Main causes for burn injuries

Main causes for burn injuries


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Each year in the United States more than 3 million people
receive some type of burn. The majorities of burn injuries are minor and
require little or no treatment. Yet, over 10 percent of the victim do require
treatment and some of these, despite advanced medical technology, will die from
burn injuries.

Just watch the evening news or online newspapers/channels for
a week, and you will probably hear of someone being burned by a fire or an
explosion. My purpose in writing this article is to present some basic facts
about injuries caused by heat. By having some knowledge about this type of
injury you hopefully will become more careful. One should know how to assist
someone who wasn’t careful or was simply at the wrong place at the wrong time.

The obvious and most common causes of burn injuries are
fire, hot metal, scalding hot fluids or steam. In the hot summer months
especially near the beach or large bodies of water, the ultraviolet irradiation
from the sun, better known as sunburn, can cause severe skin damage.

Recently, the news media has covered stories about the
concerns expressed by many scientists regarding the change in the chemical
composition of the atmosphere. Some scientists believe this change is caused by
the emission of ozone-destroying chlorofluorocarbons ozone, a chemical that
absorbs ultraviolet radiation from the sun, is thinning. This allows for more
harmful ultraviolet radiation to reach the earth. Since it is believed that the
major cause of skin cancer is the ultraviolet rays of the sun, too much sunburn
over a period of time could kill you.

Mechanical abrasions and electrical current (these two may
cause occult or hidden damage and frequently progress in severity after the
initial injury. Chemicals such as acids and alkalies (alkali burns are usually
more severe than acid burns due to alkali lipid penetration and rapid burn
depth. This is why alkali burns are more likely to result in a full thickness
burn). X-ray irradiation, nuclear radiation, dry heat and severe cold such as
that from liquid nitrogen are also causes of burn injuries.

Burn injuries, especially those caused by an open flame may
be associated with internal injuries not immediately apparent or suspected.
Don’t fall into this trap and ignore what you can’t see. Heat and toxic fumes
can burn and damage the esophagus and lungs. Various synthetics when burned
give off toxic fumes. Many of your local firefighters can verify this from
personal experiences.

An explosion is especially dangerous since it can cause
trauma in addition to burns to organs from the combustion. Along with getting a
standard medical history, ask about immunization. This is important because
someone with extensive burns will need his immunization status against Clostridium
tetani evaluated.

A major factor used to determine the potential for healing
of a burn is its depth. By classifying burns into three degrees of depth, you
can better assess the extent of the injury and probability of recovery.

This involves only the epidermis or outer layer of the skin.
It is usually caused by ultraviolet damage (better known as a sunburn) or brief
thermal contact as from a mild scald.

Clinical findings include erythema or red akin which is
painful. This discomfort is present since the nerve elements in the dermis or
liner below the epidermis are intact. Although quite painful, on many
occasions, it will heal on its own without scarring. A fever or systemic
symptoms are rare unless a large area of the body has been involved.

Usually, no treatment is indicated except some mild
painkillers (in some cases) or various creams to ease the pain. Before taking
any medication, be sure you are not allergic or have a condition that is
contraindicated to the medicine.

This is also known and probably more correctly so as a
partial thickness burn. The epidermis and some of the underlying dermis is
destroyed.

Clinically, the skin is red as in a first-degree burn but
with the addition of blister formation on the epidermis and dermis. There is
also a weeping surface with swelling. Pain is present and can be slightly
decreased depending on the burn’s depth. The burned area can be hypersensitive
to even a light touch.

Someone with a partial thickness burn is very vulnerable to
infection so try to use sterile techniques. Conversion to a full thickness burn
as well as fluid and protein  losses can
occur. Skin texture is normal to the firm.

Cover the entire area with sterile burn pads If not
available, cover with clean dressing, one without a lot of lint that can get
into the burn. If sterile water is available, moisten the dressing. Watch for
shock and respiratory problems and transport the patient to a hospital for
medical care.

Superficial second-degree burns may heal within two weeks
with little scarring. If you were unfortunate to experience a deep partial
burn, then four to six weeks may be needed for healing. Scarring here is likely
to occur. The outcome is generally good provided that there is no infection to
add to complications and your nutrition is adequate. Good nutrition plays an
important role in wound healing. You will have a problem with any healing if
you are in negative nitrogen balance. This means that your body is using more protein
than it is making, a common finding in starvation. Vitamin C and zinc
deficiencies along with chronic corticosteroid therapy are all implicated in
impairing wound healing. Steroids reduce the inflammatory response to an
initial injury which impedes the cleaning of necrotic tissue.

