Burn

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Management 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• ocular burn
• sunburn

Etiology

• heat
• chemicals
• mechanical abrasion ( friction)
• sunlight
• electricity
• nuclear radiation

Pathology

• 1st burn is a partial epidermal thickness burn
• 2nd degree burn is full thickness epidermal burn with the dermis remaining largely intact
• 3rd degree burns are full thickness epithelial burns with damage to the underlying dermis
• epithelial appendages within the dermis provide the seed for re- epithelialization for a burned area

Clinical-manifestations

• 1st & second degree burns are hypersensitive & painful
• 3rd degree burns destroy nerves making them insensitive to pain
• 1st degree burns

• erythema
• tenderness
• edema

• 2nd degree burns

• same as 1st degree burns plus
• blisters
• shiny appearance
• weeping

• 3rd degree burns

• skin charred with a leathery surface insensitive to pain or touch
• surface will not blanch because blood vessels are thrombosed

Management

• estimation of body surface area ( BSA) burned
• outpatient treatment (minor burns)

• 1st degree burns
• 2nd degree burns < 15% of BSA
• 3rd degree burns < 2% of BSA
• burns that spare the face, hands, feet & perineum

• inpatient treatment

• more extensive burns
• chemical or electrical burns
• associated inhalation injury or major trauma
• patients with significant medical problems

• 1st degree burns

• cooling, ice or cold compresses
• analgesics
• emollient
• topical anesthetic
• 1st degree burns will heal spontaneously without scarring in 3-4 days
• dressing not indicated [3]

• 2nd degree burns

• debridement

• intact blisters may be left for 3-4 days if no sign of infection
• bulky blisters may be decompress & devitalized skin removed

• gentle cleansing with antiseptic or mild soap
• topical antibiotics

• bacitracin for very limited 2nd degree burns
• silver sulfadiazine ( Silvadene) is preferred agent for larger or deeper burns

• dressings

• non-adherent gauze next to skin covered by bulky dressing
• wounds of face & ears may be easier to treat without bandages
• daily dressing changes ( premedication may be required)

• tetanus prophylaxis

• tetanus toxoid 0.5 mL SC booster
• tetanus immune globulin (Hyper-Tet) 25 U IM plus tetanus toxoid 0.5 mL SC if never immunized

• 2nd degree burns heal spontaneously without scarring in 2-3 weeks

• 3rd degree burns

• generally requires skin grafting
• months may be required for healing
• scarring occurs

• extensive burns (> 15% of BSA)

• may require fluid resuscitation

• 2-4 mL x weight in kg x % 2nd or 3rd degree burn/24 hr
• administer 1st 1/2 over 8 hours

• beta blocker ( propranolol 1 mg/kg every 4 hours) may attenuate catabolic response to catecholamines [2]

• vitamin C 500 mg QD & vitamin A 10,000 IU QD my be helpful
• if burn overlies a joint, attempt full range of motion at least 3 times/day
• elevation of burned part to limit edema
• diet

• 30 kcal/kg/day
• dietary protein 2.5 g/kg/day
• supplemental glutamine & arginine may diminish infections [3]

More General Terms

• skin disease (dermatologic disorder, dermatopathy, dermatosis)
• trauma

Additional Terms

• dermis
• electrical injury
• epidermis
• silver sulfadiazine (Silvadene)
• tetanus immune globulin (Hyper-Tet, TIG, tetanus antitoxin)
• tetanus toxoid

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1001-1002
2. Journal Watch 21(23):188, 2001 Herndon DN et al Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345:1223, 2001 PMID: [1]
3. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
4. Burns: NIH Institute and Center Resources [2]
5. National Guideline Clearinghouse Burns. (Work Loss Data Institute) ngc-guideline: [3]
   - Management of burns and scalds in primary care. New Zealand Guidelines Group ngc-guideline: [4]

burn