BURNS – CAUSES; SYMPTOMS; TREATMENT
DEFINITION
CAUSES OF BURNS
1) THERMAL:
DRY HEAT: flash, flame, fire, clothes, caching fire
Moist heat: hot liquids, steam ( result in scald)
Cold heat : freezing ( frost bite) ; non freezing
2) ELECTRICAL:
Contact with high voltage electrical current
Usually results in cardiac or respiratory arrest
3) CHEMICAL
Strong acids or base
4) RADIATION
X RAY, electrons, y rays and sunrays.
CLASSIFICATION OF BURNS (degree of burns)
A) ERTHEMA ( redness)
The skin remains intact
Erythema lasts for a few days
Usually associated with sun burns
B) Superficial burns
-It is a 1 degree burn
– It only involves the epidermis and is characterized by erythema and minor microscopic change
– Skin edema is minimal
– Blister can be seen which is surrounded by a dark red erythema
– Pain is the chief symptom which resolves once the healing process begins
– later the damaged epithelium peels off leaving no residual scaring
C) Partial thickness burns
– It is a 2 degree burn
– It involves the epidermis and a little part of dermis layer
– These are formed by blisters, patches of white destroyed tissue and red areas
– the systemic and sensory loss is directly proportional to the amount of dermis which is destroyed
– Tge heel with minimal scaring within 10-15 days unless injected
– this burn is extremely painful due to the irritation of nerve endings in the dermis
D) Full thickness burns:
– It is a 3 degree burn
– The epidermis, dermis and other underlying tissue may be damaged.
– It usually has a tough leathery surface which is brown , tan, black, white or red in color.
-The skin surface becomes anesthetic as the entire thickness of akin along with the pain receptors have been destroyed.
– If pressure is applied over the burn eschar then the surface will not rebound back as the blood vessels have been destroyed and tissue are dead.
– Hair follicles are destroyed and hard, dry, leathery patches are seen called eschar.
– Escharotomy and skin grafting may be necessary.
PATHOLOGICAL CHANGES IN BURNS
.- The microscopic feature of burn wound is mainly coagulation and necrosis.
There are 3 distinct zones.
A) 1st is the zone of coagulation with permanent and no capillary blood flow.
B) 2nd is the zone of stasis, which is characterized by sluggish capillary blood flow. Here there is no coagulation of tissue.
C) 3rd is the zone of hyperemia which shows inflammatory reaction to a non lethal injury.
STAGES OF BURN INJURY
1) STAGE OF SHOCK
– This last for 2-3 days
– It is characterized by:
– increased blood viscosity and slowing of blood circulation.
– reduced plasma volume
– increased blood viscocity and slowing of blood circulation
– reduced cardiac output
– increased heart rate.
2) STAGE OF ESCHAR REMOVAL:
– The burnt skin become tough and leathery
– It gets sepreated in 3-4 weeks
– After a superficial burn the skin is healed
– In case of deeper burns the tissue are exposed and hence require skin grafting.
3)STAGE OF HEALING AND RECONSTRUCTION
– In case of superficial burns the skin heals in few days
– In partial thickness burns epidermis is destroyed and scar tissue is produced. It gets healed in few weeks or may produce keloid formation.
– In full thickness burns healing takes few months by skin grafting and reconstructive surgery.
WALLACE’S RULE OF NINE.
– The surface area of burn injury is estimated by rule of nine.
– It was developed by POLASKI AND TENNISION
-It divides the body into 11 areas each constituting of 9% and perineum 1%.
-It is divided as follows
Head and neck – 9% each
Chest back and front – 9% each
Abdomen: back and front – 9% each
Upper limb: right and left -9% each
Lower limb : right and left – 9% each
Perineum – 1%
NOTE-: THIS RULE DOES NOT APPLY TO CHILDREN BELOW 10 YEARS OF AGE DUE TO LESSER SURFACE AREA.
# INHALATION BURNS
It occurs due to inhalation of
Facial burns
Dry heat
Smoke
Fumes
Hot gases
Co poisoning
Clinical feature
– damage to upper respiratory tract and air passage.
-Laryngeal edema
– pulmonary edema
– tracheal edema
– nasal edema
– acute respiratory distress syndrome
– hypoxia
PHYSIOTHERAPY MANAGEMENT OF BURNS
1) O2 therapy and analgesics:
– O2 is given in fascial masks and ventilators or tracheostomy in severe cases.
– analgesics is administered for pain relief.
2) HUMIDIFICATION
– Moistening of gases or air is essential as the function of upper respiratory tract is damaged
– Thus, humidification helps in maintaining adequate air entry during inhalation
3) INTERMITTENT POSITIVE PRESSURE BREATHING ( IPPB)
-It helps to maintain a positive pressure in the airway throughout inspiration and then returning back to normal atmospheric pressure during expiration.
– Usually bird or Bennett device is used.
4) SUCTIONING
-It is very essential to maintain the lung field to maintain the airway.
– Suctioning is done after 6-8 inflation
5) NEBULIZATION
-Bronchodilators are administered by nebulizer to maintain the airway.
-It has to be given 2-3 times a day in early stages.
6) BREATHING EXERCISE
– It is of almost importance in these patient and must be started within few hours of admission.
7) MOVEMENT OF JAW
– Jaw movements must be initiated with the range of pain to prevent stiffness and loss of function
– Jaw opening closing ,protrusion, retraction are taught to patient.
8) RE-EDUCATION
-Coughing techniques is taught to remove respiratory secretion
– spirometry training
– breathing exercise
– postural drainage
– airway clearance techniques
COMPLICATIONS OF BURNS
a) Infection
– urinary tract infection
– pulmonary tract infection
b) Pulmonary complication
-restrictive lung disease
– pneumonia
c) Metabolic complication
– increase in body temperature
– negative N2 balance
d) CVS complication
– congestive cardiac failure
-cardiac arrhythmias
e) Heterotrophic ossification
– usually seen in full thickness burns
– severe pain with decreased ROM
f) CNS complication
– spinal cord injury
– encephalopathy
g) Musculoskeletal system
– contractures
– decreased ROM
– joint deformity
h) OTHERS:
– renal failure
-liver failure
-septic shock
