3 ) Electric Burns caused by a ) Low Voltage Electric Burns which causes direct hurt to the tissues at the point of contact while the beneath castanetss and musculuss may be damaged. B ) High Voltage Electric Burns causes direct hurt at the point of contact but besides causes amendss tissues underneath and conducts the electricity through the organic structure. It causes harm at the site of the entry and site of issue and at the way through which it travels. The harm depends upon the sum of electric current passing, the opposition offered by the tissues wherein the tegument offers the maximal opposition while the musculuss, blood vass and the nervousnesss are the least immune. The harm increases if the tissue is wet.
4 ) Chemical Burns caused by contact with strong acid or strong base. The badness of Burnss depends upon the concentration of the agent, the continuance of contact and the sum of agent.
5 ) Radiation Nathan birnbaums caused by X raies or Radium. It is type of Inflammation of Skin which is regarded as Burns. Two types: a ) Acute Radiodermatitis which can do usual alterations of acute redness like erythema, hydrops and exfoliation. It can besides do mortification and deep indolent ulcer. B ) Chronic Radiodermatitis occurs when Acute radiodermatitis has occurred antecedently or when little doses of Radiation is given for a long clip. It can do irregular pigmentation or depigmentation, telangieactases and faineant ulcers. It can besides turn into Cancer.
6 ) Cold Burns caused by exposure to cold which includes freeze hurts ( frostbite which is existent freeze of tissues with formation of ice crystals. It can do tissue mortification, microvascular occlusion, cellular desiccation, hyperemia and hydrops of tegument ) or non freeze hurts e.g. pernio which is painful erythema in fingers, toes or ears green goodss by cold moistness conditions, Trench Foot which is found in mainly soldiers due to cold conditions and circulatory perturbations caused by tight vesture, Immersion pes which is like trench pes found in boggy boats.
Pathology of Burns can be seen under two headers:
Local Changes: 1 ) Badness of Nathan birnbaums: First Degree Burnss cause hyperemia and hydrops of tegument. There is no marking. These Burnss heal quickly. Second Degree Burns cause devastation of full cuticle and causes blister or cysts which is the trademark of Second Degree Burns. Subdivided into Mild and Severe. In Mild instances epithelial tissue is left for growing of new tegument and in Severe Cases no epithelial tissue is left in cuticular secretory organs and hair follicles. Skin grafting is necessary. Third Degree causes complete devastation of the cuticle, corium, cuticular extremities and the centripetal nervousnesss. Skin grafting is obligatory.
Some Surgeon goes with the categorization as Partial Thickness Burns and Full Thickness Burns.
2 ) Extent of Burns: Percentage of Burn surface is normally estimated by & A ; acirc ; ˆ?the Rule of Nine & A ; acirc ; ˆA?
Head, Neck and Face 9 % ; Right Upper Limb 9 % ; Left Upper Limb 9 % ; Right Lower Limb 18 % ;
Left Lower Limb 18 % ; Anterior Trunk 18 % , Posterior Trunk 18 % ; External Genitalia 1 % . This is for grownups and differs in Pediatric instances.
3 ) Vascular Changes: there is distension of little vass, addition in their permeableness, local release of Histamine, and outpouring of exudations which is rich in Protein and which collects in the Blisters. On drying it forms dry brown crust.
4 ) Infections: In first Degree Burns the Skin is integral hence it serves every bit barrier to occupying deadly beings. In other Burns the Skin is broken therefore the virulent organisms entre and do infections. General Malnutrition, Anemia, loss of blood volume increases the badness of infections. This bacterialisation can besides do oligaemic daze.
B ) Systemic Changes: they include four things 1 ) Shock 2 ) Biochemical Changes 3 ) Blood Changes 4 ) systemic lesions
1 ) Daze: a ) Oligaemic Shock: Heat causes release of Vasoactive stuffs which increases the cell wall permeableness which cause loss of fluid and proteins apparent as hydrops and blister. There concentration of blood that leads to oligaemic daze. Sodium and Chloride degrees lessenings and Potassium degrees increases which cause monolithic cell devastation and fluid loss which is described as Burn Shock. The blood supply to critical variety meats is affected due to haemolysis.
