Burn

Last updated

Burn
Hand2ndburn.jpg
Second-degree burn of the hand
Specialty Critical care medicine
SymptomsSuperficial: Red without blisters [1]
Partial-thickness: Blisters and pain [1]
Full-thickness: Area stiff and not painful [1]
Complications Infection [2]
DurationDays to weeks [1]
TypesSuperficial, partial-thickness, full-thickness [1]
Causes Heat, cold, electricity, chemicals, friction, radiation [3]
Risk factors Open cooking fires, unsafe cook stoves, smoking, alcoholism, dangerous work environment [4]
TreatmentDepends on the severity [1]
MedicationPain medication, intravenous fluids, tetanus toxoid [1]
Frequency67 million (2015) [5]
Deaths176,000 (2015) [6]

A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. [3] Most burns are due to heat from hot liquids, solids, or fire. [7] While rates are similar for males and females the underlying causes often differ. [4] Among women in some areas, risk is related to use of open cooking fires or unsafe cook stoves. [4] Among men, risk is related to the work environments. [4] Alcoholism and smoking are other risk factors. [4] Burns can also occur as a result of self-harm or violence between people. [4]

Injury Physiological wound caused by an external source

Injury, also known as physical trauma, is damage to the body caused by external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or death.

Skin soft outer covering organ of vertebrates

Skin is the soft outer tissue covering of vertebrates with three main functions: protection, regulation, and sensation.

Heat energy transfer process, or its amount (and direction), that is associated with a temperature difference

In thermodynamics, heat is energy in transfer to or from a thermodynamic system, by mechanisms other than thermodynamic work or transfer of matter. The mechanisms include conduction, through direct contact of immobile bodies, or through a wall or barrier that is impermeable to matter; or radiation between separated bodies; or isochoric mechanical work done by the surroundings on the system of interest; or Joule heating by an electric current driven through the system of interest by an external system; or a combination of these. When there is a suitable path between two systems with different temperatures, heat transfer occurs necessarily, immediately, and spontaneously from the hotter to the colder system. Thermal conduction occurs by the stochastic (random) motion of microscopic particles. In contrast, thermodynamic work is defined by mechanisms that act macroscopically and directly on the system's whole-body state variables; for example, change of the system's volume through a piston's motion with externally measurable force; or change of the system's internal electric polarization through an externally measurable change in electric field. The definition of heat transfer does not require that the process be in any sense smooth. For example, a bolt of lightning may transfer heat to a body.

Contents

Burns that affect only the superficial skin layers are known as superficial or first-degree burns. [1] [8] They appear red without blisters and pain typically lasts around three days. [1] [8] When the injury extends into some of the underlying skin layer, it is a partial-thickness or second-degree burn. [1] Blisters are frequently present and they are often very painful. [1] Healing can require up to eight weeks and scarring may occur. [1] In a full-thickness or third-degree burn, the injury extends to all layers of the skin. [1] Often there is no pain and the burnt area is stiff. [1] Healing typically does not occur on its own. [1] A fourth-degree burn additionally involves injury to deeper tissues, such as muscle, tendons, or bone. [1] The burn is often black and frequently leads to loss of the burned part. [1] [9]

Muscle contractile soft tissue of mammals

Muscle is a soft tissue found in most animals. Muscle cells contain protein filaments of actin and myosin that slide past one another, producing a contraction that changes both the length and the shape of the cell. Muscles function to produce force and motion. They are primarily responsible for maintaining and changing posture, locomotion, as well as movement of internal organs, such as the contraction of the heart and the movement of food through the digestive system via peristalsis.

Tendon type of tissue that connects muscle to bone

A tendon or sinew is a tough band of fibrous connective tissue that connects muscle to bone and is capable of withstanding tension.

Bone rigid organs that constitute part of the endoskeleton of vertebrates

A bone is a rigid organ that constitutes part of the vertebrate skeleton. Bones protect the various organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, and enable mobility. Bones come in a variety of shapes and sizes and have a complex internal and external structure. They are lightweight yet strong and hard, and serve multiple functions.

Burns are generally preventable. [4] Treatment depends on the severity of the burn. [1] Superficial burns may be managed with little more than simple pain medication, while major burns may require prolonged treatment in specialized burn centers. [1] Cooling with tap water may help pain and decrease damage; however, prolonged cooling may result in low body temperature. [1] [8] Partial-thickness burns may require cleaning with soap and water, followed by dressings. [1] It is not clear how to manage blisters, but it is probably reasonable to leave them intact if small and drain them if large. [1] Full-thickness burns usually require surgical treatments, such as skin grafting. [1] Extensive burns often require large amounts of intravenous fluid, due to capillary fluid leakage and tissue swelling. [8] The most common complications of burns involve infection. [2] Tetanus toxoid should be given if not up to date. [1]

A burn center, burn unit or burns unit is a hospital specializing in the treatment of burns. Burn centers are often used for the treatment and recovery of patients with more severe burns.

Hypothermia A human body core temperature below 35.0°C

Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans. Symptoms depend on the temperature. In mild hypothermia there is shivering and mental confusion. In moderate hypothermia shivering stops and confusion increases. In severe hypothermia, there may be paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.

Dressing (medical) sterile pad or compress applied to a wound

A dressing is a sterile pad or compress applied to a wound to promote healing and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a dressing in place. Many modern dressings are self-adhesive.

In 2015, fire and heat resulted in 67 million injuries. [5] This resulted in about 2.9 million hospitalizations and 176,000 deaths. [6] [10] Most deaths due to burns occur in the developing world, particularly in Southeast Asia. [4] While large burns can be fatal, treatments developed since 1960 have improved outcomes, especially in children and young adults. [11] In the United States, approximately 96% of those admitted to a burn center survive their injuries. [12] The long-term outcome is related to the size of burn and the age of the person affected. [1]

Southeast Asia Subregion of Asia

Southeast Asia or Southeastern Asia is a subregion of Asia, consisting of the countries that are geographically south of China and Japan, east of India, west of Papua New Guinea, and north of Australia. Southeast Asia is bordered to the north by East Asia, to the west by South Asia and the Bay of Bengal, to the east by Oceania and the Pacific Ocean, and to the south by Australia and the Indian Ocean. The region is the only part of Asia that lies partly within the Southern Hemisphere, although the majority of it is in the Northern Hemisphere. In contemporary definition, Southeast Asia consists of two geographic regions:

  1. Mainland Southeast Asia, also known historically as Indochina, comprising parts of Northeast India, Vietnam, Laos, Cambodia, Thailand, Myanmar and West Malaysia.
  2. Maritime Southeast Asia, also known historically as Nusantara, the East Indies and Malay Archipelago, comprises the Andaman and Nicobar Islands of India, Indonesia, East Malaysia, Singapore, the Philippines, East Timor, Brunei, Christmas Island, and the Cocos (Keeling) Islands.

