Burns

A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight or radiation. Scalds from hot liquids and steam, building fires and flammable liquids and gases are the most common causes of burns.

There are three types of burns:



• First-degree burns damage only the outer layer of skin

• Second-degree burns damage the outer layer and the layer underneath

• Third-degree burns damage or destroy the deepest layer of skin and tissues underneath

Burns can cause swelling, blistering, scarring and, in serious cases, shock and even death. They also can lead to infections because they damage your skin's protective barrier. Antibiotic creams can prevent or treat infections. After a third-degree burn, you need skin or synthetic grafts to cover exposed tissue and encourage new skin to grow. First- and second-degree burns usually heal without grafts.

Introduction

Burn injuries are very common.

Burns can be mild or very severe, requiring hospitalization and possibly more than one surgery.

This patient education program explains burns and how they can be treated.

The Skin

The skin is the body's outer covering. It protects us against heat, light, injury and infection. It also regulates body temperature.

Weighing about 6 pounds, the skin is the body's largest organ. It has 2 main layers: the outer epidermis and the inner dermis.

The epidermis, or outer layer of the skin, is mostly made of flat, scale-like cells called squamous cells. Under the squamous cells are round cells called basal cells.

The deepest part of the epidermis is made of cells called melanocytes. Melanocytes produce melanin, which gives the skin its color.

The dermis, the inner layer of the skin, contains

• Blood
• nerves
• lymph vessels
• hair follicles
• glands

The skin’s glands produce sweat, which helps regulate body temperature. They also produce sebum, an oily substance that helps keep the skin from drying out. Sweat and sebum get to the surface of the skin through tiny openings called pores.

The skin contains a fine network of nerves. This network gives us the ability to feel sensations and pain.

Burns

A burn is damaged tissue caused by heat, chemicals, electricity, sunlight or nuclear radiation.

Burns caused by scalds, building fires, flammable liquids and gases are most common.

Burns are divided into 3 different degrees, depending on how severe the damage is to the skin and its underlying tissues.

1^st degree burns only affect the outer layer of the skin called the epidermis.

2^nd degree burns damage the epidermis and the dermis, the layer underneath.

3^rd degree burns involve damage or complete destruction to the fullest depth of the skin and underlying tissues. People who experience 3^rd degree burns often require skin grafts.

Symptoms and Treatment

1^st and 2^nd degree burns are very painful. 3^rd degree burns are usually NOT painful because the nerves that supply the pain sensation are destroyed.

Burns cause severe damage to blood vessels. This type of damage causes fluid to seep out of the blood vessels, which causes swelling and blistering.

In very severe cases with extensive burns, loss of fluid can lead to depletion of blood volume, shock and dangerously low blood pressure. Death is likely if the fluid is not replenished.

Immediate transfusion with blood or a salt solution may be required to replace fluid and maintain blood pressure.

Burns often lead to infection due to damage of the skin's protective barrier.

In many cases creams or ointments with antibiotics in them are applied to the skin to prevent and treat infection.

1^st and 2^nd degree burns can heal over time without skin grafts since there is enough underlying skin tissue to rebuild the skin.

3rd-degree burns need skin grafts or application of artificial materials to cover and protect the exposed areas, as well as trigger new skin to grow.

Bandages must be changed very frequently for all degrees of burns to speed healing and prevent infections.

Infections caused by the burn can also occur elsewhere in the body. Blood infection called septicemia, and lung infection called pneumonia, can complicate severe burns. Such infections can result in death.

Since extensive burns usually increase metabolism, nutritional support is very important to help patients survive the burn.

Approximately 50,000 burn patients require hospitalization, and about 1/2 of all burn patients are admitted to a specialized Burn Unit or Intensive Care Unit (ICU).

• Adult respiratory distress syndrome, or ARDS, causes the lungs to fail. Patients with severe burns commonly get ARDS, which can result in death.

• Scarring may result from the burns. Recent advances in plastic surgery can improve the appearance of some of these scars.

Summary

Twenty years ago, burns covering 1/2 the body frequently ended in death. Today, patients with burns covering even 90% of their body can survive.

• The quality of life for burn patients continually improves as the methods of wound healing and tissue repair keep getting better.