Types of Burns - Signs and Symptoms

Burns are often categorized as first-, second-, or third-degree burns, depending on how badly the skin is damaged. Each of the injuries above can cause any of these three types of burn. But both the type of burn and its cause will determine how the burn is treated. All burns should be treated quickly to reduce the temperature of the burned area and reduce damage to the skin and underlying tissue (if the burn is severe).

First-degree burns, the mildest of the three, are limited to the top layer of skin:

* Signs and symptoms: These burns produce redness, pain, and minor swelling. The skin is dry without blisters.
* Healing time: Healing time is about 3 to 6 days; the superficial skin layer over the burn may peel off in 1 or 2 days.

Second-degree burns are more serious and involve the skin layers beneath the top layer:

* Signs and symptoms: These burns produce blisters, severe pain, and redness. The blisters sometimes break open and the area is wet looking with a bright pink to cherry red color.
* Healing time: Healing time varies depending on the severity of the burn.

Third-degree burns are the most serious type of burn and involve all the layers of the skin and underlying tissue:

* Signs and symptoms: The surface appears dry and can look waxy white, leathery, brown, or charred. There may be little or no pain or the area may feel numb at first because of nerve damage.
* Healing time: Healing time depends on the severity of the burn. Deep second- and third-degree burns (called full-thickness burns) will likely need to be treated with skin grafts, in which healthy skin is taken from another part of the body and surgically placed over the burn wound to help the area heal.

Treatment of Infected Burns

Amanda van den Broek

Infection is the most common and most serious complication of a major burn injury related to burn size. Sepsis accounts for 50-60% of deaths in burn patients today despite improvements in antimicrobial therapies. Infection is promoted by loss of the epithelial barrier, by malnutrition induced by the hypermetabolic response to burn injury, and by a generalized post-burn immunosuppressant due to release of immuno reactive agents from the burn wound. Burn injury leads to suppression of nearly all aspects of immune response. Post-burn serum levels of immuno globulins, fibronectin, and complement levels are reduced, as well as a diminished ability for opsonization. Chemotaxis, phagocytosis, and killing function of neutrophils, monocytes, and macrophages are impaired. If bacterial counts are 105, wound infection should be suspected and treated with antibiotics.

Therapeutic Antibiotics - Depending on the infection, therapy may continue for several days. Systemic antibiotic treatment for burn wound sepsis is continued for at least 72 hours after evidence of sepsis has resolved. If the wounds appear clean, other sources such as the lungs, the kidney, and peripheral veins should be suspected. In the absence of a confirmed organism or site, antibiotic selection should be based on routine surveillance cultures. Empiric antibiotic choice should also be based on sensitivities of the burn facility's endogenous organisms. Commonly Vancomycin, Imipenem, Timentin or Ceftazidime for coverage against the usual strains of Staph. aureus and Pseudomonas aeruginosa are used. Routine perioperative antibiotics should also take ward-endogenous organisms into account. Post-operative antibiotics are continued until quantitative excisional wound biopsies from surgery are identified.

Currently, a number of topical agents are available to assist in microbial control of the burn wound, including silver sulfadiazine, mefenide acetate, 0.5% silver nitrate, bacitracin/polymyxin B, mupirocin, and Mycostatin. No single agent is totally effective and each has advantages and disadvantages. Almost all agents will affect wound healing and increase metabolic rate.

• Silver sulfadiazine (e.g. Silvadene or SSD) is the most commonly used topical antimicrobial agent in burns. It has a broad spectrum of antimicrobial coverage including gram positive bacteria, most gram negative bacteria, and some yeast forms. Unlike mafenide or silver nitrate, silver sulfadiazine does not hinder epithelialization, although it does hamper contraction of fibroblasts. It is painless on application, has high patient acceptance, and is easy to use with or without dressing.
• Mafenide acetate is one of the oldest effective topical antimicrobial agents. Mafenide has a broad spectrum of antimicrobial activity, including silver sulfadiazine-resistant Pseudomonas and enterococci, but reduced antifungal properties. Mafenide cream is toxic to epithelial cells and fibroblasts. Unlike other topical agents, mafenide has good penetration through the eschar. For this reason mafenide is commonly used on dirty or infected burn wounds, or electrical burns, and on burned ears to prevent chondritis. Mafenide can cause an allergic skin rash. Through carbonic anhydrase inhibition, mafenide can also cause bicarbonate wasting in the kidneys, hyperchloremia, systemic metabolic acidosis and compensatory hyperventilation.
  
• Silver nitrate 0.5% solution is a broad spectrum, non-penetrating, painless antimicrobial agent. It requires multiple daily applications on burn dressings and is messy and staining. The solution is hypotonic; so electrolyte leeching, hyponatremia, and hypokalemia are common side-effects.
  
• Petroleum-based antimicrobial ointments such as bacitracin and/or polymyxin B are clear on application, painless, and allow for easy wound observation. These agents are commonly used for treatment of facial burns, graft sites, healing donor sites, and small partial-thickness burns.
  
• Mupirocin (e.g. Bactroban) has improved activity against gram positive bacteria, especially methillin resistant Staph. aureus (MRSA) and selected enteric bacteria.
  
