Burns

treatment

Burn location is very important in determining treatment. Burns of the neck or signs of burns to the nose or mouth can require emergent protection of the patient's airway, as swelling can result in life-threatening obstruction of the airway. Burned tissue shrinks and can cause damage to underlying structures. Burns that extend circumferentially around body structures require surgical release of the tissue, often referred to as escharotomy. Escharotomy usually causes some bleeding, but because the burn causing the eschar has destroyed the nerve endings in the skin, there is little pain. Escharotomy is considered a surgical procedure.
All eye burns require special attention as soon as possible. Burns to the eye may lead to clouded or lost vision if tissues, such as the cornea, are injured.
A doctor should examine a burn if it has any of the following characteristics: it is larger than the approximate size of the person's palm; contains blisters; darkens or breaks the skin; involves the face, hand, feet, genitals, or skin folds; is not completely clean; causes pain that is not relieved by acetaminophen (Tylenol®) or ibuprofen (Advil®); or causes pain that does not improve within one day after the burn was sustained.
Burn first aid: To care for a burn victim with a first- or second-degree burn, first remove the burning agent from inflicting further damage. For example, fires are extinguished and smoldering clothing that may be covered with hot tar or soaked with chemicals is immediately removed. Any constricting jewelry, such as rings are removed. It is important to distinguish that all third degree burns and complicated location burns, such as the airway and eyes, need immediate evaluation by a doctor, and burnt clothing and/or burning agents should not be removed without supervision by a healthcare provider.
It is recommended by healthcare professionals not to use butter or oils on a burn. The effected area should be dowsed with cool water as soon as possible. It can be cleansed gently with chlorhexidine (Betadine®) solution. It is recommended by healthcare professionals to not apply ice or cool to near-freezing temperatures; this can cause additional tissue injury.
A tetanus booster will be given if the individual has not had a tetanus shot or booster within the previous five years.
First degree thermal burns can be treated with local skin care such as aloe vera. Many topical antibiotics (such as Neosporin® or Bacitracin®) and antiseptics (such as chlorhexidine (Betadine®) are available over-the-counter (OTC) for minor burns.
Keeping the burned area clean is important because the damaged skin is easily infected. Cleaning may be accomplished by gently running water over the burns periodically. Wounds are cleaned and bandages changed one to three times per day. The burn can be covered with a sterile gauze bandage. The gauze should be wrapped loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain, and protects blistered skin.
Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. It is recommended by healthcare professionals to watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. Seek medical help if infection develops. Avoid re-injuring or tanning if the burns are less than a year old. Tanning may cause more extensive pigmentation changes.
Sunburns: Burns caused by solar radiation may be painful and may also blister. Cool the burn. Individuals may want to put a product designed specifically for sunburn on the area; these products usually contain aloe vera and help cool the area and reduce the pain. Protect the burn by staying out of the sun. If the individual must go in the sun, it is recommended by healthcare professionals to wear a sunscreen with a sun protection factor (SPF) of at least 15 and reapply it frequently. Be sure to cover up any existing sunburn if going outside again. It is best not to apply sunscreen to already burned skin, as irritation may occur.
Severe burns: All third degree thermal burns and complicated location burns, such as the airway and eyes, need immediate evaluation by a doctor. Special topical antiseptic creams, such as silver sulfadiazine (Silvadene®) and mafenide acetate (Sulfamylon®), are used for more serious burns.
For severe burns, healthcare professionals recommend dialing 911 and calling for emergency medical assistance.
If someone is on fire, the following steps are recommended until emergency personnel arrive: tell the person to STOP, DROP, and ROLL. Wrap the person in thick material to smother the flames (a wool or cotton coat, rug, or blanket). Douse the person with water; do not remove burnt clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat; do not immerse severe large burns in cold water. Doing so could cause shock; check for signs of circulation (breathing, coughing, or movement). If there is no breathing or other sign of circulation, begin cardiopulmonary resuscitation (CPR) and cover the burn area with a dry sterile bandage (if available) or clean cloth. A sheet will do if the burned area is large. Do not apply any ointments. Avoid breaking burn blisters.
Pain medications: A doctor may advise individuals with minor or moderate burns to use ibuprofen (Motrin® or Advil®) or acetaminophen (Tylenol®) if the burn is minor and the pain mild. If pain is severe, the doctor may prescribe a narcotic pain reliever, such as acetaminophen with codeine (Tylenol#3®) or hydrocodone (Lortab®). Severe burns are treated with stronger narcotic pain relievers such as morphine (MS Contin®) or meperidine (Demerol®). Side effects of narcotic pain medications include sedation, constipation, and addiction.
