Burn overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]
Overview
A burn is an injury caused by heat, cold, electricity, chemicals, light, radiation, or friction. Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. Muscle, bone, blood vessel, and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerve endings. Depending on the location affected and the degree of severity, a burn victim may experience a wide number of potentially fatal complications including shock, infection, electrolyte imbalance and respiratory distress. Beyond physical complications, burns can also result in severe psychological and emotional distress due to scarring and deformity.
Historical Perspective
The first case of burns injury was discovered from more than 3,500 years ago. French barber-surgeon Ambroise Paré was the first to describe different degrees of burns in the 1500s. For many decades after original description, there was little progress in defining the pathogenesis of burns occurred and different treatment. In the 1900's, it was found that the development of modern burn care began by Arabian physician his name Rhazes, at about the ninth century. In 1940's major advances procedure was acknowledged(skin graft). to improve the body structure and early wound healing of patients. The term was subsequently formally adopted in medical nomenclature to describe individuals of all ages with a characteristic common symptom pattern, disease causes, and treatment.
Classification
Burns may be classified according to severity into first, second and third degree burn injury. It may also be classified based on superficial and deep categories into "Superficial Thickness" , "Partial Thickness" of burns.
Pathophysiology
A burn is an injury caused by heat, cold, electricity, chemicals, light, radiation, or friction. Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. Muscle, bone, blood vessel, and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerve endings. Depending on the location affected and the degree of severity, a burn victim may experience a wide number of potentially fatal complications including shock, infection, electrolyte imbalance and respiratory distress. Beyond physical complications, burns can also result in severe psychological and emotional distress due to scarring and deformity
Causes
Burn injury may be caused by chemicals, friction, electricity, radiation, extreme temperatures(hot and cold) and Inhalation injury in burns.
Differentiating (Disease name) from other Conditions
Epidemiology and Demographics
Burn injuries is the most frequently observed form of scald (thermal) injuries, and it typically develops in Children, younger children and younger patients. An estimated 1,344,100 fires Americans of all ages have burn injuries. An estimated patients aged 20 and 30 years are the most prevalent age group . Burn injuries has been known to affect females more than males. people of low and middle income and people in low-income countries are more likely to develop burn injuries than older whites. Pulmonary complications following burns and inhalation injury are responsible for up to 77 percent of the deaths.
Risk Factors
Natural History, Complications and Prognosis
Burns injuries is a common condition that involves complications such as the disability . If left untreated, progresses from early stage of burn to advanced skin scar and contraction. Common complications of burns injuries include infection, bedsores, post-burn seizures, hypertrophic scars and keloids, Respiratory complications, systemic complications. There is a cure for burns injuries and the treatment focuses on the stage of the burn( size and depth) so fluid resuscitation, wound excision, grafting and coverage, infection control and nutritional support can be part of the management of the burn injuries.
Diagnosis
History and Symptoms
Although each patient experiences burn injury in a unique way, there are many common symptoms. The symptoms of burn we can divided it in to two types, skin and airways symptoms.
Physical Examination
Patients with burn injury usually appear as burned(injury) skin . When a doctor or physician has been admitted burned patient, the diagnosis is usually known by physical examination of the patient. Physical examination of burn injury consists of a thorough of thickness and total body surface area of the patient body. Patient may be have burn on his head, neck, arm, leg, Anterior trunk,Posterior trunk, and genitalia.
Laboratory Findings
There are no specific diagnostic laboratory findings associated with burn injury. However, laboratory findings are done to the estimate the severity of the burn and the symptoms. These include CBC analysis like increase WBC for infection and inflammation , RBC decrease due to trauma of the burn, high hematocrit, because of lost a lot of fluid from leaky blood vessels. BUN reflects kidney damage, decrease total Protein, albumin, and globulin values (proteins have been lost through damaged blood vessels).
Electrocardiogram
ECG has minimal diagnostic value in diagnosing burns but plays a role in diagnosing concurrent conduction abnormalities and monitoring side effects of sever and electrical weapons . Electrocardiogram of a patient with acute burn injury may show prolonged QT and sinus tachycardia .Fatal cardiac arrest by electrical weapons .
Chest X Ray
Echocardiography or Ultrasound
Other Imaging Findings
CT scan of the burn may be helpful in the diagnosis of burn injury. Findings include skin thickening, subcutaneous soft tissue, and The deep fascia and underlying muscle layer. Computed tomography (CT) the chest evaluate the lungs for inhalation injury and smoke inhalation
Treatment
Medical Therapy
Surgery
Prevention
Education, engineering, and enforcement are often recommended as both a possible prevention and a sensible way of managing the burn injury. Combination of prevention and care strategies have made progress reducing the incidence of burn injuries and burn severity and lowering rates of burn death and length of hospital stay.