This is known as a full thickness burn, and it is the most
serious of the three.

Clinically, the burn surface has a charred, waxen or
leathery appearance. Depending on the cause of the burn, the skin may appear
white, translucent and dead. The surface is usually dry instead of weeping.
Since the burn is deep, the nerve elements have been destroyed, and there is no
pain. There is also no sensitivity to temperature. Blisters don’t occur.

Care is the same as for second-degree burn injuries, and
transport. This is a true life-threatening emergency. Transportation to a burn
center is highly recommended. By knowing what is available in your area before
an emergency arises, you are better able to pick the best facility.

Since all skin layers have been destroyed in third-degree
burns, there is no chance for regeneration. Grafting is therefore mandatory.

Since skin, the largest body organ, is so important to and
the main structure compromised in a burn, some space should be devoted to this important
structure which performs the following functions:

The outer layer which is made up of stratified squamous
epithelium. It provides protection and does not contain blood vessels or lymphatics.
Its thickness varies depending on the region of the body. It is thickest on the
soles of the feet and palms of the hands

Dermis: This irregularly arranged connective tissue contains
nerves and nerve ending, blood vessels, lymphatics sebum and sweat glands, hair
follicles, and mammary glands.

This layer is not really part of the skin. It contains fibroelastic
tissue and fat. It attaches the skin to the muscles and bones

To quickly help the examiner in estimating and assessing the
extent of the body area involved you should be familiar with the standard “rule
of nines.” This system divides the body’s surface area into anatomic percentage
areas, each of which is 9 percent or a multiple of 9 as 18.

9 percent for face, scalp, and neck; 9 percent for each arm;
18 percent for each leg, anterior (front), front and back or posterior; 18
percent for chest or back; 1 percent reserved for the perineum.

18 percent for the face, scalp, and neck; 14 percent for each leg

Considerations for partial and full thickness burns:

Some of which may be controversial:

1. Medications for pain.

2. IV fluids to replace those lost. In any person with
partial or full thickness burns greater than 20 percent of the body surface area,
IV fluid replacement with isotonic solutions as lactated Ringer’s or normal
saline is necessary.

3. Sterile dressings with topical ointments end/or antibiotics.

4. IV antibiotics for prophylaxis (controversial) and if an
infection is present cultures should be done before antibiotics are started.

5 Tetanus prophylaxis: it is important that you keep your
immunizations updated. You, as well as your doctor,  should have a record and be responsible for
getting immunizations when scheduled.

6. Antacids to prevent Curling’s stress ulcers of the
duodenum.

7. Proper nutrition. More protein and calories oil are needed

8. Surgical grafts and plastic surgery may be required.

9. Debridement of loose dead tissues.

10. Counseling.

The best treatment is prevention. For most, sunburns are the
worst that will ever be experienced. For those unfortunate to experience a
partial or full thickness burn, their lives could be at stake if they are not
treated at a medical facility, preferably one with a recognized burn center. In
burns, you can’t do much to treat. But in the meet of occult injuries, first
aid is important, especially in surveying the victim before transport.

Visit your local fire company or ambulance association and inquire about taking a first aid or EMT course. Learn how to properly assist or treat, and not maim a victim due to ignorance.

This article has been written by James H. Redford MD for Prepper’s Will.

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The best treatment for 1st, 2nd and small 3rd degree burns is to IMMEDIATELY puncture a gel cap of Vitamin E and smear the thick, oily vitamin on the wound. The results are miraculous. Pain vanishes in minutes and the burn heals quickly, often without leaving so much as a blister. I have treated my own burns this way for decades, including severe 2nd degree and small 3rd degree burns I received while welding and touching red-hot steel and touching hot pans, fresh from the oven in a commercial bakery.

For survival situations, keep an aloe vera plant growing as a houseplant. Cut a piece off of a leaf, squeeze the sap out and smear the sap on the burn. The results are just as miraculous as with Vitamin E. The only difference is that the aloe vera is absorbed by the skin and must be reapplied every few minutes. After three or four applications, consider the burn healed. A bottle of Vitamin E gel caps can also be kept with your survival gear and one in your bug-out bag. Don’t mind the expiration date on the bottle. I have used gel caps that had been expired for umpteen years and they still work, fine.

One note: The Vitamin E or aloe must be applied almost IMMEDIATELY. If more than a few minutes go by without applying them to the burn, their efficacy vanishes. The longer you wait to apply them, the less good they will do.

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Main causes for burn injuries

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