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Management of burn

TAREQ SALAHUDDIN
The arrival of the victim of a burning accident at the emergency department is one of the most dramatic events in the hospitals. In the recent days the number of burn cases are a bit higher because of devastating events during strike and bomb blasts at different public meetings.
The patients immediately need resuscitation and pain relief. For the proper management, burn cases need hospital management. But sometimes it is not possible to transfer the patient immediately to the hospital. This is why we should have the primary knowledge about the management of burn.
Our country lacks of specialised burn hospitals to meet up the demand of the country. We have just one burn unit in the Dhaka Medical College Hospital, Dhaka which is inadequate to meet up the demand.
How burns are caused?
Burns occur when heat from any source -- hot liquids (scalds), hot solids, flames, ultraviolet radiation (sun burn) or radioactivity, electricity and chemicals destroy some or all of the different layers of cells which form the human skin. Respiratory insults resulting from smoke inhalation are also burn injuries. Tissue damage from cold can also occur. Sometimes tissues are damaged in friction burns and it occurs due to combination of heat and abrasion.
Classification of burn depth
They may be classified into four types like First degree burn (Epidermal burn), Second degree burn (Superficial dermal burn), Third degree burn (Sub dermal burn) and Fourth degree burn.
Effects of burn injury
The effects of burn upon the patients include tissue damage, inflammation, infection, compromise of the circulation due to the damage to the vessels, fluid loss and dehydration, multiple organ failure, inhalation injury and many other systemic complications like pain, acute anxiety, local tissue oedema, coma (in the terminal condition).
What determines the severity of burn?
It depends on the depth the heat has penetrated which will depend
on the temperature of the burning agent and the duration of exposure. Also on the surface area of the burn, the body region involved and the age and previous health condition of the patient. Even small burns can be very serious in children. Electric burns are usually very deep burns. Smoke burns can cause severe respiratory insufficiency.
What are the
first aid procedures?
First remove the heat source,
look for associated trauma and remove the non-sticking garments.
Immediate cooling of the part is beneficial and should continue about 30 to 60 minutes. Cool water eases the pain, removes the heat and lowers the temperature of the injured tissue therefore minimising further injury. Then wrap the wound in a clean towel and take the patient to the hospital.
With electrical burns it is important that any live current is switched off, and with chemical burns the first-aid worker must avoid the contact with
the chemical.
How are burns managed? The order of priorities in the management of a major burn injury is -- A: airway maintenance; B: breathing and ventilation; C: circulation; D: disability; E: exposure and environmental control (keep warm); F: fluid resuscitation.
The initial management involves resuscitation for shock, taking care of the fluid balance, relieving pain and preventing infection. Blood grouping and collection of blood for emergency need are very important.
The long term management involves preventing the formation of contractures. Skin grafting involves taking skin from the healthy areas of the body and putting it over the wound. The skin is the best dressing for the wound. It reduces the chances of getting an infection and prevents the formation of contractures.
What are the problems related to burns?
Large burns cause shock because of the loss of body fluids and infection because the protective covering of the skin is lost and the body immunity is lowered. If the burn wound is allowed to heal without intervention then the skin heals with contraction thus forming contractures which can lead to serious deformity and disability if overlying a joint or other vital areas of the body, besides being cosmetically very demoralising for the patient.
How can burns be prevented?
The most important thing regarding burn injuries is that 95 per cent of them are accidental and can be prevented with care and precautions. Public places and factories etc. should install proper fire alarms and firefighting equipment and should be built keeping the fire safety norms in mind. At home extreme care should be taken while working in the kitchen and children should not be allowed to play there.
We have to remember that -l Proper early management of burns is crucial
l A systematic approach to burn management is vital
l Superficial burns heal by regeneration within weeks
l Deep burns require surgery.