A salve is a medical ointment used to soothe the skin .
47-493: Metabolic: protein and lean muscle loss Scarring: keloid/hypertrophic Cardiovascular complications Neuropathy Medical Treatment Antiseptics Analgesics Dressings Wound management Respiratory management Skin grafts: cloned skin, autografts and adjacent tissue grafts Rehabilitation Positioning and splinting Active and passive exercise Resistive and conditioning exercise Aerobic exercise Respiratory management Ambulation A burn
94-469: A burn center survive their injuries. The long-term outcome is related to the size of burn and the age of the person affected. Cave paintings from more than 3,500 years ago document burns and their management. The earliest Egyptian records on treating burns describes dressings prepared with milk from mothers of baby boys, and the 1500 BCE Edwin Smith Papyrus describes treatments using honey and
141-524: 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 Wallace rule of nines , Lund and Browder chart , and estimations based on
188-580: A form of domestic violence , occurs in some cultures, such as India where women have been burned in revenge for what the husband or his family consider an inadequate dowry . In Pakistan, acid burns represent 13% of intentional burns, and are frequently related to domestic violence. Self-immolation (setting oneself on fire) is also used as a form of protest in various parts of the world. At temperatures greater than 44 °C (111 °F), proteins begin losing their three-dimensional shape and start breaking down. This results in cell and tissue damage. Many of
235-493: A guide, with infusions ideally tailored to a urinary output of >30 mL/h in adults or >1mL/kg in children and mean arterial pressure greater than 60 mmHg. While lactated Ringer's solution is often used, there is no evidence that it is superior to normal saline . Crystalloid fluids appear just as good as colloid fluids , and as colloids are more expensive they are not recommended. Blood transfusions are rarely required. They are typically only recommended when
282-670: A hospital, and major burns are managed by a burn center. Severe burn injury represents one of the most devastating forms of trauma. Despite improvements in burn care, patients can be left to suffer for as many as three years post-injury. Historically, about half of all burns were deemed preventable. Burn prevention programs have significantly decreased rates of serious burns. Preventive measures include: limiting hot water temperatures, smoke alarms, sprinkler systems, proper construction of buildings, and fire-resistant clothing. Experts recommend setting water heaters below 48.8 °C (119.8 °F). Other measures to prevent scalds include using
329-538: A lightning strike is about 10%. While electrical injuries primarily result in burns, they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions . In high voltage injuries, most damage may occur internally and thus the extent of the injury cannot be judged by examination of the skin alone. Contact with either low voltage or high voltage may produce cardiac arrhythmias or cardiac arrest . Radiation burns may be caused by protracted exposure to ultraviolet light (such as from
376-411: A person's palm size. The rule of nines is easy to remember but only accurate in people over 16 years of age. More accurate estimates can be made using Lund and Browder charts, which take into account the different proportions of body parts in adults and children. The size of a person's handprint (including the palm and fingers) is approximately 1% of their TBSA. To determine the need for referral to
423-496: 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
470-428: A strong base (55%) or a strong acid (26%). Most chemical burn deaths are secondary to ingestion . Common agents include: sulfuric acid as found in toilet cleaners, sodium hypochlorite as found in bleach, and halogenated hydrocarbons as found in paint remover, among others. Hydrofluoric acid can cause particularly deep burns that may not become symptomatic until some time after exposure. Formic acid may cause
517-449: A thermometer to measure bath water temperatures, and splash guards on stoves. While the effect of the regulation of fireworks is unclear, there is tentative evidence of benefit with recommendations including the limitation of the sale of fireworks to children. 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
SECTION 10
#1732844368306564-516: A variety of external sources classified as thermal (heat-related), chemical, electrical, and radiation. In the United States, the most common causes of burns are: fire or flame (44%), scalds (33%), hot objects (9%), electricity (4%), and chemicals (3%). Most (69%) burn injuries occur at home or at work (9%), and most are accidental, with 2% due to assault by another, and 1–2% resulting from a suicide attempt. These sources can cause inhalation injury to
611-438: Is a particular risk for adolescent males. In the United States, for non-fatal burn injuries to children, white males under the age of 6 comprise most cases. Thermal burns from grabbing/touching and spilling/splashing were the most common type of burn and mechanism, while the bodily areas most impacted were hands and fingers followed by head/neck. Chemical burns can be caused by over 25,000 substances, most of which are either
