Burns
What are burns?
Burns are a type
of painful wound caused by thermal, electrical, chemical, or electromagnetic
energy. Smoking and open flame are the leading causes of burn injury for older
adults. Scalding is the leading cause of burn injury for children. Both infants
and the older adults are at the greatest risk for burn injury.
What are the different types of burns?
There are many
types of burns caused by thermal, radiation, chemical, or electrical contact.
·
Thermal burns. These burns are due to heat
sources which raise the temperature of the skin and tissues and cause tissue
cell death or charring. Hot metals, scalding liquids, steam, and flames, when
coming into contact with the skin, can cause thermal burns.
·
Radiation burns. These burns are due to
prolonged exposure to ultraviolet rays of the sun, or to other sources of
radiation such as X-ray.
·
Chemical burns. These burns are due to
strong acids, alkalies, detergents, or solvents coming into contact with the
skin or eyes.
·
Electrical burns. These burns are from electrical
current, either alternating current (AC) or direct current (DC).
The skin and its functions
The skin is the
largest organ of the body and has many important functions. It is made up of
several layers, with each layer having a specific functions:
Epidermis
|
The epidermis is the thin,
outer layer of the skin with many layers including:
·
Stratum corneum (horny layer)
This layer is made up of cells containing the protein keratin. it keeps body fluid in while keeping external substances out. As the outermost layer, it continuously flakes off.
·
Keratinocytes (squamous
cells)
This layer is made up of living cells that are maturing and moving toward the surface to become the stratum corneum.
·
Basal layer
This layer is where new skin cells divide to replace the old cells that are shed at the surface.
The epidermis also contains melanocytes, which are cells that
produce melanin (skin
pigment).
|
Dermis
|
The dermis is
the middle layer of the skin. The dermis contains the following:
·
Blood vessels
·
Lymph vessels
·
Hair follicles
·
Sweat glands
·
Collagen bundles
·
Fibroblasts
·
Nerves
The dermis is held together by a protein called collagen, made by
fibroblasts. This layer also contains nerve endings that conduct pain
and touch signals.
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Subcutis
|
The subcutis is
the deepest layer of skin. The subcutis, consisting of a network of collagen
and fat cells, helps conserve the body's heat and protects the body from
injury by acting as a "shock absorber."
|
In
addition to serving as a protective shield against heat, light, injury, and
infection, the skin also:
·
Regulates body temperature
·
Stores water and fat
·
Is a sensory organ
·
Prevents water loss
·
Prevents entry of bacteria
What are the classifications of burns?
Burns
are classified as first-, second-, or third-degree, depending on how deep and
severely they penetrate the skin's surface.
·
First-degree (superficial)
burns
First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually involves an increase or decrease in the skin color.
First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually involves an increase or decrease in the skin color.
·
Second-degree (partial
thickness) burns
Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.
Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.
·
Third-degree (full thickness)
burns
Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. When bones, muscles, or tendons are also burned, this may be referred to as a fourth-degree burn. The burn site appears white or charred. There is no feeling in the area since the nerve endings are destroyed.
Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. When bones, muscles, or tendons are also burned, this may be referred to as a fourth-degree burn. The burn site appears white or charred. There is no feeling in the area since the nerve endings are destroyed.
Burns
that are more severe and extensive need specialized treatment. Because the age
of a burn victim and the percentage of the body's surface area that has been
burned are the most important factors affecting the outlook of a burn injury,
the American Burn Association recommends that burn patients who meet the
following criteria should be treated at a specialized burn center:
·
Individuals with partial-thickness burns
over 10% or more of the total body surface area (TBSA)
·
Any age with full-thickness burns
·
Burns of the face, hands, feet, or groin, or
genital area, or burns that extend all the way around a portion of the body
·
Burns accompanied by an inhalation injury
affecting the airway or the lungs
·
Burn patients with existing chronic conditions
such as diabetes, high blood pressure, heart disease, kidney disease, or
multiple sclerosis
·
Suspected child or elder abuse
·
Chemical burn
·
Electrical injury
The effects of burns
A severe burn
can be a seriously devastating injury -- not only physically but emotionally.
It can affect not only the burn victim, but the entire family. Persons
with severe burns may be left with a loss of certain physical abilities,
including loss of limb(s), disfigurement, loss of mobility, scarring, and
recurrent infections because the burned skin has decreased ability to
fight infection. In addition, severe burns can penetrate deep skin layers,
causing muscle or tissue damage that may affect every system of the body.
Burns can also
cause emotional problems such as depression, nightmares, or flashbacks from the
traumatizing event. The loss of a friend or family member and possessions in
the fire may add grief to the emotional impact of a burn.
The burn rehabilitation team
Because
so many functions and systems of the body can be affected by severe burns, the
need for rehabilitation becomes even more crucial.
Many
hospitals have a specialized burn unit or center and some facilities are
designated solely for the rehabilitation of burn patients. Burn patients need
the highly specialized services of medical professionals who work together
on a multidisciplinary team, including the following:
·
Physiatrists
·
Plastic surgeons
·
Internists
·
Orthopedic surgeons
·
Infectious disease specialists
·
Rehabilitation nurses who specialize in burn
care
·
Psychologists/psychiatrists
·
Physical therapists
·
Occupational therapists
·
Respiratory therapists
·
Dietitians
·
Social workers
·
Case managers
·
Recreation therapists
·
Vocational counselors
The burn rehabilitation program
Burn
rehabilitation starts during the acute treatment phase and may last days to
months to years, depending on the extent of the burn. Rehabilitation is
designed to meet each patient's specific needs; therefore, each program is
different. The goals of a burn rehabilitation program include helping the
patient return to the highest level of function and independence possible,
while improving the overall quality of life -- physically, emotionally, and
socially.
To
help reach these goals, burn rehabilitation programs may include the following:
·
Complex wound care
·
Pain management
·
Physical therapy for positioning, splinting, and
exercise
·
Occupational therapy for assistance with
activities of daily living (ADLs)
·
Cosmetic reconstruction
·
Skin grafting
·
Counseling to deal with common emotional
responses during convalescence, such as depression, grieving, anxiety, guilt,
and insomnia
·
Patient and family education and counseling
·
Nutritional counseling
Advances
in the understanding and treatment of burns, state-of-the-art burn units and
facilities, comprehensive burn rehabilitation services, and integrated medical
care have all contributed to the increase in the survival rate and recovery of
burn patients.
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