Signs and symptoms

The characteristics of a burn depend upon its depth. Superficial burns cause pain lasting two or three days, followed by peeling of the skin over the next few days. [8] [13] Individuals suffering from more severe burns may indicate discomfort or complain of feeling pressure rather than pain. Full-thickness burns may be entirely insensitive to light touch or puncture. [13] While superficial burns are typically red in color, severe burns may be pink, white or black. [13] Burns around the mouth or singed hair inside the nose may indicate that burns to the airways have occurred, but these findings are not definitive. [14] More worrisome signs include: shortness of breath, hoarseness, and stridor or wheezing. [14] Itchiness is common during the healing process, occurring in up to 90% of adults and nearly all children. [15] Numbness or tingling may persist for a prolonged period of time after an electrical injury. [16] Burns may also produce emotional and psychological distress. [17]

Shortness of breath, also known as dyspnea, is the feeling that one cannot breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing the intensity of the distinct sensations, the degree of distress involved, and its burden or impact on activities of daily living. Distinct sensations include effort/work, chest tightness, and air hunger.

Stridor is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is different from a stertor which is a noise originating in the pharynx. Stridor is a physical sign which is caused by a narrowed or obstructed airway. It can be inspiratory, expiratory or biphasic, although it is usually heard during inspiration. Inspiratory stridor often occurs in children with croup. It may be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause. Visualization of the airway by medical experts equipped to control the airway may be needed.

Type [1] Layers involvedAppearanceTextureSensationHealing TimePrognosisExample
Superficial (first-degree) Epidermis [8] Red without blisters [1] Dry Painful [1] 5–10 days [1] [18] Heals well. [1] Repeated sunburns increase the risk of skin cancer later in life. [19] Sunburn.jpg
Superficial partial thickness (second-degree)Extends into superficial (papillary) dermis [1] Redness with clear blister. [1] Blanches with pressure. [1] Moist [1] Very painful [1] 2–3 weeks [1] [13] Local infection (cellulitis) but no scarring typically [13]

Scaldburn.jpg

Deep partial thickness (second-degree)Extends into deep (reticular) dermis [1] Yellow or white. Less blanching. May be blistering. [1] Fairly dry [13] Pressure and discomfort [13] 3–8 weeks [1] Scarring, contractures (may require excision and skin grafting) [13] Major-2nd-degree-burn.jpg
Full thickness (third-degree)Extends through entire dermis [1] Stiff and white/brown. [1] No blanching. [13] Leathery [1] Painless [1] Prolonged (months) and incomplete [1] Scarring, contractures, amputation (early excision recommended) [13] 8-day-old-3rd-degree-burn.jpg
Fourth-degreeExtends through entire skin, and into underlying fat, muscle and bone [1] Black; charred with eschar DryPainlessRequires excision [1] Amputation, significant functional impairment and in some cases, death. [1] Ozhog kist'.jpg

Cause

Burns are caused by a variety of external sources classified as thermal (heat-related), chemical, electrical, and radiation. [20] In the United States, the most common causes of burns are: fire or flame (44%), scalds (33%), hot objects (9%), electricity (4%), and chemicals (3%). [21] Most (69%) burn injuries occur at home or at work (9%), [12] and most are accidental, with 2% due to assault by another, and 1–2% resulting from a suicide attempt. [17] These sources can cause inhalation injury to the airway and/or lungs, occurring in about 6%. [2]

Suicide Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, and substance abuse—including alcoholism and the use of benzodiazepines—are risk factors. Some suicides are impulsive acts due to stress, such as from financial difficulties, relationship problems such as breakups, or bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide—such as firearms, drugs, and poisons; treating mental disorders and substance misuse; careful media reporting about suicide; and improving economic conditions. Even though crisis hotlines are common, there is little evidence for their effectiveness.

Burn injuries occur more commonly among the poor. [17] Smoking and alcoholism are other risk factor. [7] Fire-related burns are generally more common in colder climates. [17] Specific risk factors in the developing world include cooking with open fires or on the floor [3] as well as developmental disabilities in children and chronic diseases in adults. [22]

Thermal

In the United States, fire and hot liquids are the most common causes of burns. [2] Of house fires that result in death, smoking causes 25% and heating devices cause 22%. [3] Almost half of injuries are due to efforts to fight a fire. [3] Scalding is caused by hot liquids or gases and most commonly occurs from exposure to hot drinks, high temperature tap water in baths or showers, hot cooking oil, or steam. [23] Scald injuries are most common in children under the age of five [1] and, in the United States and Australia, this population makes up about two-thirds of all burns. [2] Contact with hot objects is the cause of about 20–30% of burns in children. [2] Generally, scalds are first- or second-degree burns, but third-degree burns may also result, especially with prolonged contact. [24] Fireworks are a common cause of burns during holiday seasons in many countries. [25] This is a particular risk for adolescent males. [26]

Chemical

Chemicals cause from 2 to 11% of all burns and contribute to as many as 30% of burn-related deaths. [27] Chemical burns can be caused by over 25,000 substances, [1] most of which are either a strong base (55%) or a strong acid (26%). [27] Most chemical burn deaths are secondary to ingestion. [1] Common agents include: sulfuric acid as found in toilet cleaners, sodium hypochlorite as found in bleach, and halogenated hydrocarbons as found in paint remover, among others. [1] Hydrofluoric acid can cause particularly deep burns that may not become symptomatic until some time after exposure. [28] Formic acid may cause the breakdown of significant numbers of red blood cells. [14]

Electrical

Electrical burns or injuries are classified as high voltage (greater than or equal to 1000  volts), low voltage (less than 1000  volts), or as flash burns secondary to an electric arc. [1] The most common causes of electrical burns in children are electrical cords (60%) followed by electrical outlets (14%). [2] Lightning may also result in electrical burns. [29] Risk factors for being struck include involvement in outdoor activities such as mountain climbing, golf and field sports, and working outside. [16] Mortality from a lightning strike is about 10%. [16]

While electrical injuries primarily result in burns, they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions. [16] In high voltage injuries, most damage may occur internally and thus the extent of the injury cannot be judged by examination of the skin alone. [16] Contact with either low voltage or high voltage may produce cardiac arrhythmias or cardiac arrest. [16]

Radiation

Radiation burns may be caused by protracted exposure to ultraviolet light (such as from the sun, tanning booths or arc welding) or from ionizing radiation (such as from radiation therapy, X-rays or radioactive fallout). [30] Sun exposure is the most common cause of radiation burns and the most common cause of superficial burns overall. [31] There is significant variation in how easily people sunburn based on their skin type. [32] Skin effects from ionizing radiation depend on the amount of exposure to the area, with hair loss seen after 3  Gy, redness seen after 10 Gy, wet skin peeling after 20 Gy, and necrosis after 30 Gy. [33] Redness, if it occurs, may not appear until some time after exposure. [33] Radiation burns are treated the same as other burns. [33] Microwave burns occur via thermal heating caused by the microwaves. [34] While exposures as short as two seconds may cause injury, overall this is an uncommon occurrence. [34]

Non-accidental

In those hospitalized from scalds or fire burns, 310% are from assault. [35] Reasons include: child abuse, personal disputes, spousal abuse, elder abuse, and business disputes. [35] An immersion injury or immersion scald may indicate child abuse. [24] It is created when an extremity, or sometimes the buttocks are held under the surface of hot water. [24] It typically produces a sharp upper border and is often symmetrical, [24] known as "sock burns", "glove burns", or "zebra stripes" - where folds have prevented certain areas from burning. [36] Deliberate cigarette burns are preferentially found on the face, or the back of the hands and feet. [36] Other high-risk signs of potential abuse include: circumferential burns, the absence of splash marks, a burn of uniform depth, and association with other signs of neglect or abuse. [37]

