How to treat a burn

1. Gastroepato
2. Dermatology
3. How to treat a burn
4. Burns
5. The wounds
6. Management patient with bedsores

Surface burns (first degree)

The news contained in this article are reported only as scientific reading. In case of burns you should always contact your doctor, especially if they are extensive.

Remember that burns are very serious injuries and can leave disfiguring wounds, especially if localized to the face, or burns can become life-threatening.

First-degree burns only involve the epidermis; like sunburn, they appear as erythematous areas, with pain and dryness of the skin. These burns are usually the result of intense exposure to ultraviolet light or mild thermal injury.

First-degree burns usually resolve within 5 to 10 days.

Partial thickness superficial burns (second degree superficial burns)

Second-degree burns involve the entire thickness of the epidermis and part of the underlying dermis. Partial thickness superficial lesions damage the superficial portion of the papillary dermis; the lesions appear with evident vesicles and with a moist, erythematous, exudate skin; when the examiner exerts pressure on the affected area, lesion whitening and pain appear. The lesions heal within 2 weeks and generally do not cause scars; scars and changes in skin pigmentation are possible.

Deep partial-thickness burns (second-degree deep burns)

The second degree deep burns involve the deeper layers of the dermis (ie the reticular dermis). The lesions have a whitish appearance and do not whiten with the pressure exerted from the outside. These burns do not heal before 3 weeks and often result in scars and contractures.

Full-thickness burns (third degree)

Third-degree burns destroy all skin layers, including subcutaneous fat. The lesions have a dark brown complexion, and on palpation they recall the consistency of the leather; tactile sensitivity is lost. Lesions often require skin grafts, and can result in contractures.
4th degree burns
The fourth-degree burns destroy all the skin layers and extend to the muscles, tendons, and underlying bones.

Initial treatment of burns

2nd grade burn

More than 95% of burn injuries can be successfully treated on an outpatient basis. Treatment goals include rapid healing of the lesions, pain control, recovery of normal burn area functions, and good results from an aesthetic point of view.

All burns must be considered traumatic events; therefore, the initial assessment must include primary surveillance interventions; the doctor must make sure that, after inspection of the lesion, the lesion is adequately covered and protected, as the damage to the epidermis can cause thermoregulation problems. In light of the risk of airway edema, and possible inhalation injuries, burns to the face or neck region should always prompt the physician to evaluate the airway, regardless of the size of the burn. The secondary surveillance must instead include a careful examination of the burn area and the assessment of the possibility of malicious events. The doctor must in particular evaluate the size, depth and margins of the burn. This initial assessment is useful for deciding whether to proceed with an outpatient treatment or to hospitalize the patient.

All patients with lesions more severe than a first-degree burn should undergo tetanus vaccination.

The immediate treatment of minor injuries due to thermal causes, by irrigation with cold water, is controversial but is often recommended. Studies conducted on animals have shown that the exposure of the burn area to cold water for 20 minutes reduces the depth of the lesion, facilitates re-epithelialization and improves the outcomes from an aesthetic point of view; studies conducted on humans, on the other hand, are limited, and have shown benefits that would last only one hour. While the administration of cold water is an acceptable treatment, to be carried out at home, the immersion of the damaged area in ice water is not, as it can cause further injury and hypothermia.

At the level of the injury, any material that could cause further damage must be eliminated. The problem of pain control must receive immediate attention from the doctor. Since healing of burns can take weeks, judicious use of narcotic analgesics is recommended.

Adequate analgesia should be obtained before cleaning the lesion or applying bandages. After obtaining pain control, the wound must be cleaned. Deterioration of the lesion with povidone iodine, chlorhexidine or other drugs is not recommended. The removal of debris is usually sufficient to clean the lesion with sterile water. Treatment of vesicles in patients with partial thickness lesions is a controversial topic; There are clear indications that small vesicles (diameter less than 6 mm) must be left intact.

Large vesicles with thin walls should be eliminated; these lesions, in fact, present a high risk of spontaneous rupture, and also from the point of view of the risk of infections it is preferable that the bandage be performed directly on the wound bed. Vesicles that prevent normal joint movements or have a high probability of rupture must also be eliminated. The most appropriate topical treatment of burns has been the subject of many studies and discussions. Burn injuries heal best in wet, but not frankly wet environments, which favor re-epithelialization and prevent cell dehydration.

A humid environment is best achieved by applying a topical agent or with an occlusive bandage, aimed at reducing fluid loss at the level of the lesion. Topical medications gain pain control, promote healing, and prevent infections. the dryness of the lesions. Surface burns can be treated successfully with topical application of lotions, honey, aloe vera, or an antibiotic cream. The lipid component of these treatments accelerates the repair processes of damaged skin and reduces the dryness of the lesion. Although patients with superficial burns do not need medication, evidence shows that topical administration of non-steroidal anti-inflammatory drugs and aloe vera is able to reduce pain.

Topical administration of corticosteroids is not able to reduce the inflammatory reaction; these drugs should therefore not be used in the treatment of superficial burns from heat or sunburn. Partial thickness burns should be treated with topical administration of antimicrobial drugs or with an absorbing occlusive bandage, aimed at reducing pain, facilitating wound healing, preventing dryness of the wound. The standard antimicrobial treatment of partial-thickness burns is represented by topical administration of silver sulfadiazine; the drug is partially contraindicated in patients with allergies to sulphonamides, pregnant or nursing mothers, in newborns.

Numerous small studies have compared some new occlusive bandages with silver sulfadiazine. The new occlusive bandages should be taken into consideration, as an alternative to silver sulfadiazine, as they are associated with faster healing, more pronounced decrease in pain, lower frequency of bandage changes, improvements in patient satisfaction with treatment. Some of the new occlusive bandages have a more favorable risk / benefit ratio than silver sulfadiazine. The patient should be trained in how to change the bandage at home. According to a systematic review, the prophylactic administration of systemic antibiotics, conducted at an intra-hospital level, does not improve mortality rates; this treatment

Long-term treatment

Although it is not frequently associated with burns, cellulite can cause severe erythema, exudation, pain and edema. The cellulite diagnosis can be difficult, because during the healing phase the burn injury appear typically erythematous, edematous, and painful. Infections can present rapid progression; some pathogens frequently identified in burn wounds include Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella and Acinetobacter species. The antibiotic treatment depends on local resistance to drugs, and should cover a wide spectrum of gram-positive and gram-negative bacteria.
Frequent post-burn complications include pruritus and neuropathic pain. anti-histamine drugs such as cetirizine represent the safest drug treatment of post-burn itch. Topical doxepin, tricyclic antidepressant with potent anti-histamine activity, it can reduce the itching and the post-burn erythema.
Patients with burns located above a joint, and in whom a possible functional loss or a limitation of the amplitude of joint movements is hypothesised, should receive, during the healing phase of the lesion, occupational therapy and physiotherapy.

The pain associated with burns often leads to a limitation of the usual activities of the patient, with the consequent stiffness of the joints placed in close proximity to the burn.

Patients with full burns must be referred to a specialist; patients with burns to the hands, feet, perineum, genital areas (as a consequence of the anatomical and functional peculiarities of these areas, patients with circumferential burns (due to the risk of compartmentalization syndrome). burns to the region of the face, as these burns can have significant psychological consequences and cause identity problems.

The intervention of a surgeon or a specialist is indicated in patients with lesions that worsen during the first 72 hours, or which start to cause significant scarring or contractures of any grade.

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