Categorization of Burns

Burns – damage to the skin and other soft tissues as a result of thermal, radiation, chemical and electrical effects. Burns are distinguished by the depth of the lesion (superficial and deep non-full-layer and full-layer lesions) and the percentage of affected skin areas from the total surface of the body (GPRS). Complications include hypovolemic shock, inhalation damage, infection, scarring, and contracture. In case of extensive burns (> 20% of OPPT) adequate rehydration is required. Treatment of burn wounds includes topical application of antibacterial drugs, regular debridement, elevated position, sometimes skin grafting. Often, intensive rehabilitation of the victim is necessary, which includes the development of movements and splinting. 

Common sense and warnings

If symptoms of the respiratory tract, soot in the sputum, burns of the eyelids, burnt nasal hairs, or stay in the burning area are detected, an assessment of the condition of the respiratory tract and preparation for intubation is performed.

In the United States, about 3,000 people die from burns annually and about 2 million injured seek medical help at custom compounding pharmacy.

 

Etiology

Thermal burns can occur as a result of exposure to any external heat sources (flame, hot liquid, hot solid objects, or even gases). Burning can also be the result of inhaling toxic smoke (carbon monoxide poisoning).

Radiation burns most often occur as a result of prolonged exposure to solar ultraviolet radiation (sunburn) or prolonged or intense exposure to other sources of ultraviolet radiation (e.g., a solarium), after x-ray exposure or after other non-solar radiation (radiation damage and pollution).

Chemical burns can result from exposure to concentrated acids, alkalis (e.g. lye, cement), phenols, cresols, mustard gas, phosphorus, and certain petroleum products (e.g. gasoline, paint thinner). Necrosis of the skin and deeper tissues caused by these products can progress within a few hours.

Electric burns are the result of exposure to tissue heat and electroporation of cell membranes, which is associated with a massive flow of electrons. Electric burns often cause extensive damage to deep electrically conductive tissues, such as muscles, nerves, blood vessels, despite minimal damage to the skin.

Burning incidents (such as a jump from a burning building, being under debris, or a car accident) can cause other injuries. In young children and older people with burns, the possibility of mistreatment should be considered.

Smoke inhalation

Burns and inhalation often occur simultaneously, but they can also occur independently of each other. When inhaled, toxic combustion products damage the airways. Hot smoke usually causes only burns of the pharynx, since the inhaled gas cools quickly. The exception is steam, which carries much more heat than smoke, and therefore can cause burns to lower airways (below the glottis). In a fire in an ordinary house, many toxic chemicals are formed (for example, hydrogen chloride, phosgene, sulfur dioxide, toxic aldehydes, ammonia), which cause chemical burns. Some toxic combustion products, such as carbon monoxide or cyanides, lead to systemic damage to cellular respiration.

Clinical manifestations

Symptoms and signs depend on the depth of the burn.

  • First-degree burns: these burns are red in color, with light pressure, they clearly turn pale, painful and sensitive to palpation. Bubbles or blisters do not form. 
  • Superficial full-thickness burns: these burns turn pale with pressure, painful and sensitive to palpation. Bubbles or blisters form within 24 hours. The bottom of the blisters and blisters are pinkish in color, with the formation of fibrous exudate. 
  • Deep, multi-layer burns: these burns can be white, red or have a spotty red-white tint. When pressed, they do not fade and are less painful compared to superficial burns. A prick with a pin is perceived as a pressure rather than an injection. The formation of blisters or blisters is possible; these burns are usually dry. 

Full-layer burns: these burns can be white and soft, black and charred, brown and hard or bright red due to hemoglobin fixed in the subcutaneous base. Pale full-layer burns can mimic normal skin, with the exception of blanching of the skin when pressed. Full-layer burns are usually painless and insensitive. Hair is easily extracted from follicles. Bubbles and blisters usually do not develop. Sometimes it takes from 24 to 48 hours before the formation of signs that allow to differentiate full-layer burns from deep non-full-layer burns.