658-424: Is an injury to skin , or other tissues, caused by heat , cold , electricity , chemicals , friction , or ionizing radiation (such as sunburn , caused by ultraviolet radiation ). Most burns are due to heat from hot liquids (called scalding ), solids, or fire. Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids. In
705-417: Is an uncommon occurrence. In those hospitalized from scalds or fire burns, 3–10% are from assault. Reasons include: child abuse , personal disputes, spousal abuse, elder abuse , and business disputes. An immersion injury or immersion scald may indicate child abuse. It is created when an extremity, or sometimes the buttocks are held under the surface of hot water. It typically produces a sharp upper border and
752-460: Is based on the depth of injury. The depth of a burn is usually determined via examination, although a biopsy may also be used. It may be difficult to accurately determine the depth of a burn on a single examination and repeated examinations over a few days may be necessary. In those who have a headache or are dizzy and have a fire-related burn, carbon monoxide poisoning should be considered. Cyanide poisoning should also be considered. The size of
799-425: Is dedicated to the treatment of injuries. The World Health Organization has developed a classification of injuries in humans by categories including mechanism, objects/substances producing injury, place of occurrence, activity when injured and the role of human intent. In addition to physical harm, injuries can cause psychological harm, including post-traumatic stress disorder . In plants, injuries result from
846-450: 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. As burn wounds are prone to infection, a tetanus booster shot should be given if an individual has not been immunized within the last five years. In the United States, 95% of burns that present to the emergency department are treated and discharged; 5% require hospital admission. With major burns, early feeding
893-603: Is important. Protein intake should also be increased, and trace elements and vitamins are often required. Hyperbaric oxygenation may be useful in addition to traditional treatments. In those with poor tissue perfusion , boluses of isotonic crystalloid solution should be given. In children with more than 10–20% TBSA (Total Body Surface Area) burns, and adults with more than 15% TBSA burns, formal fluid resuscitation and monitoring should follow. This should be begun pre-hospital if possible in those with burns greater than 25% TBSA. The Parkland formula can help determine
940-593: Is not clear how to manage blisters, but it is probably reasonable to leave them intact if small and drain them if large. Full-thickness burns usually require surgical treatments, such as skin grafting . Extensive burns often require large amounts of intravenous fluid , due to capillary fluid leakage and tissue swelling . The most common complications of burns involve infection . Tetanus toxoid should be given if not up to date. In 2015, fire and heat resulted in 67 million injuries. This resulted in about 2.9 million hospitalizations and 176,000 deaths. Among women in much of
987-524: Is often black and frequently leads to loss of the burned part. Burns are generally preventable. Treatment depends on the severity of the burn. Superficial burns may be managed with little more than simple pain medication , while major burns may require prolonged treatment in specialized burn centers . Cooling with tap water may help pain and decrease damage; however, prolonged cooling may result in low body temperature . Partial-thickness burns may require cleaning with soap and water, followed by dressings . It
SECTION 20
#17328443683061034-429: Is often symmetrical, known as "sock burns", "glove burns", or "zebra stripes" - where folds have prevented certain areas from burning. Deliberate cigarette burns most often found on the face, or the back of the hands and feet. Other high-risk signs of potential abuse include: circumferential burns, the absence of splash marks, a burn of uniform depth, and association with other signs of neglect or abuse. Bride burning ,
1081-476: Is sometimes defined as mechanical damage to anatomical structure, but it has a wider connotation of physical damage with any cause, including drowning , burns , and poisoning . Such damage may result from attempted predation , territorial fights, falls, and abiotic factors. Injury prompts an inflammatory response in animals of many different phyla ; this prompts coagulation of the blood or body fluid, followed by wound healing , which may be rapid, as in
1128-489: The cnidaria . Arthropods are able to repair injuries to the cuticle that forms their exoskeleton to some extent. Animals in several phyla, including annelids , arthropods, cnidaria, molluscs , nematodes , and vertebrates are able to produce antimicrobial peptides to fight off infection following an injury. Injury in humans has been studied extensively for its importance in medicine . Much of medical practice, including emergency medicine and pain management ,
