Introduction
Burns are injuries to the skin and underlying tissues caused by heat, chemicals, electricity, radiation, or extreme cold. They can range from minor superficial burns to life-threatening full-thickness burns, depending on the depth and extent of tissue damage.
Incidence
- More common in children and elderly due to
fragile skin.
- Household burns (hot liquids, flames,
electrical appliances) are common.
- Industrial burns (chemicals, electricity)
have high morbidity.
- Thermal burns account for 90% of cases,
followed by chemical and electrical burns.
Definition
A burn is a tissue injury
caused by heat, chemicals, electricity, radiation, or cold, leading to cellular
damage, inflammation, and possible necrosis.
Types of Burns
1. Thermal
Burns
- Caused by direct contact with flames, hot liquids, steam, or hot
objects.
- Example: Fire accidents, scalds from boiling water, steam burns.
2. Chemical
Burns
- Caused by strong acids (Hâ‚‚SOâ‚„, HCl), alkalis (NaOH, KOH), or
organic compounds.
- Example: Industrial accidents, household cleaning agents, battery acid
exposure.
3. Electrical
Burns
- Caused by electric current passing through the body, leading
to internal tissue damage.
- Example: Lightning strikes, electrical wire contact.
4. Radiation
Burns
- Caused by exposure to UV rays, X-rays, or radioactive materials.
- Example: Sunburns, radiation therapy burns.
5. Cold Burns
(Frostbite)
- Caused by prolonged exposure to freezing temperatures,
leading to tissue freezing and necrosis.
- Example: Frostbite in extreme cold climates.
Classification
of Burns (Based on Depth)
1. First-Degree
Burns (Superficial Burns)
- Only affects the epidermis (outer layer).
- Symptoms: Redness, pain, swelling (e.g., Sunburn).
- Healing: Heals within 3-5 days without scarring.
2.
Second-Degree Burns (Partial Thickness Burns)
- Affects both epidermis and part of the dermis.
- Symptoms: Blisters, intense pain, red or white appearance.
- Healing: Takes 1-3 weeks, may leave scars.
3. Third-Degree
Burns (Full Thickness Burns)
- Affects epidermis, dermis, and extends into subcutaneous tissue.
- Symptoms: White, leathery, or charred skin; painless due to nerve damage.
- Healing: Requires skin grafting, long-term recovery.
4.
Fourth-Degree Burns
- Extends beyond skin to muscles, bones, tendons.
- Symptoms: Blackened, necrotic tissue, no sensation.
- Healing: Requires amputation or extensive surgery.
Pathophysiology
of Burns
- Tissue Damage → Heat destroys proteins,
causing cell necrosis.
- Inflammatory Response → Capillary leakage leads
to fluid loss, edema, and shock.
- Systemic Effects (in severe burns):
- Hypovolemic shock (fluid
loss).
- Metabolic acidosis (due to
toxin release).
- Infections & sepsis (loss of
skin barrier).
Clinical
Features (Mnemonic: "BURN")
- B – Blisters (Second-degree burns).
- U – Ulcers & necrosis (Severe burns).
- R – Redness & pain (First-degree burns).
- N – No pain in full-thickness burns (Third-degree).
Laboratory
Investigations
- Complete Blood Count (CBC) – To detect infection.
- Serum Electrolytes – To assess fluid loss (↓
Sodium, ↓ Potassium).
- Arterial Blood Gas (ABG) – To check for metabolic
acidosis.
- Wound Culture – To identify bacterial
infections.
- Carboxyhemoglobin Test – In smoke inhalation
burns.
Management of
Burns
General
Measures (Mnemonic: "STOP BURN")
- S – Stop the burning process (remove the source of burn).
- T – Take off burned clothing carefully.
- O – Oxygen support in case of inhalation injury.
- P – Pain relief (IV opioids, NSAIDs).
- B – Burn dressing (Moist sterile gauze).
- U – Use IV fluids for rehydration.
- R – Remove dead tissue (Debridement).
- N – Nutrition support (high-protein diet for healing).
Allopathic
Treatment (Mnemonic: "FLUIDS")
- F – Fluid resuscitation (Parkland Formula: RL/NS).
- L – Local wound care (Antibiotic creams, dressings).
- U – Urinary catheterization (To monitor output in severe
burns).
- I – Infection control (Tetanus prophylaxis, IV antibiotics).
- D – Debridement (Removal of necrotic tissue).
- S – Skin grafting for deep burns.
Parkland
Formula for Fluid Replacement
- Total Fluid Requirement = 4mL × Body weight (kg) ×
% Burn area
- Half given in first 8 hours, rest over next 16 hours.
Surgical
Management
- Escharotomy – Incision to relieve
pressure from swollen tissue.
- Fasciotomy – Decompression in severe
limb burns.
- Skin Grafting – For full-thickness burns.
Homeopathic
Treatment
- Cantharis
- Best for first- and second-degree burns.
- Severe burning pain with blisters.
- Raw, red, inflamed skin.
- Better with cold applications.
- Used in sunburns, scalds, and chemical burns.
- Urtica Urens
- Burning, itching skin after mild burns.
- Best for sunburns and scalds.
- Stinging pains, worse from warm applications.
- Useful for allergic skin reactions.
- Promotes quick healing of skin.
- Causticum
- Deep burns with slow healing.
- Painful contractures after burns.
- Burns leading to nerve damage.
- Better with warm applications.
- Used in electrical burns and chemical burns.
- Hypericum
- Burns with severe nerve pain.
- Pain extends along nerves.
- Best for burns on fingertips and sensitive areas.
- Tingling and shooting pain in affected areas.
- Prevents infection in burn wounds.
- Calendula
- Promotes rapid healing of burns.
- Prevents secondary infections.
- Best as an external application (Calendula
lotion/gel).
- Reduces pus formation in burns.
- Used for minor burns and superficial injuries.
Mnemonic for
Homeopathic Treatment (C-UCH)
- C – Cantharis (Blisters, raw burning skin).
- U – Urtica Urens (Sunburns, scalds).
- C – Causticum (Deep burns, contractures).
- H – Hypericum (Nerve pain, shooting sensation).
- C – Calendula (Healing, infection prevention).