Bride burning, a form of domestic violence, occurs in some cultures, such as India where women have been burned in revenge for what the husband or his family consider an inadequate dowry. [38] [39] In Pakistan, acid burns represent 13% of intentional burns, and are frequently related to domestic violence. [37] Self-immolation (setting oneself on fire) is also used as a form of protest in various parts of the world. [17]

Pathophysiology

Three degrees of burns Burn Degree Diagram.svg
Three degrees of burns

At temperatures greater than 44 °C (111 °F), proteins begin losing their three-dimensional shape and start breaking down. [40] This results in cell and tissue damage. [1] Many of the direct health effects of a burn are secondary to disruption in the normal functioning of the skin. [1] They include disruption of the skin's sensation, ability to prevent water loss through evaporation, and ability to control body temperature. [1] Disruption of cell membranes causes cells to lose potassium to the spaces outside the cell and to take up water and sodium. [1]

In large burns (over 30% of the total body surface area), there is a significant inflammatory response. [41] This results in increased leakage of fluid from the capillaries, [14] and subsequent tissue edema. [1] This causes overall blood volume loss, with the remaining blood suffering significant plasma loss, making the blood more concentrated. [1] Poor blood flow to organs such as the kidneys and gastrointestinal tract may result in renal failure and stomach ulcers. [42]

Increased levels of catecholamines and cortisol can cause a hypermetabolic state that can last for years. [41] This is associated with increased cardiac output, metabolism, a fast heart rate, and poor immune function. [41]

Diagnosis

Burns can be classified by depth, mechanism of injury, extent, and associated injuries. The most commonly used classification is based on the depth of injury. The depth of a burn is usually determined via examination, although a biopsy may also be used. [1] It may be difficult to accurately determine the depth of a burn on a single examination and repeated examinations over a few days may be necessary. [14] In those who have a headache or are dizzy and have a fire-related burn, carbon monoxide poisoning should be considered. [43] Cyanide poisoning should also be considered. [14]

Size

Burn severity is determined through, among other things, the size of the skin affected. The image shows the makeup of different body parts, to help assess burn size. 513 Degree of burns.jpg
Burn severity is determined through, among other things, the size of the skin affected. The image shows the makeup of different body parts, to help assess burn size.

The size of a burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full thickness burns. [1] First-degree burns that are only red in color and are not blistering are not included in this estimation. [1] Most burns (70%) involve less than 10% of the TBSA. [2]

There are a number of methods to determine the TBSA, including the Wallace rule of nines, Lund and Browder chart, and estimations based on a person's palm size. [8] The rule of nines is easy to remember but only accurate in people over 16 years of age. [8] More accurate estimates can be made using Lund and Browder charts, which take into account the different proportions of body parts in adults and children. [8] The size of a person's handprint (including the palm and fingers) is approximately 1% of their TBSA. [8]

Severity

American Burn Association severity classification [43]
MinorModerateMajor
Adult <10% TBSAAdult 10–20% TBSAAdult >20% TBSA
Young or old < 5% TBSAYoung or old 5–10% TBSAYoung or old >10% TBSA
<2% full thickness burn2–5% full thickness burn>5% full thickness burn
High voltage injuryHigh voltage burn
Possible inhalation injuryKnown inhalation injury
Circumferential burnSignificant burn to face, joints, hands or feet
Other health problemsAssociated injuries

To determine the need for referral to a specialized burn unit, the American Burn Association devised a classification system. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area affected, the involvement of specific anatomical zones, the age of the person, and associated injuries. [43] Minor burns can typically be managed at home, moderate burns are often managed in hospital, and major burns are managed by a burn center. [43]

Prevention

Historically, about half of all burns were deemed preventable. [3] Burn prevention programs have significantly decreased rates of serious burns. [40] Preventive measures include: limiting hot water temperatures, smoke alarms, sprinkler systems, proper construction of buildings, and fire-resistant clothing. [3] Experts recommend setting water heaters below 48.8 °C (119.8 °F). [2] Other measures to prevent scalds include using a thermometer to measure bath water temperatures, and splash guards on stoves. [40] While the effect of the regulation of fireworks is unclear, there is tentative evidence of benefit [44] with recommendations including the limitation of the sale of fireworks to children. [2]

Management

Resuscitation begins with the assessment and stabilization of the person's airway, breathing and circulation. [8] If inhalation injury is suspected, early intubation may be required. [14] This is followed by care of the burn wound itself. People with extensive burns may be wrapped in clean sheets until they arrive at a hospital. [14] As burn wounds are prone to infection, a tetanus booster shot should be given if an individual has not been immunized within the last five years. [45] In the United States, 95% of burns that present to the emergency department are treated and discharged; 5% require hospital admission. [17] With major burns, early feeding is important. [41] Protein intake should also be increased, and trace elements and vitamins are often required. [46] Hyperbaric oxygenation may be useful in addition to traditional treatments. [47]

Intravenous fluids

In those with poor tissue perfusion, boluses of isotonic crystalloid solution should be given. [8] In children with more than 10–20% TBSA burns, and adults with more than 15% TBSA burns, formal fluid resuscitation and monitoring should follow. [8] [48] [49] This should be begun pre-hospital if possible in those with burns greater than 25% TBSA. [48] The Parkland formula can help determine the volume of intravenous fluids required over the first 24 hours. The formula is based on the affected individual's TBSA and weight. Half of the fluid is administered over the first 8 hours, and the remainder over the following 16 hours. The time is calculated from when the burn occurred, and not from the time that fluid resuscitation began. Children require additional maintenance fluid that includes glucose. [14] Additionally, those with inhalation injuries require more fluid. [50] While inadequate fluid resuscitation may cause problems, over-resuscitation can also be detrimental. [51] The formulas are only a guide, with infusions ideally tailored to a urinary output of >30 mL/h in adults or >1mL/kg in children and mean arterial pressure greater than 60 mmHg. [14]

While lactated Ringer's solution is often used, there is no evidence that it is superior to normal saline. [8] Crystalloid fluids appear just as good as colloid fluids, and as colloids are more expensive they are not recommended. [52] [53] Blood transfusions are rarely required. [1] They are typically only recommended when the hemoglobin level falls below 60-80 g/L (6-8 g/dL) [54] due to the associated risk of complications. [14] Intravenous catheters may be placed through burned skin if needed or intraosseous infusions may be used. [14]

Wound care

Early cooling (within 30 minutes of the burn) reduces burn depth and pain, but care must be taken as over-cooling can result in hypothermia. [1] [8] It should be performed with cool water 10–25 °C (50.0–77.0 °F) and not ice water as the latter can cause further injury. [8] [40] Chemical burns may require extensive irrigation. [1] Cleaning with soap and water, removal of dead tissue, and application of dressings are important aspects of wound care. If intact blisters are present, it is not clear what should be done with them. Some tentative evidence supports leaving them intact. Second-degree burns should be re-evaluated after two days. [40]