Dietary concerns: In severe burns, a proper diet that includes adequate amounts of calories, protein, and nutrients is important for healing. Individuals who cannot consume enough calories may drink nutritional supplements or receive them by way of a tube inserted through the nose into the stomach (a nasogastric or NG tube), or nutrition may be given intravenously (IV, or through the veins), termed hyperalimentation. Oral rehydration therapy may be given to replace lost fluids.
Depression: Because severe burns take a long time to heal, sometimes years, and can cause disfigurement, the person can become depressed. Depression often can be relieved with medications, psychotherapy, or both.
Other treatments: Some doctors may debride blisters (cut away dead tissue). Others may leave them intact. Blisters on the soles of the feet or palms of the hands will usually be left intact. Topical antibiotics (such as Neosporin® or Bacitracin®) and antiseptics (such as chlorhexidine or Betadine®) may be used to decrease the chances of infection.
Severe, life-threatening burns require immediate care. Dehydration is treated with large amounts of fluids given intravenously (IV, or into the veins). An individual who has gone into shock as a result of dehydration is also given oxygen through a face mask.
Burn center: Depending on the severity and extent of the burn, the doctor may advise or request that patient care be continued at a special Burn Center. Burns may affect so many functions and systems of the body that continued rehabilitation is critical.
Many hospitals have a specialized burn unit or center and some facilities are designated solely for the rehabilitation of burn patients. Burn patients need the highly specialized services of medical experts who work together on a multidisciplinary team, including physiatrists, plastic surgeons, internists, orthopedic surgeons, infection disease specialists, rehabilitation nurses who specialize in burn care, pharmacists, psychologists/psychiatrists, physical therapists, occupational therapists, respiratory therapists, dietitians, social workers, case managers, recreation therapists, and vocational counselors.
Burn rehabilitation begins during the acute treatment phase and may last days to months to years, depending on the extent of the burn. Rehabilitation is designed to meet each patient's specific needs; therefore, each program is different. General goals of a burn rehabilitation program include helping the patient return to the highest level of function and making independence possible, while improving the overall quality of life - physically, emotionally, and socially.
In order to help reach these goals, burn rehabilitation programs may include complex wound care, pain management, physical therapy for positioning, splinting, and exercise, occupational therapy for assistance with activities of daily living (ADLs), cosmetic reconstruction, skin grafting, counseling to deal with common emotional responses during rest, such as depression, grieving, anxiety, guilt, and insomnia, patient and family education and counseling, and nutritional counseling. Advances in the understanding and treatment of burns, state-of-the-art burn units and facilities, comprehensive burn rehabilitation services, and integrated medical care have all contributed to the increase in survival rate and recovery of burn patients.
Skin graft: A skin graft may be needed with deep minor or moderate burns or severe burns. Most skin grafts replace the burned skin. Other skin grafts help by temporarily covering and protecting the skin as it heals on its own. In a skin grafting procedure, a piece of healthy skin is taken from an unburned area of the individual's body (autograft), from another living or dead person (allograft), or from another species (xenograft, usually pigs because their skin is most similar to human skin). The skin graft is surgically sewn over the burned area after removing any dead tissue and ensuring that the wound is clean. Autografts are permanent. Allografts and xenografts, however, are rejected after 10-14 days by the individual's immune system. Medications are given to decrease the chances of skin graft rejection. Artificial skin has been developed recently and can also be used to replace the burned skin. Burned skin should be replaced within several days of the burn.
Physical and occupation therapy: Physical and occupation therapy usually are needed to prevent immobility caused by scarring around the joints from a skin graft. Stretching exercises are started within the first few days after the burn. Splints are applied to ensure that joints that are likely to be immobile rest in positions that are least likely to lead to contractures. The splints are left in place except when the joints are moved. If a skin graft has been used, however, therapy is not started for the first five to 10 days after the grafts are attached. This allows for the graft to heal undisturbed. Bulky dressings that put pressure on the burn can prevent large scars from developing.
Electrical burns: An electrical burn may appear minor or not show on the skin surface at all, but the damage can extend deep into the tissues beneath the skin. If a strong electrical current passes through the body, internal damage, such as a heart rhythm disturbance or cardiac arrest, can occur. Sometimes the jolt associated with the electrical burn can cause an individual to be thrown or to fall, resulting in fractures or other associated injuries. Healthcare professionals recommend dialing 911 or calling for emergency medical assistance if the individual who has been burned is in pain, is confused, or is experiencing changes in his or her breathing, heartbeat, or consciousness.