1175-728: The hemoglobin level falls below 60-80 g/L (6-8 g/dL) due to the associated risk of complications. Intravenous catheters may be placed through burned skin if needed or intraosseous infusions may be used. Injury Injury is physiological damage to the living tissue of any organism, whether in humans , in other animals , or in plants . Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with blunt objects , by heat or cold, or by venoms and biotoxins . Injury prompts an inflammatory response in many taxa of animals; this prompts wound healing . In both plants and animals, substances are often released to help to occlude
1222-643: The salve of resin. Many other treatments have been used over the ages, including the use of tea leaves by the Chinese documented to 600 BCE, pig fat and vinegar by Hippocrates documented to 400 BCE, and wine and myrrh by Celsus documented to the 1st century CE. French barber-surgeon Ambroise Paré was the first to describe different degrees of burns in the 1500s. Guillaume Dupuytren expanded these degrees into six different severities in 1832. The first hospital to treat burns opened in 1843 in London, England, and
1269-463: The 1970s, researchers demonstrated the significance of the hypermetabolic state that follows large burns. The "Evans formula", described in 1952, was the first burn resuscitation formula based on body weight and surface area (BSA) damaged. The first 24 hours of treatment entails 1ml/kg/% BSA of crystalloids plus 1 ml/kg/% BSA colloids plus 2000ml glucose in water, and in the next 24 hours, crystalloids at 0.5 ml/kg/% BSA, colloids at 0.5 ml/kg/% BSA, and
1316-403: The age of five and, in the United States and Australia, this population makes up about two-thirds of all burns. Contact with hot objects is the cause of about 20–30% of burns in children. Generally, scalds are first- or second-degree burns, but third-degree burns may also result, especially with prolonged contact. Fireworks are a common cause of burns during holiday seasons in many countries. This
1363-440: The airway and/or lungs, occurring in about 6%. Burn injuries occur more commonly among the poor. Smoking and alcoholism are other risk factors. Fire-related burns are generally more common in colder climates. Specific risk factors in the developing world include cooking with open fires or on the floor as well as developmental disabilities in children and chronic diseases in adults. In the United States, fire and hot liquids are
1410-411: The area, with hair loss seen after 3 Gy , redness seen after 10 Gy, wet skin peeling after 20 Gy, and necrosis after 30 Gy. Redness, if it occurs, may not appear until some time after exposure. Radiation burns are treated the same as other burns. Microwave burns occur via thermal heating caused by the microwaves . While exposures as short as two seconds may cause injury, overall this
1457-588: The breakdown of significant numbers of red blood cells . 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 . The most common causes of electrical burns in children are electrical cords (60%) followed by electrical outlets (14%). Lightning may also result in electrical burns. Risk factors for being struck include involvement in outdoor activities such as mountain climbing, golf and field sports, and working outside. Mortality from
Burn - Misplaced Pages Continue
1504-423: The damaged area, by producing antimicrobial chemicals, and in woody plants by regrowing over wounds. Cell injury is a variety of changes of stress that a cell suffers due to external as well as internal environmental changes. Amongst other causes, this can be due to physical, chemical, infectious, biological, nutritional or immunological factors. Cell damage can be reversible or irreversible. Depending on
1551-458: The development of modern burn care began in the late 1800s and early 1900s. During World War I, Henry D. Dakin and Alexis Carrel developed standards for the cleaning and disinfecting of burns and wounds using sodium hypochlorite solutions, which significantly reduced mortality. In the 1940s, the importance of early excision and skin grafting was acknowledged, and around the same time, fluid resuscitation and formulas to guide it were developed. In
1598-480: The direct health effects of a burn are caused by failure of the skin to perform its normal functions, which include: protection from bacteria, skin sensation, body temperature regulation , and prevention of evaporation of the body's water. Disruption of these functions can lead to infection, loss of skin sensation , hypothermia , and hypovolemic shock via dehydration (i.e. water in the body evaporated away). Disruption of cell membranes causes cells to lose potassium to
1645-428: The eating of plant parts by herbivorous animals including insects and mammals , from damage to tissues by plant pathogens such as bacteria and fungi , which may gain entry after herbivore damage or in other ways, and from abiotic factors such as heat, freezing, flooding, lightning, and pollutants such as ozone. Plants respond to injury by signalling that damage has occurred, by secreting materials to seal off
1692-941: The extent of injury, the cellular response may be adaptive and where possible, homeostasis is restored. Cell death occurs when the severity of the injury exceeds the cell's ability to repair itself. Cell death is relative to both the length of exposure to a harmful stimulus and the severity of the damage caused. Salve Magnesium sulphate paste is used as a drawing salve to treat small boils and infected wounds and to remove 'draw' small splinters. Black ointment, or Ichthyol Salve, also called Drawing Salve , has been traditionally used to treat minor skin problems such as sebaceous cysts , boils, ingrown toenails and splinters. The main ingredients are often ichthammol , phenyl alcohol , or Arnica montana , and may contain herbs such as echinacea or calendula . The name comes from archaic belief that an irritant can "draw out" evil humors . (This should not be confused with black salve which