• In severely burned patients (>40% BSA), the combination of Mycostatin ointment or powder with other topical agents reduces the incidence of fungal superinfection and improves antimicrobial action. Mycostatin should not be combined with mafenide, however, because both become inactivated. In addition, Mycostatin 5-15 ml given orally 3 times daily reduces alimentary fungal overgrowth. This regimen has markedly decreased the incidence of candida septicemia.

Source: http://www.totalburncare.com/orientation_postburn_infection.htm

Alternative Therapies for Burns Treatment

PCL 11 – Betty burns her hand
Amber Hartley

Alternative therapies for treating burns

There are many folk-remedies suggested for treating burns, ranging from honey and oatmeal, to various herbs designed to speed healing. We must, however, look at some studies which test the effectiveness of these alternative therapies in order to determine which may be useful.

One study (Matheson et al., 2001) looked at the effect of an oatmeal paste as a dressing for burns. The focus of the study was assessing oatmeal’s effect on pain rating, itch rating and antihistamine use during burn healing. The subject group consisted of 34 patients, with the control group receiving liquid paraffin dressing, and the test group receiving the liquid paraffin dressing in conjunction with 5% colloidal oatmeal cream. The findings were that the test group reported half as many itch complaints as the control group, and half as many anti-histamine requests.

Another study (Starley et al., 1999), examined the effect of mashed papaya on burn infection rates. In the cohort of 32 subjects, the control group received standard care, while the test group had a papaya paste applied to the burn. The findings were that the burns treated with papaya paste needed less debridement.

A study in 1997 (Patterson, Ptacek, 1997) examined the effect of hypnosis on pain caused by burn injuries. The control group received standard care, while the test group received standard care and hypnosis. The study consisted of 61 subjects, and found that patients with high initial pain ratings experienced decreased pain after undergoing hypnosis, in comparison with the control group.

Two studies conducted by Field et al. (1998, 2000) looked at the effects of massage therapy on the healing of burns. Test groups received massage for 20-30 minutes (twice a week in the 2000 study, once daily for one week in the 1998 study), on top of the treatment received by the control group.
Findings of the 1998 study included decreased salivary cortisol levels and increased positive behaviours in the test group, while findings of the 2000 study show that the those receiving massage therapy had decreased itching of the burn site, decreased pain, and decreased depressed mood.
The subject groups for these studies were 20 patients (2000) and 28 patients (1998).

One study conducted in 2001 by Fratianne et al. examined the effect of music therapy on burn healing. This involved a music therapist improvising song lyrics which referenced patient’s imagery patterns, and deep breathing exercises. The subject group was 25 patients.
The study found that the music therapy decreased pain.

The important thing to note about the above studies is that all have very small subject numbers. This casts doubt on their reliability and indicates that further, more extensive trials are necessary before these treatments can be expanded into mainstream practise.

Aside from those treatments considered formally in trials, as discussed above, a number of other remedies may have some efficacy in treating burns, or are often considered to have some use. These include:
§ Aloe – although this is often recommended, there is no evidence to support this, and some evidence states that it is ineffectual.
§ St. John’s Wort
§ Comfrey root
§ Tea tree oil
§ Nutritional support: vitamins A, C, E, zinc and B-complex, essential fatty acids
§ Traditional Chinese Medicine approach: eat foods that remove heat and toxins, nourish yin, and promote production of body fluids. These foods include mung beans, kidney beans, lima beans, soybeans, cucumber, potatoes, summer squash, sweet potatoes, barley. In addition to this dietary support, fresh ginger, potatoes and cucumbers are considered to reduce pain and swelling if applied directly to the burn.
§ Pulp of fresh pumpkin (used as a poultice)
§ Calendula tincture
§ Raw honey – according to a study in India, raw honey and gauze may be more effective than conventional types of bandages, with results indicating faster healing and lower infection rates
§ Potato peel
§ A herb called ‘gotu kola’, claimed to speed healing and reduce scarring
§ Chamomile
§ Goldenseal


References:
Spencer & Jacobs, (2003). “Complementary and Alternative Medicine: an evidence-based approach.” Mosby Inc. USA.
The Gale Encyclopaedia of Alternative Medicine, (2001) vol 1. “Burns”
Bratman, S. (2007), “Complementary and Alternative Health: the scientific verdict on what really works.” Harper Collins, London.

Preventing Burns

Preventing Burns in the workplace

By Josh

Online Video
Go to youtube and search for The Chef - WSIB Workplace Safety Ad (please not that there is graphic content and most people will find disturbing)

Various states have different organisations or boards for preventing workplace injury.

http://www.workcover.tas.gov.au
http://www.workcover.vic.gov.au

Major Risk Areas for Burns

Synthetics manufacturing is largely a chemical process in which chemicals are mixed and treated to form a wide variety of products. Much of the work is highly repetitive and involves contact with machinery and chemical raw materials which can cause significant injuries and illnesses if they are not handled properly.
Burns occur from exposure to hot materials, electrical sources, steam, machinery, fires or chemical exposure

The Hospitality industry is one of the largest industry’s in Australia and includes chef’s, kitchen hands, waiters and bar attendants. Major causes of burns in this area are from hot liquids including oil, water and some vapours such as steam

The electrical industry consists of electricians, electrical manufacturers and electricity workers. Major causes of burns in this area include burns caused by faulty wiring, contact with live power lines and electrical circuits.