While helping someone with an electrical burn and waiting for medical help, following these steps are recommended by healthcare professionals: do not touch the individual - they may still be in contact with the electrical source passing the current to the one helping; the electricity source should be turned off immediately if possible; move the source away from both injured person and the helper using a non-conducting object made of cardboard, plastic, or wood; check signs of circulation (breathing, coughing, or movement) and, if absent, begin cardiopulmonary resuscitation (CPR) immediately; prevent shock by laying the individual down with the head slightly lower than the trunk and the legs elevated; and cover the affected areas. If the person is breathing, cover any burned areas with a sterile gauze bandage, if available, or a clean cloth. Do not use a blanket or towel. Loose fibers can stick to the burns.
Any significant burn resulting from electricity requires immediate physician evaluation. These burns often result in serious muscle breakdown, electrolyte (including sodium and potassium) abnormalities, and occasionally kidney failure. The actual site of damage can be internal and may not be visible on the skin surface.
Chemical burns: The first step in stopping chemical burns is to remove contaminated clothing and brush away any dry particles. Next, the area is rinsed with large amounts of water. Because chemicals can continue to inflict damage long after first contacting the skin, rinsing should continue for at least 30 minutes. In rare cases involving certain industrial chemicals (for example, metal sodium), water should not be used because it can actually worsen the burn. In addition, some chemicals have specific treatments that can further reduce skin damage.
The treatment for chemical burns is similar to thermal burns except large amounts of water should be used to irrigate the effected region. It is recommended by healthcare professionals not to attempt to neutralize the burn with another chemical, such as putting baking soda on an acid burn. This may cause a chemical reaction that could result in a thermal burn too. If are uncertain, call the local poison control center or go to the local Emergency Room (ER).

integrative therapies

: Depending on the location and extent of injury, burns may be considered a medical emergency and should not be treated without guidance by a healthcare provider. All third degree burns and complicated location burns, such as the airway and eyes, need immediate evaluation by a doctor.
Unclear or conflicting scientific evidence :
Acupuncture: Acupuncture is a technique of inserting and manipulating needles into "acupuncture points" on the body with the aim of restoring health and well-being, e.g. treating pain and diseases. The practice of acupuncture originated in China 5,000 years ago. Today, it is widely used throughout the world and is one of the main pillars of Chinese medicine. Although some studies report beneficial results, there is currently not adequate available evidence to recommend for or against acupuncture in the treatment of pain associated with burns.
Aloe: Aloe (including Aloe vera) gel has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Preliminary evidence suggests that aloe may be effective in promoting healing of mild to moderate skin burns. Further study is needed in this area.
Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. A randomized, controlled clinical trial designed to evaluate immune function of patients suggests that arginine may help with the recovery of immune function and protein function in partial-thickness burn patients. Further research is necessary in this area before a conclusion can be drawn.
Astragalus: Astragalus supplements are derived from the roots of Astragalus membranaceus or related species, which are native to China. Few clinical trials have been investigated in terms of astragalus and burn patients. Limited research suggests that astragalus may have positive effects. Further research is required.
Beta-glucan: Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. Beta-glucan collagen matrix, which combines the carbohydrate beta-glucan with collagen, has been used as a temporary coverage for partial thickness burns with good results. Beta-glucan collagen matrix may help reduce pain, improve healing, and lessen scar appearance. However, further study is needed to confirm these results.
Bromelain: Classified as an herb, bromelain is a sulfur-containing proteolytic digestive enzyme that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus, family Bromeliaceae). A bromelain-derived debriding agent, Debridase, has been studied on deep second degree and third degree burns with positive results. Further results are needed to confirm these results.
Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Although animal studies suggest that danshen may speed healing of burns and wounds, there are no reliable studies in humans evaluating this claim. Danshen may increase bleeding in sensitive individuals, including in those taking blood thinning medications, such as aspirin and warfarin (Coumadin®).
Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis mellifera) from the nectar of flowers. Early evidence suggests that the topical (on the skin) use of honey on burns may reduce burn-healing time. Additional study is needed.
Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. Hydrotherapy is widely used in hospitals and rehabilitation centers in the management of burns. Various techniques are used, with variations in methods, lengths of time, frequency, and training levels of personnel administering treatments. There is limited research at this time, and no clear conclusions can be drawn.
Pantothenic acid (Vitamin B5): Pantothenic acid (Vitamin B5) is essential to all life, and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. Vitamin supplementation is often recommended in individuals who have sustained severe burns, due to loss of nutrients and increased metabolic needs. It is unclear if vitamin B5 has specific beneficial effects in burn healing beyond its usual functions in the body.
