Burns: What They Are, Care and First Aid

, and sometimes of the underlying tissues, caused by a thermal, physical or chemical agent. The possible causes are therefore numerous and heterogeneous, as well as the extent of the damage caused by them.

, burns can be divided into:

Heat burns: flames, liquids, objects or gases at high temperatures alter the structure and functionality of surface tissues, leading to cell death, protein coagulation or tissue carbonization. Excessive cold temperatures can also cause serious injuries.
Burns from chemical substances: strong acids or bases generally cause serious alterations which, although limited to the contact area, are quite deep.
Electricity burns: these are attributable to the heat generated by the electric current as it passes through the body, between the entry and exit points; these are generally apparently limited burns but which, in the most severe cases (high voltage), can cause a rather extensive deep necrosis.
Burns from radiant agents: the sun and any other source of UVA (including tanning lamps) or ionizing radiation can cause burns of varying degrees.

Classification based on Severity

The severity of the burn depends on the degree of heat reached, the duration of contact and the anatomical area affected.

First Degree Burns

We speak of first degree burn when the pathological process affects only the most superficial layer of the skin (called epidermis); This category includes minor burns that occur with a slight redness, associated with swelling, pain and local burning. The "barrier" function of the skin is not compromised, as well as the general health of the patient; healing takes place over a few days, usually without scarring and often with extensive peeling. Injuries caused by excessive sun exposure or those caused by contact with liquids at a moderately high temperature, such as coffee or tea that is still too hot, are a typical example of first degree burns.

For further information: First Degree Burns

Second Degree Burns

In second degree burns, the lesion is deeper, affects the dermis (the second of the three skin layers) and is accompanied by flittene (vesicles filled with a clear liquid); intense pain is also characteristic. Second-degree burns are further divided into simple and deep. The first, similar to the first degree, heal spontaneously and with a favorable outcome, even if they require longer times (10-20 days) and may have slight complications; for this reason it is however advisable to undergo a medical check-up. Deeper burns, as well as third degree burns, do not tend to heal or repair very slowly (within 3-4 weeks) and often with severe scarring. For this reason, prompt surgical treatment is often necessary, with the purpose of removing necrotic tissues and applying skin grafts (dermo-epidermal).

For further information: Second Degree Burns

Third Degree Burns

The maximum severity of the injurious process is reached with third degree burns, where the thermal, physical or chemical insult causes lesions to the deep layers of the skin (it can affect the adipose and muscle tissue, up to, in the most serious cases, to the underlying bones). When the burn is caused by flame or hot objects, skin necrosis leads to the formation of dry and black crusts, while when the causative agent is a boiling liquid the skin is soft and whitish. carbonization of the nerve endings, the pain can be paradoxically little or even absent. Surgery is always necessary.

For further information: Third Degree Burns

Together with the depth, the severity of the burns is also determined by the extent of the injured area; the greater this is and the more insidious is the danger to life of the burned person.

For a quick calculation of the affected body surface area, the so-called "rule of nine" is used: the body surface is divided into zones and a percentage is assigned to each of it (in this case the nine, a multiple or a fraction of it is used ). The sum of these numbers provides a simple and immediate assessment of the severity of the burn.This formula is imprecise when applied to children, due to the proportionately larger head and proportionally smaller limbs than adults.

Thirdly, the severity of a "burn depends on the body site affected (areas covered with hair and a thicker skin layer protect better than hairless ones with thin skin, such as flexor surfaces and joint folds), but also on the condition general of the injured person: age (the most at risk are small children and the elderly), physical conditions and concomitant injuries (aggravating factors of the burn are the simultaneous presence of head trauma, fractures, body dehydration) and pre-existing diseases (it is more dangerous in the presence of cardiomyopathies, bronchopneumopathies, diabetes and liver or kidney diseases).

; real interface with the external environment, it opposes, first of all, an excessive dispersion of organic liquids. For this reason, when it is damaged by a "burn, the water losses can become dramatic, up to compromising the very survival of the" To further complicate the situation, the massive release into the circulation of the inflammatory mediators that facilitate the passage of fluids from the blood to the interstitial spaces contributes. Dehydration, associated with a reduction in circulating blood volume, can lead to hypotension and hypovolemic shock. It is precisely the loss of the serum that oozes from the dermal surfaces that gives rise, in second degree burns, to the characteristic blisters or blisters.

Another and very important function of the skin, which fails in the event of a burn, is the protective effect against bacterial agents which, in its absence, can penetrate deeply, taking advantage, among other things, of the drop in immune defenses due to severe organic suffering For this reason, at the hospital level there are specialized wards for severe burns, built and managed in such a way as to minimize the risk of infections.

In severe burns, the body metabolism undergoes a sharp surge, up to double in the most desperate situations. Protein and adipose catabolism is high, weight loss is rather rapid; preventing malnutrition of the severe burn victim is therefore essential to increase the chance of survival.

All burns are considered serious if:

They are complicated by respiratory tract injuries, other soft tissue injuries, and bone injuries.
Extensive burns to the face, hands, feet, anal - genital and major joints, respiratory tract or digestive tract.
Inhalation, explosion, electrical and chemical burns.
III degree burns involving more than 10% of the body surface.
Second degree burns involving more than 25-30% of the body surface or 18-20% in children.
When the extension exceeds 40% the chances of survival are significantly reduced.