In the management of first and second-degree burns, little quality evidence exists to determine which dressing type to use. [55] It is reasonable to manage first-degree burns without dressings. [40] While topical antibiotics are often recommended, there is little evidence to support their use. [56] Silver sulfadiazine (a type of antibiotic) is not recommended as it potentially prolongs healing time. [57] There is insufficient evidence to support the use of dressings containing silver [58] or negative-pressure wound therapy. [59] Silver sulfadiazine does not appear to differ from silver containing foam dressings with respect to healing. [60]

Medications

Burns can be very painful and a number of different options may be used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and opioids such as morphine.Benzodiazepines may be used in addition to analgesics to help with anxiety. [40] During the healing process, antihistamines, massage, or transcutaneous nerve stimulation may be used to aid with itching. [15] Antihistamines, however, are only effective for this purpose in 20% of people. [61] There is tentative evidence supporting the use of gabapentin [15] and its use may be reasonable in those who do not improve with antihistamines. [62] Intravenous lidocaine requires more study before it can be recommended for pain. [63]

Intravenous antibiotics are recommended before surgery for those with extensive burns (>60% TBSA). [64] As of 2008, guidelines do not recommend their general use due to concerns regarding antibiotic resistance [56] and the increased risk of fungal infections. [14] Tentative evidence, however, shows that they may improve survival rates in those with large and severe burns. [56] Erythropoietin has not been found effective to prevent or treat anemia in burn cases. [14] In burns caused by hydrofluoric acid, calcium gluconate is a specific antidote and may be used intravenously and/or topically. [28] Recombinant human growth hormone (rhGH) in those with burns that involve more than 40% of their body appears to speed healing without affecting the risk of death. [65] The use of steroids is of unclear evidence. [66]

Surgery

Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small full thickness burn) should be dealt with as early as possible. [67] Circumferential burns of the limbs or chest may need urgent surgical release of the skin, known as an escharotomy. [68] This is done to treat or prevent problems with distal circulation, or ventilation. [68] It is uncertain if it is useful for neck or digit burns. [68] Fasciotomies may be required for electrical burns. [68]

Skin grafts can involve temporary skin substitute, derived from animal (human donor or pig) skin or synthesized. They are used to cover the wound as a dressing, preventing infection and fluid loss, but will eventually need to be removed. Alternatively, human skin can be treated to be left on permanently without rejection. [69]

Alternative medicine

Honey has been used since ancient times to aid wound healing and may be beneficial in first- and second-degree burns. [70] There is tentative evidence that honey helps heal partial thickness burns. [71] The evidence for aloe vera is of poor quality. [72] While it might be beneficial in reducing pain, [18] and a review from 2007 found tentative evidence of improved healing times, [73] a subsequent review from 2012 did not find improved healing over silver sulfadiazine. [72] There were only three randomized controlled trials for the use of plants for burns, two for aloe vera and one for oatmeal. [74]

There is little evidence that vitamin E helps with keloids or scarring. [75] Butter is not recommended. [76] In low income countries, burns are treated up to one-third of the time with traditional medicine, which may include applications of eggs, mud, leaves or cow dung. [22] Surgical management is limited in some cases due to insufficient financial resources and availability. [22] There are a number of other methods that may be used in addition to medications to reduce procedural pain and anxiety including: virtual reality therapy, hypnosis, and behavioral approaches such as distraction techniques. [62]

Prognosis

Prognosis in the USA [77]
TBSAMortality
0–9%0.6%
10–19%2.9%
20–29%8.6%
30–39%16%
40–49%25%
50–59%37%
60–69%43%
70–79%57%
80–89%73%
90–100%85%
Inhalation23%

The prognosis is worse in those with larger burns, those who are older, and those who are females. [1] The presence of a smoke inhalation injury, other significant injuries such as long bone fractures, and serious co-morbidities (e.g. heart disease, diabetes, psychiatric illness, and suicidal intent) also influence prognosis. [1] On average, of those admitted to United States burn centers, 4% die, [2] with the outcome for individuals dependent on the extent of the burn injury. For example, admittees with burn areas less than 10% TBSA had a mortality rate of less than 1%, while admittees with over 90% TBSA had a mortality rate of 85%. [77] In Afghanistan, people with more than 60% TBSA burns rarely survive. [2] The Baux score has historically been used to determine prognosis of major burns. However, with improved care, it is no longer very accurate. [14] The score is determined by adding the size of the burn (% TBSA) to the age of the person, and taking that to be more or less equal to the risk of death. [14] Burns in 2013 resulted in 1.2 million years lived with disability and 12.3 million disability adjusted life years. [10]

Complications

A number of complications may occur, with infections being the most common. [2] In order of frequency, potential complications include: pneumonia, cellulitis, urinary tract infections and respiratory failure. [2] Risk factors for infection include: burns of more than 30% TBSA, full-thickness burns, extremes of age (young or old), or burns involving the legs or perineum. [78] Pneumonia occurs particularly commonly in those with inhalation injuries. [14]

Anemia secondary to full thickness burns of greater than 10% TBSA is common. [8] Electrical burns may lead to compartment syndrome or rhabdomyolysis due to muscle breakdown. [14] Blood clotting in the veins of the legs is estimated to occur in 6 to 25% of people. [14] The hypermetabolic state that may persist for years after a major burn can result in a decrease in bone density and a loss of muscle mass. [41] Keloids may form subsequent to a burn, particularly in those who are young and dark skinned. [75] Following a burn, children may have significant psychological trauma and experience post-traumatic stress disorder. [79] Scarring may also result in a disturbance in body image. [79] In the developing world, significant burns may result in social isolation, extreme poverty and child abandonment. [17]

Epidemiology

Disability-adjusted life years for fires per 100,000 inhabitants in 2004.
no data
< 50
50-100
100-150
150-200
200-250
250-300
300-350
350-400
400-450
450-500
500-600
> 600 Fires world map - DALY - WHO2004.svg
Disability-adjusted life years for fires per 100,000 inhabitants in 2004.

In 2015 fire and heat resulted in 67 million injuries. [5] This resulted in about 2.9 million hospitalizations and 238,000 dying. [10] This is down from 300,000 deaths in 1990. [81] This makes it the fourth leading cause of injuries after motor vehicle collisions, falls, and violence. [17] About 90% of burns occur in the developing world. [17] This has been attributed partly to overcrowding and an unsafe cooking situation. [17] Overall, nearly 60% of fatal burns occur in Southeast Asia with a rate of 11.6 per 100,000. [2] The number of fatal burns has changed from 280,000 in 1990 to 176,000 in 2015. [82] [6]

In the developed world, adult males have twice the mortality as females from burns. This is most probably due to their higher risk occupations and greater risk-taking activities. In many countries in the developing world, however, females have twice the risk of males. This is often related to accidents in the kitchen or domestic violence. [17] In children, deaths from burns occur at more than ten times the rate in the developing than the developed world. [17] Overall, in children it is one of the top fifteen leading causes of death. [3] From the 1980s to 2004, many countries have seen both a decrease in the rates of fatal burns and in burns generally. [17]

