What is a burn?

A burn is a type of injury to the skin caused by various agents. Thermal burns are caused by contact with flames, hot liquids, hot surfaces, and other sources of high temperatures, or by contact with elements at extremely low temperatures. There are also chemical burns and electrical burns.

Causes

• Fire.
• Prolonged exposure to hot liquids or objects.
• Prolonged exposure to sunlight.
• Vapors, gases, and chemicals.
• Contact with electricity.
• Explosions.

Classification of burns

• Determined by the depth and extent of the injury.
• The depth of the burn determines its severity.
• First-degree burns are the most superficial, affecting only the outer layer of the skin (epidermis), causing redness and pain.
• Second-degree burns cause blistering or destruction that spreads to the middle layer of the skin (dermis).
• Third-degree burns penetrate all the thickness of the skin, including nerve endings, blood and lymphatic vessels, compromising the regeneration capacity. This type of burn does not hurt on contact, because the nerve endings have been destroyed by the heat source.

In terms of severity, burns are classified as mild, moderate, and severe.

• Minor burns: All first degree burns, as well as second-degree burns that represent less than 10% of the body surface area, are usually classified as minor.
• Moderate and severe burns: lBurns that affect the hands, feet, face or genitals, second-degree burns that cover more than 10% of the body surface, and all third-degree burns that affect more than 1% of the body are classified as moderate or, more frequently, as severe.

For the diagnosis of burned patients, the following should be considered:

• The extent of burns.
• The depth of burns.
• The location of burns.
• The age and sex of the patient.
• Weight and nutritional condition of the patient.
• The causal agent, mechanism, and time of action.
• The setting where the burn occurs.
• Other injuries originated simultaneously.

The following areas are considered special areas in case of burns, due to their aesthetic and/or functional connotation

• Face.
• Neck.
• Hands and feet.
• Joint folds (underarm, elbow, inguinal region).
• Genitalia and perineum.
• Breast.
• Underarm.

Age

The prognosis of burn patients is less favorable in the extremes of age:

• Patients under 2 years old.
• Patients above 65 years old.

Treatment

Patients with third-degree burns will take weeks or months to regenerate their skin. In many cases, the skin does not regenerate so it will be necessary to perform skin grafting.

Nutrition

The objective is to provide nutritional support as soon as possible, to the extent that clinical conditions are allowed, and before the first 24 hours.

Route of administration

• Enteral administration: Oral and tube feeding. It is recommended to start within the first 6 hours.
• Parenteral administration: Intravenous feeding is an exception. It is used in cases when adequate caloric and protein intake through the enteral administration is not achieved or when the intestine does not work. If the patient requires a central venous line, he will need special care as he may be at risk of infection. Parenteral nutrition provides the patient with the basic nutrients needed intravenously. The substances supplied must provide the required energy, all the essential nutrients (sugars, salts, amino acids, vitamins, etc.), and must be safe and suitable for metabolism.
  

Severely burned patients are patients with burn greater than 20% of the body surface area, burn of the head and neck, with serious underlying disease, and burn associated with multiple trauma.

Treatment and management of these patients are required to take place in specialized intensive care units.