Critical burns

Burns occur when the body comes into contact with a source of energy that raises the temperature of the tissue. This produces tissue damage in which proteins coagulate and cause the cells to die. Even a localised injury may affect the organs and internal systems. In most cases, burns occur because our body comes into contact with a source of thermal energy, in other words, its temperature is higher than our body’s and heat transfer takes place. This is the case with flames, boiling water, hot objects and radiation from the sun. Other types of burns are caused by mechanical energy produced by friction such as dragging.

Description

What is the effect of burns?

When burns are extensive and cover 15% of an adult’s body or 10% of a child or a person over 50 years old, they are called “minor burns”. When they occur, a high number of pro-inflammatory molecules are released from the burn and reach the rest of the body through circulation of the blood. During the acute stage, the permeability of the blood vessel membranes and of the body's cells is increased, which results in changes to the distribution of liquid in the body and the depression of cellular function.

To tackle the burn, a few days later the body initiates a generalised inflammatory response via a notable increase in catabolism processes in order to obtain energy resources. It also initiates a hyperdynamic response that transfers these resources to the injured areas. If the burn does not heal quickly, the inflammatory response may consume the body's resources, exhaust the patient, cause organ failure and, ultimately, death.

Once healed, however, there may be lasting functional and aesthetic consequences due to scarring or retraction. This is the case with hypertrophic and keloid scars; thickened areas of scar tissue that limit the mobility of joints, retraction of the eyelids, microstomia, and others.

Symptoms

Burns are graded depending on their severity and they also look different:

First-degree burns: painful and with reddening of the skin (erythema), but the skin is not broken.
Superficial second-degree burns: very painful due to blisters with red and watery skin underneath.
Deep second-degree burns: may or may not include blistering, and appear dry and whitish. May also be less painful.
Third-degree burns: look like scar tissue, leathery appearance, dry, sunken and dark in colour. In this case, there is no sensitivity to pain.

Who do burns affect?

Burns are a common, serious and debilitating traumatic injury that mainly results from accidents in the workplace, the home or traffic accidents. The Spanish Society of Family and Community Medicine estimates that three out of every thousand people a year suffer burns requiring medical attention. Primary care centres (CAPs) deal with most cases, but 15-20% will require admission to hospital.

Diagnosis

Diagnosis is clinical and treatment must be carried out by highly specialised professionals as this is not a common pathology.

Typical treatment

Depending on the degree of the burn, treatment may be:

First-degree: hydrating creams.
Superficial second-degree: if there are no complications they can be left to heal by themselves with the application of topical treatment.
Deep second-degree and third-degree: require skin grafts as they need at least three weeks to heal by themselves. There may also be functional and aesthetic complications.
Extensive burns: require specific life support in a Burns Unit.