Developed countries

An estimated 500,000 burn injuries receive medical treatment yearly in the United States. [40] They resulted in about 3,300 deaths in 2008. [3] Most burns (70%) and deaths from burns occur in males. [1] [12] The highest incidence of fire burns occurs in those 1835 years old, while the highest incidence of scalds occurs in children less than five years old and adults over 65. [1] Electrical burns result in about 1,000 deaths per year. [83] Lightning results in the death of about 60 people a year. [16] In Europe, intentional burns occur most commonly in middle aged men. [35]

Developing countries

In India, about 700,000 to 800,000 people per year sustain significant burns, though very few are looked after in specialist burn units. [84] The highest rates occur in women 16–35 years of age. [84] Part of this high rate is related to unsafe kitchens and loose-fitting clothing typical to India. [84] It is estimated that one-third of all burns in India are due to clothing catching fire from open flames. [85] Intentional burns are also a common cause and occur at high rates in young women, secondary to domestic violence and self-harm. [17] [35]

History

Guillaume Dupuytren (1777-1835) who developed the degree classification of burns Guillaume Dupuytren.jpg
Guillaume Dupuytren (1777–1835) who developed the degree classification of burns

Cave paintings from more than 3,500 years ago document burns and their management. [11] The earliest Egyptian records on treating burns describes dressings prepared with milk from mothers of baby boys, [86] and the 1500 BCE Edwin Smith Papyrus describes treatments using honey and the salve of resin. [11] Many other treatments have been used over the ages, including the use of tea leaves by the Chinese documented to 600 BCE, pig fat and vinegar by Hippocrates documented to 400 BCE, and wine and myrrh by Celsus documented to 100 CE. [11] French barber-surgeon Ambroise Paré was the first to describe different degrees of burns in the 1500s. [87] Guillaume Dupuytren expanded these degrees into six different severities in 1832. [11] [88]

The first hospital to treat burns opened in 1843 in London, England and the development of modern burn care began in the late 1800s and early 1900s. [11] [87] During World War I, Henry D. Dakin and Alexis Carrel developed standards for the cleaning and disinfecting of burns and wounds using sodium hypochlorite solutions, which significantly reduced mortality. [11] In the 1940s, the importance of early excision and skin grafting was acknowledged, and around the same time, fluid resuscitation and formulas to guide it were developed. [11] In the 1970s, researchers demonstrated the significance of the hypermetabolic state that follows large burns. [11]

Related Research Articles

Acupuncture stimulation of points on skin

Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience because the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery. There is a range of acupuncture variants which originated in different philosophies, and techniques vary depending on the country in which it is performed. It is most often used to attempt pain relief, though it is also recommended by acupuncturists for a wide range of other conditions. Acupuncture is generally used only in combination with other forms of treatment.

Urinary tract infection human and animal infection

A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis). Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. Symptoms of a kidney infection include fever and flank pain usually in addition to the symptoms of a lower UTI. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific.

Pneumonia Infection of the lungs

Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.

Skin cancer class of skin illnesses, tumor or cancer of the skin

Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin, that may be shiny with small blood vessels running over it or may present as a raised area with an ulcer. Squamous-cell skin cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.

Common cold common viral infection of upper respiratory tract

The common cold, also known simply as a cold, is a viral infectious disease of the upper respiratory tract that primarily affects the nose. The throat, sinuses, and larynx may also be affected. Signs and symptoms may appear less than two days after exposure to the virus. These may include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days, but some symptoms may last up to three weeks. Occasionally those with other health problems may develop pneumonia.

Back pain type of pain felt in the back

Back pain, also known as backache, is pain felt in the back. The back is divided into neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia based on the segment affected. The lumbar area is the most common area affected. Episodes of back pain may be acute, sub-acute, or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain, or a burning sensation. Discomfort can radiate into the arms and hands as well as the legs or feet, and may include numbness, or weakness in the legs and arms.

Otitis media otitis which involves inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. The two main types are acute otitis media (AOM) and otitis media with effusion (OME). AOM is an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. OME is typically not associated with symptoms. Occasionally a feeling of fullness is described. It is defined as the presence of non-infectious fluid in the middle ear for more than three months. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in discharge from the ear for more than three months. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. The hearing loss in OME, due to its chronic nature, may affect a child's ability to learn.

Preterm birth birth at less than a specified gestational age

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks' gestational age, as opposed to the usual about 40 weeks. These babies are known as preemies or premies. Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes or the leaking of fluid from the vagina. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and sight problems. These risks are greater the earlier a baby is born.

Acute respiratory distress syndrome Human disease

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. Among those who survive, a decreased quality of life is relatively common.

Cellulitis Human disease

Cellulitis is a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

Skin grafting

Skin grafting is a type of graft surgery involving the transplantation of skin. The transplanted tissue is called a skin graft.

Major trauma injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

Gastroenteritis Inflammation of the stomach and small intestine

Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of energy and dehydration may also occur. This typically lasts less than two weeks. It is not related to influenza, though it has erroneously been called the "stomach flu".

Postherpetic neuralgia (PHN) is neuropathic pain which occurs due to damage to a peripheral nerve caused by the reactivation of the varicella zoster virus. Typically, the nerve pain (neuralgia) is confined to an area of skin innervated by a single sensory nerve, which is known as a dermatome. PHN is defined as dermatomal nerve pain that persists for more than 90 days after an outbreak of herpes zoster affecting the same dermatome. Several types of pain may occur with PHN including continuous burning pain, episodes of severe shooting or electric-like pain, and a heightened sensitivity to gentle touch which would not otherwise cause pain or to painful stimuli (hyperalgesia). Abnormal sensations and itching may also occur.

Silver sulfadiazine chemical compound

Silver sulfadiazine, sold under the brand Silvadene among others, is a topical antibiotic used in partial thickness and full thickness burns to prevent infection. Tentative evidence has found other antibiotics to be more effective and therefore it is no longer generally recommended.

Venous ulcer

Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are the major occurrence of chronic wounds, occurring in 70% to 90% of leg ulcer cases. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.

Penetrating trauma type of injury

Penetrating trauma is an injury that occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out the way it entered, or pass through the tissues and exit from another area. An injury in which an object enters the body or a structure and passes all the way through is called a perforating injury, while penetrating trauma implies that the object does not pass through. Perforating trauma is associated with an entrance wound and an often larger exit wound.

Intraventricular hemorrhage

Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from physical trauma or from hemorrhaging in stroke.

Meningitis inflammation of membranes around the brain and spinal cord

Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Young children often exhibit only nonspecific symptoms, such as irritability, drowsiness, or poor feeding. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash.