Phosphorus: Phosphorus is a mineral found in many foods, such as milk, cheese, dried beans, peas, colas, nuts, and peanut butter. Phosphate is the most common form of phosphorus. In the body, phosphate is the most abundant intracellular negative ion. It is critical for energy storage and metabolism, for the utilization of many B-complex vitamins, to buffer body fluids, for kidney excretion of hydrogen ions, for proper muscle and nerve function, and for maintaining calcium balance. Phosphorus is vital to the formation of bones and teeth, and healthy bones and soft tissues require calcium and phosphorus to grow and develop throughout life. Patients with serious burns may lose phosphate, and replacement may be necessary.
Prayer: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Prayer on behalf of the ill or dying has played a prominent role throughout history and across cultures. Limited research in burn patients reports improved outcomes when prayer is used, although due to methodological problems these results cannot be considered conclusive.
Propolis: Propolis is a natural resin created by bees, used in the construction of hives. Propolis is produced from the buds of conifer and poplar tress, in combination with beeswax and other bee secretions. Preliminary research reports that propolis may have a beneficial effect on the healing of partial thickness burn wounds.
Sea buckthorn: Sea buckthorn (Hippophae rhamnoides) is found throughout Europe and Asia, particularly eastern Europe and central Asia. Sea buckthorn oil is a traditional Chinese medicine (TCM) preparation derived from the fruits of sea buckthorn. In one clinical trial, topical (on the skin) application of sea buckthorn oil reduced pain, swelling, and exudation and increased epithelial cell growth and wound healing. Additional, higher quality studies are needed to confirm these results.
Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Early study results suggest that supplementation with selenium and other trace elements (copper, zinc) may increase the rate of burn wound healing. Additional research is necessary.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Thymus extract is commonly used in conditions where immune function is decreased. Thymus extract may be useful for reducing infections, septicemia, and mortality. However, the evidence is mixed. More clinical trials are required.
Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing, although the usefulness of this approach is only partially confirmed by the clinical data of today. Study results of zinc sulfate supplements given to burn victims to increase healing rate yield mixed results. Further research is needed.
Traditional or theoretical uses lacking sufficient evidence :
Integrative therapies used in burns that have historical or theoretical uses but lack sufficient clinical evidence include: abuta (Cissampelos pareira), adrenal extract, bilberry (Vaccinium myrtillus), bloodroot (Sanguinaria canadensis), burdock (Arctium lappa), calendula (Calendula officinalis), chamomile (Matricaria recutita, Chamaemelum nobile),chondroitin sulfate, colloidal silver, comfrey (Symphytum spp.),devil's club (Oplopanax horridus),DHEA, DMSO (dimethylsulfoxide), Echinacea (E. angustifolia, E. pallida, E. purpurea), emu oil, English ivy (Hedera helix), eucalyptus oil (E. globulus), gotu kola (Centella asiatica), iodine, lavender (Lavandula angustifolia), lutein, marshmallow (Althaea officinalis), massage, MSM (methylsulfonylmethane), noni (Morinda citrifolia), ozone therapy, physical therapy, reiki, slippery elm (Ulmus fulva), St. John's wort (Hypericum perforatum), tea tree oil (Melaleuca alternifolia), and white oak (Quercus alba).

prevention

More than two million Americans suffer from burn injuries each year, and about 70,000 of them require admission to the hospital. Burns are one of the leading causes of accidental injuries in childhood, and the greatest tragedy is that many of these could be prevented.
For prevention, experts recommend: when cooking, keep pot handles turned toward the rear of the stove and never leave the pans unattended; do not leave hot cups of coffee on tables or counter edges; do not carry hot liquids or food near a child or while holding a child; always test food temperatures before serving a child, especially foods or liquids heated in a microwave; keep matches and lighters out of children's reach in a locked cabinet. Use only child-resistant lighters; prevent scalding by keeping the water heater set at 120-125º Fahrenheit; test bath water before putting a child in the bathtub; cover unused electric outlets with safety caps, and replace damaged, frayed or brittle electrical cords. Keep fire extinguishers on every floor of the home, especially in the kitchen - and know how to use them. Do not put water on a grease fire - it can spread the fire. Have a working smoke detector on every floor of the home. Check batteries at least once a year. Know what to do in case clothing catches fire: stop (do not run), drop (to the floor immediately), and roll (cover the face and hands while rolling over to smother the flames).
Healthcare professionals recommend getting immediate medical attention if any of the following symptoms appear related to a burn: fever; pus or foul-smelling drainage; excessive swelling; redness of the skin; a blister filled with greenish or brownish fluid; and a burn that does not heal in 10 days to two weeks.