ADVANCED TRENDS IN BURN MANAGEMENT

Abstract

BURN A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. CAUSES Burns are caused by a variety of external sources classified as thermal (heat-related), chemical, electrical, and radiation. The most common causes of burns are: fire or flame (44%), scalds (33%), hot objects (9%), electricity (4%), and chemicals (3%). 1- Thermal Scalding is caused by hot liquids or gases and most commonly occurs from exposure to hot drinks, high temperature tap water in baths or showers, hot cooking oil. 2- Chemical Chemical burns can be caused by over 25,000 substances, most of which are either a strong base (55%) or a strong acid (26%). Most chemical burn deaths are secondary to ingestion. 3- Electrical Electrical burns or injuries are classified as high voltage (greater than or equal to 1000 volts), low voltage (less than 1000 volts), or as flash burns secondary to an electric arc. 4- Radiation Radiation burns may be caused by protracted exposure to ultraviolet light (such as from the sun, tanning booths or arc welding) or from ionizing radiation (such as from radiation therapy, X-rays or radioactive fallout). 5- Non accidental It is created when an extremity or the lower body (buttock or perineum) is held under the surface of hot water. It typically produces a sharp upper border and is often symmetrical. SIZE The size of a burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full thickness burns. First-degree burns that are only red in color and are not blistering are not included in this estimation. Most burns (70%) involve less than 10% of the TBSA. There are a number of methods to determine the TBSA, including the "rule of nines", Lund and Browder charts, and estimations based on a person's palm size SEVERITY In order to determine the need for referral to a specialized burn unit, the American Burn Association devised a classification system. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area affected, the involvement of specific anatomical zones, the age of the person, and associated injuries. Minor burns can typically be managed at home, moderate burns are often managed in hospital, and major burns are managed by a burn center. MANAGEMENT 1- ABC: Resuscitation begins with the assessment and stabilization of the person's airway, breathing and circulation. If inhalation injury is suspected, early intubation may be required. This is followed by care of the burn wound itself. People with extensive burns may be wrapped in clean sheets until they arrive at a hospital. 2- Intravenous fluids Parkland formula can help determine the volume of intravenous fluids required over the first 24 hours. The formula is based on the affected individual's TBSA and weight. Half of the fluid is to be administered over the first 8 hours, and the remainder given over the following 16 hours. 3- Wound care Early cooling (within 30 minutes of the burn) reduces burn depth and pain, but care must be taken as over-cooling can result in hypothermia. It should be performed with cool water 10–25 °C (50.0–77.0 °F) and not ice water as the latter can cause further injury. Chemical burns may require extensive irrigation. Cleaning with soap and water, removal of dead tissue, and application of dressings are important aspects of wound care. It is reasonable to manage first degree burns without dressings. 4- Medications Burns can be very painful and a number of different options may be used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and opioids such as morphine. Benzodiazepines may be used in addition to analgesics to help with anxiety. 5- Surgery Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small full thickness burn) should be dealt with as early as possible. Circumferential burns of the limbs or chest may need urgent surgical release of the skin, known as an escharotomy. This is done to treat or prevent problems with distal circulation, or ventilation. 6- Advanced products for burn care: a. Silver-release products: Silver has been used for centuries to prevent and treat a variety of diseases, most notably infections. b. Skin substitutes: • Temporary skin substitutes: They are used to help heal partial thickness burns or donor sites and close clean excised wounds until skin is available for grafting. The first objective is to close the wound; the second objective is to provide an optimal wound healing environment. • Permanent skin substitutes: One disadvantage of skin substitutes is the absence of active antimicrobial activity. c. Topical negative pressure therapy: Effects of topical negative pressure 1 Enhances dermal perfusion, increasing blood flow