A pediatric burn is an injury to the skin or underlying tissue in person under the age of 18, and is globally the most common type of pediatric injury. Burns can be caused my heat, cold, chemical or irritation. Most burns do not require hospital admission but a small percentage are serious and need to be transferred to specialist burn centers, where a multidisciplinary team of specially trained doctors, including surgeons and anesthesiologists can care for the child. Mortality rates at centers like this at are recorded at 3%

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 1374–1386. ISBN   978-0-07-148480-0.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Herndon D, ed. (2012). "Chapter 3: Epidemiological, Demographic, and Outcome Characteristics of Burn Injury". Total burn care (4th ed.). Edinburgh: Saunders. p. 23. ISBN   978-1-4377-2786-9.
  3. 1 2 3 4 5 6 7 8 9 Herndon D, ed. (2012). "Chapter 4: Prevention of Burn Injuries". Total burn care (4th ed.). Edinburgh: Saunders. p. 46. ISBN   978-1-4377-2786-9.
  4. 1 2 3 4 5 6 7 8 "Burns". World Health Organization. September 2016. Archived from the original on 21 July 2017. Retrieved 1 August 2017.
  5. 1 2 3 GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC   5055577 . PMID   27733282.
  6. 1 2 3 GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC   5388903 . PMID   27733281.
  7. 1 2 "Burns Fact sheet N°365". WHO. April 2014. Archived from the original on 10 November 2015. Retrieved 3 March 2016.
  8. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Granger, Joyce (January 2009). "An Evidence-Based Approach to Pediatric Burns". Pediatric Emergency Medicine Practice. 6 (1). Archived from the original on 17 October 2013.
  9. Ferri, Fred F. (2012). Ferri's netter patient advisor (2nd ed.). Philadelphia, PA: Saunders. p. 235. ISBN   9781455728268. Archived from the original on 21 December 2016.
  10. 1 2 3 Haagsma, JA; Graetz, N; Bolliger, I (February 2016). "The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013". Injury Prevention. 22 (1): 3–18. doi:10.1136/injuryprev-2015-041616. PMC   4752630 . PMID   26635210.
  11. 1 2 3 4 5 6 7 8 9 Herndon D, ed. (2012). "Chapter 1: A Brief History of Acute Burn Care Management". Total burn care (4th ed.). Edinburgh: Saunders. p. 1. ISBN   978-1-4377-2786-9.
  12. 1 2 3 "Burn Incidence and Treatment in the United States: 2012 Fact Sheet". American Burn Association. 2012. Archived from the original on 21 February 2013. Retrieved 20 April 2013.
  13. 1 2 3 4 5 6 7 8 9 10 Herndon D, ed. (2012). "Chapter 10: Evaluation of the burn wound: management decisions". Total burn care (4th ed.). Edinburgh: Saunders. p. 127. ISBN   978-1-4377-2786-9.
  14. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Brunicardi, Charles (2010). "Chapter 8: Burns". Schwartz's principles of surgery (9th ed.). New York: McGraw-Hill, Medical Pub. Division. ISBN   978-0-07-154769-7.
  15. 1 2 3 Goutos, I; Dziewulski, P; Richardson, PM (March–April 2009). "Pruritus in burns: review article". Journal of Burn Care & Research. 30 (2): 221–8. doi:10.1097/BCR.0b013e318198a2fa. PMID   19165110.
  16. 1 2 3 4 5 6 7 Marx, John (2010). "Chapter 140: Electrical and Lightning Injuries". Rosen's emergency medicine : concepts and clinical practice (7th ed.). Philadelphia: Mosby/Elsevier. ISBN   978-0-323-05472-0.
  17. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Peck, MD (November 2011). "Epidemiology of burns throughout the world. Part I: Distribution and risk factors". Burns : Journal of the International Society for Burn Injuries. 37 (7): 1087–100. doi:10.1016/j.burns.2011.06.005. PMID   21802856.
  18. 1 2 Lloyd, EC; Rodgers, BC; Michener, M; Williams, MS (1 January 2012). "Outpatient burns: prevention and care". American Family Physician. 85 (1): 25–32. PMID   22230304.
  19. Buttaro, Terry (2012). Primary Care: A Collaborative Practice. Elsevier Health Sciences. p. 236. ISBN   978-0-323-07585-5. Archived from the original on 13 May 2016.
  20. Kowalski, Caroline Bunker Rosdahl, Mary T. (2008). Textbook of basic nursing (9th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 1109. ISBN   978-0-7817-6521-3. Archived from the original on 12 May 2016.
  21. National Burn Repository Pg. i
  22. 1 2 3 Forjuoh, SN (August 2006). "Burns in low- and middle-income countries: a review of available literature on descriptive epidemiology, risk factors, treatment, and prevention". Burns : Journal of the International Society for Burn Injuries. 32 (5): 529–37. doi:10.1016/j.burns.2006.04.002. PMID   16777340.
  23. Eisen, Sarah; Murphy, Catherine (2009). Murphy, Catherine; Gardiner, Mark; Sarah Eisen (eds.). Training in paediatrics : the essential curriculum. Oxford: Oxford University Press. p. 36. ISBN   978-0-19-922773-0. Archived from the original on 25 April 2016.
  24. 1 2 3 4 Maguire, S; Moynihan, S; Mann, M; Potokar, T; Kemp, AM (December 2008). "A systematic review of the features that indicate intentional scalds in children". Burns : Journal of the International Society for Burn Injuries. 34 (8): 1072–81. doi:10.1016/j.burns.2008.02.011. PMID   18538478.
  25. Peden, Margie (2008). World report on child injury prevention. Geneva, Switzerland: World Health Organization. p. 86. ISBN   978-92-4-156357-4. Archived from the original on 24 April 2016.
  26. World Health Organization. "World report on child injury prevention" (PDF). Archived (PDF) from the original on May 2008.
  27. 1 2 Hardwicke, J; Hunter, T; Staruch, R; Moiemen, N (May 2012). "Chemical burns—an historical comparison and review of the literature". Burns : Journal of the International Society for Burn Injuries. 38 (3): 383–7. doi:10.1016/j.burns.2011.09.014. PMID   22037150.
  28. 1 2 Makarovsky, I; Markel, G; Dushnitsky, T; Eisenkraft, A (May 2008). "Hydrogen fluoride—the protoplasmic poison". The Israel Medical Association Journal : IMAJ. 10 (5): 381–5. PMID   18605366.
  29. Edlich, RF; Farinholt, HM; Winters, KL; Britt, LD; Long WB, 3rd (2005). "Modern concepts of treatment and prevention of lightning injuries". Journal of Long-Term Effects of Medical Implants. 15 (2): 185–96. doi:10.1615/jlongtermeffmedimplants.v15.i2.60. PMID   15777170.
  30. Prahlow, Joseph (2010). Forensic pathology for police, death investigators, and forensic scientists. Totowa, N.J.: Humana. p. 485. ISBN   978-1-59745-404-9. Archived from the original on 20 May 2016.