1739-545: The injury extends into some of the underlying skin layer, it is a partial-thickness or second-degree burn . Blisters are frequently present and they are often very painful. Healing can require up to eight weeks and scarring may occur. In a full-thickness or third-degree burn , the injury extends to all layers of the skin. Often there is no pain and the burnt area is stiff. Healing typically does not occur on its own. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle , tendons , or bone . The burn
1786-450: The kidneys and gastrointestinal tract may result in kidney failure and stomach ulcers . Increased levels of catecholamines and cortisol can cause a hypermetabolic state that can last for years. This is associated with increased cardiac output , metabolism , a fast heart rate , and poor immune function . Burns can be classified by depth, mechanism of injury, extent, and associated injuries. The most commonly used classification
1833-404: The most common causes of burns. Of house fires that result in death, smoking causes 25% and heating devices cause 22%. Almost half of injuries are due to efforts to fight a fire. 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, or steam. Scald injuries are most common in children under
1880-529: The mouth or singed hair inside the nose may indicate that burns to the airways have occurred, but these findings are not definitive. More worrisome signs include: shortness of breath , hoarseness, and stridor or wheezing . Itchiness is common during the healing process, occurring in up to 90% of adults and nearly all children. Numbness or tingling may persist for a prolonged period of time after an electrical injury. Burns may also produce emotional and psychological distress. [REDACTED] Burns are caused by
1927-496: The same amount of glucose in water. The characteristics of a burn depend upon its depth. Superficial burns cause pain lasting two or three days, followed by peeling of the skin over the next few days. Individuals with more severe burns may indicate discomfort or complain of feeling pressure rather than pain. Full-thickness burns may be entirely insensitive to light touch or puncture. While superficial burns are typically red in color, severe burns may be pink, white or black. Burns around
Burn - Misplaced Pages Continue
1974-440: The spaces outside the cell and to take up water and sodium. In large burns (over 30% of the total body surface area), there is a significant inflammatory response . This results in increased leakage of fluid from the capillaries , and subsequent tissue edema . This causes overall blood volume loss , with the remaining blood suffering significant plasma loss, making the blood more concentrated. Poor blood flow to organs like
2021-419: The sun, tanning booths or arc welding ) or from ionizing radiation (such as from radiation therapy , X-rays or radioactive fallout ). Sun exposure is the most common cause of radiation burns and the most common cause of superficial burns overall. There is significant variation in how easily people sunburn based on their skin type . Skin effects from ionizing radiation depend on the amount of exposure to
2068-620: 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 administered over the first 8 hours, and the remainder over the following 16 hours. The time is calculated from when the burn occurred, and not from the time that fluid resuscitation began. Children require additional maintenance fluid that includes glucose . Additionally, those with inhalation injuries require more fluid. While inadequate fluid resuscitation may cause problems, over-resuscitation can also be detrimental. The formulas are only
2115-403: The workplace, risks are associated with fire and chemical and electric burns . Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence between people (assault). Burns that affect only the superficial skin layers are known as superficial or first-degree burns . They appear red without blisters, and pain typically lasts around three days. When
2162-511: The world, burns are most commonly related to the use of open cooking fires or unsafe cook stoves . Among men, they are more likely a result of unsafe workplace conditions. Most deaths due to burns occur in the developing world , particularly in Southeast Asia . While large burns can be fatal, treatments developed since 1960 have improved outcomes, especially in children and young adults. In the United States, approximately 96% of those admitted to
2209-424: The wound, limiting loss of fluids and the entry of pathogens such as bacteria. Many organisms secrete antimicrobial chemicals which limit wound infection; in addition, animals have a variety of immune responses for the same purpose. Both plants and animals have regrowth mechanisms which may result in complete or partial healing over the injury. Cells too can repair damage to a certain degree. Injury in animals
#305694