Burns

Introduction to burns

The skin has an important role to play in the fluid and temperature regulation of the body. If enough skin area is injured, the ability to maintain that control can be lost. The skin also acts as a protective barrier against the bacteria and viruses that inhabit the world outside the body.

The anatomy of the skin is complex, and there are many structures within the layers of the skin. There are three layers:

1. Epidermis, the outer layer of the skin
2. Dermis, made up of collagen and elastic fibers and where nerves, blood vessels, sweat glands, and hair follicles reside.
3. Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are located. This is the layer of tissue that is most important in temperature regulation.

The amount of damage that a burn can cause depends upon its location, its depth, and how much body surface area that it involves.

How are burns classified?

Burns are classified based upon their depth.

A first degree burn is superficial and causes local inflammation of the skin. Sunburns often are categorized as first degree burns. The inflammation is characterized by pain, redness, and a mild amount of swelling. The skin may be very tender to touch.

Second degree burns are deeper and in addition to the pain, redness and inflammation, there is also blistering of the skin.

Third degree burns are deeper still, involving all layers of the skin, in effect killing that area of skin. Because the nerves and blood vessels are damaged, third degree burns appear white and leathery and tend to be relatively painless.

Burns are not static and may mature. Over a few hours a first degree burn may involve deeper structures and become second degree. Think of a sunburn that blisters the next day. Similarly, second degree burns may evolve into third degree burns.

Regardless of the type of burn, inflammation and fluid accumulation in and around the wound occur. Moreover, it should be noted that the skin is the body's first defense against infection by microorganisms. A burn is also a break in the skin, and the risk of infection exists both at the site of the injury and potentially throughout the body.

Only the epidermis has the ability to regenerate itself. Burns that extend deeper may cause permanent injury and scarring and not allow the skin in that area to return to normal function.

First Aid

Regardless of the cause, the first step in managing a person with a burn is to stop the burning process at the source, and cool the burn wound (but not the patient. It is essential to avoid the "lethal triad" of hypothermia, acidosis and coagulopathy). For instance, with dry powder burns, the powder should be brushed off first. With other burns the affected area should be rinsed thoroughly with a large amount of clean water. Cold water should not be applied to a person with extensive burns for a prolonged period (greater than 20 minutes), however, as it may result in hypothermia. Do not directly apply ice to a burn wound as it may compound the injury. Iced water, creams, or greasy substances such as butter, shouldn't be applied either