  31. Kearns RD, Cairns CB, Holmes JH, Rich PB, Cairns BA (January 2013). "Thermal burn care: a review of best practices. What should prehospital providers do for these patients?". EMS World. 42 (1): 43–51. PMID   23393776.
  32. Balk SJ, Council on Environmental Health, Section on Dermatology (March 2011). "Ultraviolet radiation: a hazard to children and adolescents". Pediatrics. 127 (3): e791–817. doi:10.1542/peds.2010-3502. PMID   21357345.
  33. 1 2 3 Marx, John (2010). "Chapter 144: Radiation Injuries". Rosen's emergency medicine : concepts and clinical practice (7th ed.). Philadelphia: Mosby/Elsevier. ISBN   978-0-323-05472-0.
  34. 1 2 Krieger, John (2001). Clinical environmental health and toxic exposures (2nd ed.). Philadelphia, Pa. [u.a.]: Lippincott Williams & Wilkins. p. 205. ISBN   978-0-683-08027-8. Archived from the original on 5 May 2016.
  35. 1 2 3 4 Peck, MD (August 2012). "Epidemiology of burns throughout the World. Part II: intentional burns in adults". Burns : Journal of the International Society for Burn Injuries. 38 (5): 630–7. doi:10.1016/j.burns.2011.12.028. PMID   22325849.
  36. 1 2 Gondim, Roberta Marinho Falcão; Muñoz, Daniel Romero; Petri, Valeria (June 2011). "Violência contra a criança: indicadores dermatológicos e diagnósticos diferenciais". Anais Brasileiros de Dermatologia. 86 (3): 527–536. doi:10.1590/S0365-05962011000300015. PMID   21738970.
  37. 1 2 Herndon D, ed. (2012). "Chapter 61: Intential burn injuries". Total burn care (4th ed.). Edinburgh: Saunders. pp. 689–698. ISBN   978-1-4377-2786-9.
  38. Jutla, RK; Heimbach, D (March–April 2004). "Love burns: An essay about bride burning in India". The Journal of Burn Care & Rehabilitation. 25 (2): 165–70. doi:10.1097/01.bcr.0000111929.70876.1f. PMID   15091143.
  39. Peden, Margie (2008). World report on child injury prevention. Geneva, Switzerland: World Health Organization. p. 82. ISBN   978-92-4-156357-4. Archived from the original on 17 June 2016.
  40. 1 2 3 4 5 6 7 8 Marx, John (2010). "Chapter 60: Thermal Burns". Rosen's emergency medicine : concepts and clinical practice (7th ed.). Philadelphia: Mosby/Elsevier. ISBN   978-0-323-05472-0.
  41. 1 2 3 4 5 Rojas Y, Finnerty CC, Radhakrishnan RS, Herndon DN (December 2012). "Burns: an update on current pharmacotherapy". Expert Opin Pharmacother. 13 (17): 2485–94. doi:10.1517/14656566.2012.738195. PMC   3576016 . PMID   23121414.
  42. Hannon, Ruth (2010). Porth pathophysiology : concepts of altered health states (1st Canadian ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 1516. ISBN   978-1-60547-781-7. Archived from the original on 1 May 2016.
  43. 1 2 3 4 Garmel, edited by S.V. Mahadevan, Gus M. (2012). An introduction to clinical emergency medicine (2nd ed.). Cambridge: Cambridge University Press. pp. 216–219. ISBN   978-0-521-74776-9. Archived from the original on 20 May 2016.CS1 maint: extra text: authors list (link)
  44. Jeschke, Marc (2012). Handbook of Burns Volume 1: Acute Burn Care. Springer. p. 46. ISBN   978-3-7091-0348-7. Archived from the original on 17 May 2016.
  45. Klingensmith M, ed. (2007). The Washington manual of surgery (5th ed.). Philadelphia, Pa.: Lippincott Williams & Wilkins. p. 422. ISBN   978-0-7817-7447-5. Archived from the original on 20 May 2016.
  46. Berger, Mette M.; Ichai, Carole; Losser, Marie-Reine; Rousseau, Anne-Françoise (1 August 2013). "ESPEN endorsed recommendations: Nutritional therapy in major burns". Clinical Nutrition. 32 (4): 497–502. doi:10.1016/j.clnu.2013.02.012. ISSN   0261-5614. PMID   23582468.
  47. Cianci, P; Slade JB, Jr; Sato, RM; Faulkner, J (January–February 2013). "Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns". Undersea & Hyperbaric Medicine. 40 (1): 89–108. PMID   23397872.
  48. 1 2 Enoch, S; Roshan, A; Shah, M (8 April 2009). "Emergency and early management of burns and scalds". BMJ (Clinical Research Ed.). 338: b1037. doi:10.1136/bmj.b1037. PMID   19357185.
  49. Hettiaratchy, S; Papini, R (10 July 2004). "Initial management of a major burn: II--assessment and resuscitation". BMJ (Clinical Research Ed.). 329 (7457): 101–3. doi:10.1136/bmj.329.7457.101. PMC   449823 . PMID   15242917.
  50. Jeschke, Marc (2012). Handbook of Burns Volume 1: Acute Burn Care. Springer. p. 77. ISBN   978-3-7091-0348-7. Archived from the original on 19 May 2016.
  51. Endorf, FW; Ahrenholz, D (December 2011). "Burn management". Current Opinion in Critical Care. 17 (6): 601–5. doi:10.1097/MCC.0b013e32834c563f. PMID   21986459.
  52. Lewis, Sharon R.; Pritchard, Michael W.; Evans, David Jw; Butler, Andrew R.; Alderson, Phil; Smith, Andrew F.; Roberts, Ian (2018). "Colloids versus crystalloids for fluid resuscitation in critically ill people". The Cochrane Database of Systematic Reviews. 8: CD000567. doi:10.1002/14651858.CD000567.pub7. ISSN   1469-493X. PMC   6513027 . PMID   30073665.
  53. Eljaiek, R; Heylbroeck, C; Dubois, MJ (6 September 2016). "Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis". Burns : Journal of the International Society for Burn Injuries. 43 (1): 17–24. doi:10.1016/j.burns.2016.08.001. PMID   27613476.
  54. Curinga, G; Jain, A; Feldman, M; Prosciak, M; Phillips, B; Milner, S (August 2011). "Red blood cell transfusion following burn". Burns : Journal of the International Society for Burn Injuries. 37 (5): 742–52. doi:10.1016/j.burns.2011.01.016. PMID   21367529.
  55. Wasiak, J; Cleland, H; Campbell, F; Spinks, A (28 March 2013). "Dressings for superficial and partial thickness burns". The Cochrane Database of Systematic Reviews. 3 (3): CD002106. doi:10.1002/14651858.CD002106.pub4. PMID   23543513.
  56. 1 2 3 Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M (2010). "Prophylactic antibiotics for burns patients: systematic review and meta-analysis". BMJ. 340: c241. doi:10.1136/bmj.c241. PMC   2822136 . PMID   20156911.
  57. Wasiak, J; Cleland, H; Campbell, F; Spinks, A (28 March 2013). "Dressings for superficial and partial thickness burns". The Cochrane Database of Systematic Reviews. 3 (3): CD002106. doi:10.1002/14651858.CD002106.pub4. PMID   23543513.
  58. Storm-Versloot, MN; Vos, CG; Ubbink, DT; Vermeulen, H (17 March 2010). Storm-Versloot, Marja N (ed.). "Topical silver for preventing wound infection". Cochrane Database of Systematic Reviews (3): CD006478. doi:10.1002/14651858.CD006478.pub2. PMID   20238345.
