ACUTE PERIOD TREATMENT
Burn is the damage to the tissues due to thermal traumas, chemical traumas, electric current or freezing. It is classified as first, second, third and rarely fourth degree according to the depth of tissue damage.
First-degree burns are the burns that are limited to the most superficial layer of the skin, characterized by redness of the skin, and with unprotected skin integrity. In second-degree burns, the epidermis (the most superficial layer of the skin) and the dermis are affected.
They are divided into superficial and deep. First and second-degree superficial burns generally heal with wound care, while second-degree and deeper burns require surgical intervention.
In third-degree burns, the skin is completely burned, the layer that allows the skin to rejuvenate itself is destroyed, and pain is not expected because free nerve endings are also burned, the skin may be white or brown.
The age and the general condition of the patient, type of trauma, burn percentage and burn degree are important for the determination of the treatment algorithm and prognosis of burn patients.
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Before Acute Period Treatment
While evaluating the burn patient, the general condition is controlled first. Like every trauma patient, initially the airway patency, breathing and circulation are controlled. Accompanying comorbidities and traumas are examined. Then the type of injury is important.
During Acute Period Treatment
Scald burns that are resulting from the boiling water and tea are the most common ones seen in Turkey. Thermal burns can result from scalds or contact burns. The scald burns are generally 2nd degree burns on the larger face, while contact burns are 3rd degree burns in small percentages. Sunburns are generally first-degree burns and heal completely within a few days.
Flame injuries are generally 3rd degree burns and besides the skin injuries, air way injuries also require detailed treatment. Besides the thermal burns, electrical burns are also very common. Life-threatening situation is higher in high-voltage traumas. Electrical burns generally have an inlet and outlet hole burn.
However, these patients should be followed closely in terms of cardiac and renal functions (heart and kidney). In chemical burns, the information of the substance causing the burn should be provided to the health institution. It is very important to wash the area with plenty of water in case of burns with fluid chemicals.
If the cause of the burn is chemical powder, then the powder material should be shaken off rather than washing it with water, since water may react with this substance and increase the damage. And frostbite is an irreversible tissue damage that is generally observed in the end organs due to long-term exposure to cold. It often results in loss of limb.
In addition to the degree of burn, the percentage of burns is also very important for the evaluation. The “rule of 9s” is the most preferred method without adding the percentage of first degree burns. The burn percentage and weight of the patient are applied in a formula and the fluid therapy to be given to the patient is planned. The approach to burns in children is different from adults and requires experience and care.
The location and shape of the burn area are evaluated. Head and neck burns are prioritized due to future edema and air way problems. Eye examination should not be missed in facial burns. Bracelet-style “circular” burns on the upper and lower extremities may require immediate attention. Preventing the future functional loss in hand burns is at the forefront in the treatment. Hospitalization is recommended for burns of the hand, genital area and face.
Wound care with various creams is sufficient for first degree burns. The burnt area heals completely within 3-5 days. There will be no scar. “Wet dressing” should be applied in second degree superficial burns.
The wound is closed with sterile gauze that is moistened with saline. Leaving the intact skin open accelerates the loss of water from the wound, so disrupts the skin barriers and renders it susceptible to microorganisms. Including the burn, it is not a healthy approach for the open wound to leave the wound open and let it dry. With the right wound care, healing is expected in 2 weeks. Second-degree deep burns are the burns that also affect the deeper layers of the skin.
With wound care (dressing), it takes more than 3 weeks for the upper dead tissue to be removed and the new skin to form from below, this period prepares the way for future burn sequelae. Therefore, grafting after debridement (removal of dead tissue) – in other words, placing the skin taken from the person in this area – is a more accurate treatment in second degree deep burns.
In third-degree burns, it is not possible for the skin to heal itself, since the skin is completely affected. The burned area should be surgically cleaned and grafted as soon as possible.
After Acute Period Treatment
Superficial burns heal quickly. It is very important to protect all burnt areas from the sun for at least 1 year in order to avoid scars. If the burn is deep and a skin graft was taken, redness and itching in the grafted and applied areas may last for 1 year.
If the burn is in a functional area (such as hands, elbows, knees, neck, eyelids), additional surgeries and physical therapy sessions can be planned in the future.