B ) Neurogenic Shock due to extreme hurting and anxiousness
degree Celsius ) Cardiogenic Shock due to fall in cardiac end product consequence of increased peripheral opposition and decreased blood volume and increased viscousness of the blood.
vitamin D ) Bacteriaaemic Shock due to infections and release of toxic stuffs. It may do emesis, craze and bloody diarrhoea, haemoptysis.
2 ) Biochemical Changes: a ) Electrolyte instability in which there is lessening of Sodium and Chloride and increase in Potassium. B ) Decrease in Protein degree Celsius ) Increase in Glucose vitamin D ) Increase in Blood Urea and Creatinine
3 ) Changes in Blood: 1 ) Haemoconcentration due to loss of fluid. Hemoglobin may lift approximately 150 % 2 ) Formation of bunchs of white blood cells, thrombocytes and ruddy blood cells. It increases the blood viscousness. 3 ) Anemia due to devastation of RBCs
4 ) Systemic Lesions: 1 ) Liver: Shows focal countries of mortification may besides demo Councilman Bodies like in Yellow Fever 2 ) Kidney: Get low Blood Perfusion and show hemoglobinuria. Slowly Oliguria and Anuria may develop. 3 ) Adrenal glands: becomes enlarges and swollen. May acquire necrosed at some countries. 4 ) Gastrointestinal Tract may demo ulceration in tummy and Duodenum. They are prone for shed blooding. Ulcers in Colon can besides happen. 5 ) Pneumonic Changes: Pulmonary vascular opposition additions. It causes Pneumonic inadequacy and hyperventilation to the extent that the patient may necessitate ventilator support. 6 ) Hormone System: Glucagon, Cortisol and catecholamine flat addition while Insulin degree lessening. 7 ) Neurogenic Changes: sometimes craze and freak out can happen 8 ) Immune System Depression of Immunoglobulin, Lymphocyte, T cells degree and neutrophil maps.
Treatment of Daze: I ) Analgesic and depressants are administered. two ) Fluid Resuscitation: should be started in all patients with more than 15 % Burns in grownups and 10 % in Pediatric instances. Veins are normally collapsed so Venesection is frequently needed. Evan & A ; acirc ; ˆ™s Formula or Brooke & A ; acirc ; ˆ™s expression is used for unstable Transfusion. Oliguric instances are treated with more unstable transportation. Airway Maintenance: Patient may show with tachypnoea, hypoxia, respiratory apprehension to Coma. Upper airway obstructor may be present in Burnss of caput cervix face parts.
B ) General Treatment:
a ) Tetanus prophylaxis B ) Antibiotic degree Celsius ) Nutritional Support vitamin D ) Gastric Decompression vitamin E ) Treatment of Gastric Disorders degree Fahrenheit ) Escharotomy and Fasciotomy
C ) Local Treatment:
a ) First Aid includes taking patient from beginning of heat and giving cold clean bath. B ) Wound Care by Open or Closed Method. The burn country to be cleaned by surgical detergent and all not feasible tegument to be removed. The blisters to be punctured and the loose non feasible tegument are excised. Topical agents like Silver Nitrate and Cerium Nitrate is used on Burnss. C ) Skin Grafting for timely closing of Burn Wound.
D ) Physical Therapy and Rehabilitation is started due to contractures and malformations.
Tocopherol ) Support Groups
Complications: Curling Ulcers: these are stress ulcers of tummy and duodenum, Acute Pancreatitis, Acute Acalculous Cholecystitis, Contractures, malformations, Superior Mesenteric Artery Syndrome.
Dr.Nilesh Naik, MBBS ( MUHS )