  59. Dumville, JC; Munson, C; Christie, J (15 December 2014). "Negative pressure wound therapy for partial-thickness burns". The Cochrane Database of Systematic Reviews. 12 (12): CD006215. doi:10.1002/14651858.CD006215.pub4. PMID   25500895.
  60. Chaganti, P; Gordon, I; Chao, JH; Zehtabchi, S (11 April 2019). "A systematic review of foam dressings for partial thickness burns". The American Journal of Emergency Medicine. 37 (6): 1184–1190. doi:10.1016/j.ajem.2019.04.014. PMID   31000315.
  61. Zachariah, JR; Rao, AL; Prabha, R; Gupta, AK; Paul, MK; Lamba, S (August 2012). "Post burn pruritus—a review of current treatment options". Burns : Journal of the International Society for Burn Injuries. 38 (5): 621–9. doi:10.1016/j.burns.2011.12.003. PMID   22244605.
  62. 1 2 Herndon D, ed. (2012). "Chapter 64: Management of pain and other discomforts in burned patients". Total burn care (4th ed.). Edinburgh: Saunders. p. 726. ISBN   978-1-4377-2786-9.
  63. Wasiak, J; Mahar, PD; McGuinness, SK; Spinks, A; Danilla, S; Cleland, H; Tan, HB (17 October 2014). "Intravenous lidocaine for the treatment of background or procedural burn pain". The Cochrane Database of Systematic Reviews. 10 (10): CD005622. doi:10.1002/14651858.CD005622.pub4. PMC   6508369 . PMID   25321859.
  64. Herndon D, ed. (2012). "Chapter 31: Etiology and prevention of multisystem organ failure". Total burn care (4th ed.). Edinburgh: Saunders. p. 664. ISBN   978-1-4377-2786-9.
  65. Breederveld, RS; Tuinebreijer, WE (15 September 2014). "Recombinant human growth hormone for treating burns and donor sites". The Cochrane Database of Systematic Reviews. 9 (9): CD008990. doi:10.1002/14651858.CD008990.pub3. PMID   25222766.
  66. Snell, Jane A; Loh, Ne-Hooi W; Mahambrey, Tushar; Shokrollahi, Kayvan (2013). "Clinical review: The critical care management of the burn patient". Critical Care. 17 (5): 241. doi:10.1186/cc12706. PMC   4057496 . PMID   24093225.
  67. Jeschke, Marc (2012). Handbook of Burns Volume 1: Acute Burn Care. Springer. p. 266. ISBN   978-3-7091-0348-7. Archived from the original on 10 May 2016.
  68. 1 2 3 4 Orgill, DP; Piccolo, N (September–October 2009). "Escharotomy and decompressive therapies in burns". Journal of Burn Care & Research. 30 (5): 759–68. doi:10.1097/BCR.0b013e3181b47cd3. PMID   19692906.
  69. "General data about burns". Burn Centre Care.
  70. Wijesinghe, M; Weatherall, M; Perrin, K; Beasley, R (22 May 2009). "Honey in the treatment of burns: a systematic review and meta-analysis of its efficacy". The New Zealand Medical Journal. 122 (1295): 47–60. PMID   19648986.
  71. Jull, AB; Cullum, N; Dumville, JC; Westby, MJ; Deshpande, S; Walker, N (6 March 2015). "Honey as a topical treatment for wounds". The Cochrane Database of Systematic Reviews. 3 (3): CD005083. doi:10.1002/14651858.CD005083.pub4. PMID   25742878.
  72. 1 2 Dat, AD; Poon, F; Pham, KB; Doust, J (15 February 2012). "Aloe vera for treating acute and chronic wounds". Cochrane Database of Systematic Reviews. 2 (2): CD008762. doi:10.1002/14651858.CD008762.pub2. PMID   22336851.
  73. Maenthaisong, R; Chaiyakunapruk, N; Niruntraporn, S; Kongkaew, C (September 2007). "The efficacy of aloe vera used for burn wound healing: a systematic review". Burns : Journal of the International Society for Burn Injuries. 33 (6): 713–8. doi:10.1016/j.burns.2006.10.384. PMID   17499928.
  74. Bahramsoltani, R; Farzaei, MH; Rahimi, R (September 2014). "Medicinal plants and their natural components as future drugs for the treatment of burn wounds: an integrative review". Archives of Dermatological Research. 306 (7): 601–17. doi:10.1007/s00403-014-1474-6. PMID   24895176.
  75. 1 2 Juckett, G; Hartman-Adams, H (1 August 2009). "Management of keloids and hypertrophic scars". American Family Physician. 80 (3): 253–60. PMID   19621835.
  76. Cox, Carol Turkington, Jeffrey S. Dover; medical illustrations, Birck (2007). The encyclopedia of skin and skin disorders (3rd ed.). New York, NY: Facts on File. p. 64. ISBN   978-0-8160-7509-6. Archived from the original on 18 May 2016.
  77. 1 2 National Burn Repository, Pg. 10
  78. Christopher King; Fred M. Henretig; Brent R. King; John Loiselle; Richard M. Ruddy; James F. Wiley II, eds. (2008). Textbook of pediatric emergency procedures (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 1077. ISBN   978-0-7817-5386-9. Archived from the original on 22 May 2016.
  79. 1 2 Roberts, edited by Michael C. (2009). Handbook of pediatric psychology (4th ed.). New York: Guilford. p. 421. ISBN   978-1-60918-175-8. Archived from the original on 30 April 2016.CS1 maint: extra text: authors list (link)
  80. "WHO Disease and injury country estimates". World Health Organization. 2009. Archived from the original on 11 November 2009. Retrieved 11 November 2009.
  81. GBD 2013 Mortality and Causes of Death, Collaborators (10 January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/s0140-6736(14)61682-2. PMC   4340604 . PMID   25530442.
  82. Lozano, R (15 December 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. hdl:10536/DRO/DU:30050819. PMID   23245604.
  83. Edlich, RF; Farinholt, HM; Winters, KL; Britt, LD; Long WB, 3rd (2005). "Modern concepts of treatment and prevention of electrical burns". Journal of Long-Term Effects of Medical Implants. 15 (5): 511–32. doi:10.1615/jlongtermeffmedimplants.v15.i5.50. PMID   16218900.
  84. 1 2 3 Ahuja, RB; Bhattacharya, S (21 August 2004). "Burns in the developing world and burn disasters". BMJ (Clinical Research Ed.). 329 (7463): 447–9. doi:10.1136/bmj.329.7463.447. PMC   514214 . PMID   15321905.
  85. Gupta (2003). Textbook of Surgery. Jaypee Brothers Publishers. p. 42. ISBN   978-81-7179-965-7. Archived from the original on 27 April 2016.
  86. Pećanac, M.; Janjić, Z.; Komarcević, A.; Pajić, M.; Dobanovacki, D.; Misković, SS. (2013). "Burns treatment in ancient times". Med Pregl. 66 (5–6): 263–7. doi:10.1016/s0264-410x(02)00603-5. PMID   23888738.
  87. 1 2 Song, David (5 September 2012). Plastic surgery (3rd ed.). Edinburgh: Saunders. p. 393.e1. ISBN   978-1-4557-1055-3. Archived from the original on 2 May 2016.
  88. Wylock, Paul (2010). The life and times of Guillaume Dupuytren, 1777–1835. Brussels: Brussels University Press. p. 60. ISBN   978-90-5487-572-7. Archived from the original on 16 May 2016.

Notes

Classification
D
External resources
Tango Phone medapp.svg
Wikipedia's health care articles can be viewed offline with the Medical Wikipedia app .