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Burns Summary

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Definition

A burn is any injury to body tissue that can be caused by:

  • heat
  • steam
  • sunlight
  • electricity
  • nuclear radiaton
  • chemicals

 

History

For centuries people have been trying to understand burns and how to heal them. The Egyptians first recorded a method for burn treatment in 1600 B.C. They used resin and honey salve, rubbing it into the wounds. In 600 BC, the Chinese wrote about tea leaves and tinctures for burns and in 400 BC, Hippocrates wrote of the use of vinegar. Most of these attempts in treating burns have led up to our knowledge of burns today. Even the worst attempts of packing the wounds with excrement and smothering them with lard led to the understanding of the microbiology and pathophysiology of burns. The understanding of the pathophysiology of a burn and infection control have turned the tables on burn victim rate of mortality.

With resuscitation and first aid advancements, burn victims have a lower rate of mortality than at any point in history. That being said, new infectious organisms have lead to new problems in the care of patients with burns. Sepsis has now taken over as the most common cause of death for burn patients. As many as 85% of patients that die from burns die from infection, not the trauma of the burns. With a burn victim, burned and damaged skin is now the perfect place for bacteria to grow and thrive. The body’s immune system has been weakened by the trauma as well. If infection prevention and nutritional support are not carefully managed, sepsis will set in and the patient could die.

Antibiotics and the invention of silver sulfadiazine were milestones in prevention and treatment of sepsis resulting from burns. Unfortunately, with the emergence of antibiotic resistant strains of bacteria there have been new challenges. VRE, MRSA and pseudomonas can prevent a burn wound from healing and may lead to loss of skin grafts and inhibition of wound closures.

Many advancements have been made in bioengineering and cell culturing techniques, which can lead to safer treatment of burn patients. These advancements are making skin grafts more successful than ever before. For example, scientists are growing replacement cells in a lab that are genetically coded from the patient’s own cells. This new breakthrough is allowing for faster, more natural healing, less scarring and a greater return of function for burn patients.

All of this (in addition to the implementation of the staging system) has led to an improved survival rate of burn patients. Skin grafting techniques, dressing materials, and non-pharmacological therapies are improving, but there is still a long way to go, especially in the prevention of the detrimental scarring that occurs after the burns heal.

 

Stages of Burns

Burns are categorized into four stages:

  • Superficial skin burn – previously known as a first degree burn, the injury only affects the outer layer of skin or the epidermis. This type of burn causes pain, redness, and swelling and generally takes 7-10 days to heal.

  • Superficial partial-thickness skin burn – also known as a second degree burn, the damage affects the epidermis and the dermis, the layer below the epidermis. Superficial partial-thickness burns cause pain, redness, swelling and blistering and generally takes three weeks to heal.

  • Deep partial-thickness skin burns – also called third degree burns. There is involvement of  all layers of skin, but not the underlying tissues. This type of burn is very painful, and can be indicated when the burned area will not blanch with pressure. Burns that immediately blister are deep partial-thickness burns. Healing time is usually greater than three weeks and the scarring can be severe and disfiguring.

  • Full-thickness burns – also known as fourth degree burns. There is complete destruction of the skin to its full depth and damage to the underlying tissues. Full-thickness burns cause white or blackened and charred skin that may be numb. The burned area will have no feeling at all. A full-thickness burn cannot heal without surgical treatment.

 

Symptoms and Complications

A burn can easily become infected if the outer layers of skin are lost as bacteria quickly move into the exposed tissue. Burns can cause painful inflammation which is the response of your immune system stepping up to protect the damaged tissues. The immune system’s response to the burn is meant to limit the area of infection and to remove bacteria; however, inflammation can cause additional damage if not treated properly.

Severe burns can cause organ failure in some patients. At the time of a traumatic burn the body may cut off blood supply to vital organs in order to protect the area burned. This is a life-saving response and can help the patient live through the initial trauma. However, 7-14 days after the trauma occurred the patient may suffer multi-organ failure which is a result of the amount of time when the blood supply was interrupted to the vital organs.

Radiation, chemical and electrical burns can affect the inside of the body and therefore should always receive immediate medical attention even if the skin damage looks minor.

 

Treatment

Upon the admission of a burn patient, one of a nurse’s main goals is to monitor a patient’s pulmonary function. In the case of non-chemical burns, patients may exhibit damage to their airway due to smoke inhalation. Airway damage may still be present in chemical burn patients, as inhaled gaseous chemicals can also cause this damage. Some patients may require oxygen therapy or other therapeutic treatment options. In addition, patients may require IV fluids depending on their organ function after admission. Another key role in creating a care plan is pain management; the nurse should monitor a patient’s pain level and administer treatment as required.

Once the patient is stable and out of the acute stage, they must still be monitored constantly. Nurses should also be on the lookout for common signs of infection in and around the wound, as burn wounds are very susceptible to infection. Topical antimicrobial medication may be given to prevent infection. In addition, the wound should be debrided 1-2 times a day and proper dressings should be applied.

Surgical intervention can also be a possible treatment option. The most common procedure is a escharotomy, in which fluid buildup is removed from the site of the burn. If this pressure is not relieved, the wound may become necrotic. In some cases, skin grafts may be applied over the wound to help facilitate recovery.

 

References:

Burns. Retrieved from https://medlineplus.gov/ency/article/000030.htm.

Burns. Retrieved from https://www.nigms.nih.gov/Education/Pages/Factsheet_Burns.aspx.

Coffee, Tammy. (2015). Care of Patients with Burns. Medical-Surgical Nursing: Patient-Centered Collaborative Care. 8th ed.

Lee KC, Joory K, Moiemen NS. (2014). History of burns: The past, present, and the future. Burns Trauma, 2 (4), 169-80. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27574647.