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Paging Dr. Frischer - Burn Injuries
WRITTEN BY :   Dr. Alan Frischer

Each year, a half-million people in the United States seek treatment for this. Of those, approximately 40,000 will be hospitalized and 5,000 to 6,000 will die. A terrible disease? Not exactly; let’s discuss burn injuries.
A burn is the destruction of the different layers of the skin and the structures within the skin, such as sweat glands, oil, glands, and hair follicles. The severity of a burn has traditionally been characterized as first, second, or third degree. This system is being replaced by one reflecting the need for surgical intervention, and burns are now being described as superficial, superficial partial-thickness, deep partial-thickness, or full-thickness. Burns are also categorized by total body surface area. Burns of 10% in children or 15% in adults can be life threatening, due to low blood volume leading to shock.
Burns are caused by a variety of things, including electrical currents, fire, chemicals, steam, and hot liquids. Hot liquids cause the most damage when they enter the body, as opposed to touching the skin. For all burns, children and the elderly are at the highest risk.
A first-degree (superficial) burn involves only the outer layer of skin (the epithelium). There are no blisters, but the skin becomes pink. It may be caused by sunburn, scalding, or a brief exposure to flame (flash flame). It is painful, lasts two to five days, and will typically leave no scar.
A second-degree (partial thickness) burn involves the epithelium and part of the dermis as well. It involves severe pain and swelling, is pink or red in color, and is moist, with oozing blisters. Scalding, flash burns, or chemicals are most often the cause, but even sunburn can cause one. If the second-degree burn is no larger than three inches (7.6 centimeters) in diameter, it can be treated as a minor burn. However, if it is larger, or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, it should be treated it as a major burn, and immediate medical help is needed. It is more painful, may take up to five weeks to heal, and will likely leave a scar.
Minor burns, including first-degree burns and small second-degree burns can be treated at home:
•Cool the burn. Hold the burned area under cool running water for 10 to 15 minutes or until the pain subsides. Cold compresses work as well. Cooling the burn reduces swelling by conducting heat away from the skin. Do not, however, put ice on the wound.
•Cover the burn with a sterile gauze bandage to protect it and to keep air off of the wound. Wrap the gauze loosely to avoid putting pressure on burned skin.
•Take an over-the-counter pain reliever, such as ibuprofen (Advil or Motrin), naproxen (Aleve), acetaminophen (Tylenol), or aspirin.
Some words of caution! Do not use ice directly on the wound: Ice can over-cool the body, and can further damage the burned tissue. Do not apply butter to the wound: It can increase the risk of infection. Do not break any blisters: This can also make the wound more vulnerable to infection, as blisters provide safety while new skin is forming underneath.
Minor burns usually heal without further treatment. There may be pigment changes, meaning that the healed area may be a different color than the surrounding skin. To help lessen this, avoid sun-exposure (or use sunscreen) for the first year. Watch for infection, indicated by increased pain, redness, fever, swelling or oozing. If signs of infection develop, seek medical help.
A third-degree (partial thickness deep) burn involves all layers of the skin and causes permanent tissue damage. The term fourth-degree burn, while not a technical term, is often used to describe full thickness burns that reach muscle and bone. These burns are often lumped into the third-degree category. Causes of third or fourth-degree burns include contact with flames, hot surfaces, hot liquids, chemicals (strong acids and bases, or caustic chemicals like sodium hydroxide, silver nitrate and sulfuric acid), and electric current (contact with a frayed wire, plug or short circuit). There is often little or no pain because the nerves have been destroyed. Small areas may take months to heal, and larger areas require skin grafting. Scarring is always present after healing. If smoke inhalation accompanies the burn, there may be difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects.
For major burns, call 911 for emergency medical help. Until an emergency unit arrives, follow these steps:
•Don’t remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
•Don’t immerse large severe burns in cold water. This could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).
•Elevate the burned area. When possible, raise it above the level of the heart.
•Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.
History gives us a tremendous variety of traditional herbal remedies for minor burns. Aloe Vera has been used therapeutically for 4,000 years, and is still used on minor burns, abrasions and scrapes. Its antibiotic action helps protect against infection. Honey also has a medicinal history dating back thousands of years. Sandalwood paste, yogurt, and lavender oil have all been used to decrease inflammation and promote healing. Vitamin C promotes healing by helping the body produce collagen, which is the base material for new skin. Foods rich in Vitamin C include bell peppers, broccoli, leafy greens, berries, melons, potatoes and citrus fruits.
Most of us have and will experience burns in our lives – be careful out there!

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Published: October 14, 2010 – Volume 9 – Issue 26



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