treatment depend on the extent and depth of the damage as well as the age and general condition of the patient. Small (shallow) burns are usually treated on an outpatient basis, while the more severe burns often require time-consuming treatment.
Thermal burns according to the depth of skin damage are divided into three degrees:
– XNUMXst degree – redness appears, the superficial layer of the skin is damaged, as in the case of a sunburn. This type of burn manifests itself in addition to redness with slight swelling and pain that usually disappears after 48 to 72 hours. The epidermis heals completely after a maximum of ten days. The burn does not leave any scars.
– stage II A – the burn causes the destruction of the epidermis and the superficial layer of the dermis; blisters appear due to the detachment of the epidermis from the basal membrane. It takes 14 to 21 days for the wound to heal.
– stage II B – these are deep burns of intermediate thickness. The burn destroys not only the epidermis, but also the various deep layers of the dermis (the protrusions of the epidermis from the hair follicles and sweat glands are spared). Wounds heal up to 35 days. Unfortunately, this type of burn leaves scars.
– grade III – these are skin burns accompanied by damage to muscle and bone structures; the burn wound may be brown or pale yellow and red, and usually does not cause pain when touched. Grade III burn wounds require surgical intervention, usually a transplant. Although the wound heals over time, it leaves unsightly scars.
– grade IV – these are very deep burns that can damage tendons, muscles or bones. A transplant is required, followed by reconstructive treatment.
Apart from the burns mentioned above, they can also occur mosaic burns. Their essence is the occurrence of burns of different depth in one area, usually II A and II B burns. Patients with mosaic burns usually undergo conservative or surgical treatment.
Burn symptoms
Burns, apart from local lesions, also lead to systemic disturbances, e.g. shock. Sometimes there is also a burn disease, which is caused by factors such as: pain, loss of blood plasma and intoxication of the body by the absorbed products of tissue protein breakdown. The severity of burn disease changes is proportional to the body surface area that has been burned. Similarly – the larger the surface of the body is burned, the more fluid escapes from the blood along with protein into the swollen tissues and blisters.
The extent of a burn is assessed, for example, on the basis of the Berkov table or the “rule of nine” and the “rule of the hand”. In the latter case, the area of the patient’s hand is 1% of the body surface. Second or third degree burns in an adult, which cover 20% of the body surface, in a child or an elderly person usually lead to a significant loss of fluid, which in turn leads to burn shock and is automatically life threatening. Hospitalization is necessary.
Note: Burns affecting more than half of the body surface, especially in children or adults, are a serious threat to life.
Procedure in case of burns
The on-scene management of a burn varies depending on the causative agent of the injury:
– thermal burn: In this type of burns, the most important thing is to help the burned as quickly as possible, as the temperature higher than 55 degrees Celsius causes irreversible damage to the tissue protein and skin necrosis. On the other hand, at 70 degrees Celsius, this process takes only one second. In people with thermal burns, extinguish and remove burning clothes, rinse the skin with cold water, and then put a sterile gauze on the wound; you must not pierce the blisters or tear off charred, dead tissues and burnt clothes that stick to the skin
– chemical burn: they occur when concentrated alkali, acid, hydrogen peroxide or heavy metal salts, present in household chemicals used in household cleaning products, enter the skin, eyes or gastrointestinal tract. In the event of such a burn, remove contaminated clothing and rinse the skin with plenty of cold water; if the substance has been swallowed, do not induce vomiting, as this will cause additional damage to the esophagus. In the case of home acid burns, we usually deal with hydrochloric acid, which is an ingredient of many cleaning products. Its effect is superficial and cuts tissue proteins, which is why characteristic white scabs form on the burned skin.
– electric burn: it is necessary to disconnect the power source, and if the patient is unconscious and not breathing, resuscitation should be started (electrocution / lightning may cause cardiac arrest). Skin changes caused by electric shock depend on the voltage and intensity of the current, the duration of its operation, the thickness of the epidermis and skin moisture. Low voltage current does not cause very extensive damage, while high voltage current causes deep burns, including charring of the body.
Each patient who suffers from severe and extensive burns should be transported to the hospital as soon as possible. During transport, care should be taken that the patient does not lose too much heat. Immediately after the incident, the burned parts of the body should be discovered, and when it is difficult – cut clothes and shoes. Under no circumstances should the clothing be removed from the skin! If your hands are burned, remove any jewelry (e.g. wedding rings) from your fingers, even at the cost of cutting them. Leaving jewelry on your fingers may lead to necrosis of a burned hand due to increasing swelling. In people who experience severe pain, painkillers can be used (the use of stronger painkillers depends only on the doctor’s decision; sedatives can also be given). , but we can use the means available in the home medicine cabinet.
Sun burns – their development usually takes place between an hour and four after sunlight. After this time, swelling and erythema appear on the skin. Often blisters (as in XNUMXst and XNUMXnd degree thermal burns). Changes caused by sunburn usually disappear after about two days, leaving skin discoloration. In lighter cases, it is enough to cool down with a cold shower and lubricate the lesions with Panthenol spray or zinc ointment. Artificial sources of UV radiation (solarium) also cause burns. The procedure is then similar to that for sunburn.