Remember work SAFE
Spot the hazard
Asses the Risk
Fix the problem
Evaluate Results

Lifestyle modifications to reduce risk

As we previously in discussed in PCL, the major contributing factors of Heart Disease include;

High blood pressure (hypertension), High cholesterol levels, Diabetes, Obesity, Smoking, Inactivity, Hereditary, age, gender, alcohol intake, OCP and stress.
Although it is impossible to control some of the contributing factors such as age, gender etc there are many lifestyle modifications suggested in order to minimise the risk of developing heart disease:

Exercise
Regular exercise increases muscular strength including of the heart resulting in the ability to pump more blood around your body with less effort. The risk of a patient who exercises regularly is about half that of a sedentary patient.
Quit Smoking
Smoking speeds up the clogging and narrowing of coronary arteries. Smoking also damages other blood vessels. This can prevent blood circulation, particularly to your hands and feet. Peripheral arterial disease can result in blood clots, infection, gangrene and even amputation. Smokers have a 70 per cent greater risk of death from coronary heart disease than non-smokers.
Keep at a healthy weight or lose weight
Being overweight or obsess increases risk of high blood pressure and cholesterol levels and induces diabetes. All of which are causes of heart disease.
Reduce salt intake
Increases blood pressure
Learn to relax and reduce stress
There is a fair amount of circumstantial evidence that chronic emotional stress can be associated with heart disease and early death.
Reduce alcohol intake and maintain a “healthy” diet- all food groups, minimal amounts of processed and salty foods.

Also a patient may choose to monitor blood pressure, cholesterol and blood sugar levels in order to ensure they remain in a low risk area. The maintenance of desirable readings can be achieved by following the lifestyle modifications discussed above.

Different Symptoms for Men and Women with Heart Disease

Women's hearts are different from men's

Women's hearts are different from men's. This area of study is fairly new, and research is underway to further examine differences in the physiology and pathophysiology of women's hearts. We do know that women have smaller hearts and smaller arteries than men. Researchers from Columbia University and New York Presbyterian Hospital believe that women also have a different intrinsic rhythmicity to the pacemaker of their hearts, which causes them to beat faster. These same researchers believe that it may take a woman's heart longer to relax after each beat. Some surgeons also hypothesize that the fact that women have a 50 % greater chance of dying during heart surgery than men could be related to some fundamental difference in women's the way women's hearts work. These differences may also account for the fact that women are more likely to die after their first heart attack.

Heart attack symptoms different in women

Women are about as likely to have a heart attack as men, but the fact that they are more likely to die after their first heart attack may be because the symptoms of heart attack are different in women. Doctors and patients often attribute chest pains in women to noncardiac causes, leading to misinterpretation of their condition. Men usually experience crushing chest pain during a heart attack. Women may have a greater tendency to have pain just under the breastbone, or complain of abdominal pain, indigestion, difficulty breathing, nausea and unexplained fatigue. Women are therefore easily misdiagnosed of indigestion, gall bladder disease, or an anxiety attack. The likelihood of misdiagnosing a heart attack in women is also increased by the fact that women tend to have heart attacks later in life, when they often have other diseases (such as arthritis or diabetes) that can mask heart attack symptoms.

Significant differences exist between men and women in the clinical presentation of heart attack and in the response to treatment. Women having a heart attack are likely to be older and have a higher incidence of high blood pressure, diabetes, high cholesterol, and congestive heart failure than do men. They are less likely to be smokers. The symptoms of acute heart attack are slightly different in women. Women are more likely to have neck and shoulder pain, abdominal pain, nausea, vomiting, fatigue, and shortness of breath in addition to chest pain. Silent heart attacks are more common in women. Often, because of these atypical symptoms, women seek medical care later than do men.

Even after arrival at the hospital, women may encounter delay in establishing the diagnosis of heart attack. Women are somewhat less likely than men to have the typical EKG findings to diagnose acute heart attack. Women with heart attack are generally more ill than are men. Despite this, women are paradoxically less likely to receive aggressive clot-busting treatments and are more likely to receive it later than do men. Women are also less likely to be admitted to a coronary care unit.

range of cholesterol, BP and Blood sugar levels...

CHOLESTEROL:
For a normal healthy individual cholesterol should be lower than 5.5, and for patients who exhibit risks of heart disease (i.e overweight patients or family history of heart disease) level of cholesterol should be lower than 4.

BLOOD PRESSURE:
The standard blood pressure is 120/80 with a range of +/- 10. Fit people usually have a lower blood pressure. Older people generally have a higher blood pressure because they lose elasticity of the blood vessels.

BLOOD SUGAR LEVELS:
Fasting blood sugar levels for normal healthy people should be lower than 6-7. Generally after eating blood sugar levels are higher.

Reference: Oxford Dictionary of Clinical Medicine

Monica