Question

A young boy, age 2 years, pulled a pot of boiling water over his head, arms, and chest, resulting in a mixed burn to the anterior surface of his head and arms, chest, and feet.

Discuss the additional effects associated with burns and the treatments involved, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia. (See Effects of Burn Injury.)

Discuss the actions to promote the healing of burns. Specifically address the problems that may be associated with scarring and the effects of growth that this 2-year-old may experience. (See Healing of Burns.)

Answer 1

The effects of burn on the burn can be classified as local,regional and systemic.

• local effects: Tissue damage, inflammation and infection.
• Regional effects: circulation to the limb or the burn area is compromised.
• systemic effects include fluid loss, multiple organ failure, inhalational injury, gastric or duodenal ulcers

Treatment of these complications of burn is called burn resuscitation. Its divided into two phases. The first phase is resuscitation phase which lasts fron 24-72 hours. During this phase the vascular permeability is increased, fluid shift results in intravascular volume depletion and edema. So the primary goal of this phase is to restore and preserve tissue perfusion to avoid ischaemia from hypovolemic and cellular shock. The next phase is hypperdynamic phase which begins 24-72 hours after the injury. This phase is characterized by decreased vascular permeability, increased heart rate, and decreased peripheral vascular resistance.

The management includes :

• Fluid repalcement: The Parkland's formula for fluid replacement is used i.e IVF = total body surface burned (%) * weight (kg) * 4 ml. The rate of the volume infused is calculated by delivering half of the volume in first 8 hours and the rest fluid in next 16 hours.
• Adequate nutrition is highly important to meet the burn specific body requirements. Usually total parenteral or enteral nutrition is preferred. High carbohydrate diet consisting of 82% carbohydrate, 3% fat and 15% protein is prescribed. The adequate nutrition initiated at early phase will modulate the hypermetabolic response of severe burns.
• The toxic eschar is removed within 24-72 hours which reduces mortality and complication of severe burns.
• Topical antimicrobial agent is administered after initial decontamination to prevent bacterial colonization of the burn wound.
• Insulin treatment is given in order to treat post burn hypoglycemia.

Healing of burns:

The first degree burn being superficial heals within 7-10 days without scarring. The second degree burns extends beyond the top layer of skin, heals within 2 -3 weeks without scarring, but often with pigment changes to skin. The third degree burns involves deeper tissue of skin. Without surgery this wounds heal with scarring and contracture. There is no set timeline for healing of third degree burns. There are various methods to treat and to promote healing of burns.

• Some of the home remedies includes cold water, cold compress, antibiotic ointments, aloevera, honey, reducing exposure to sun, do not pop your blister.
• Stay away from apllication of butter, oil, toothpaste,egg white and ice applications.
• Taking immediate action is important. Identify the degree of burn.
• Run cool water over burn.
• Place a clean and cool cloth over the burn area untill emergency help arrives.
• Elevate severly burned areas above heart.
• Seek emergency treatment for any third degree burn.
• Follow doctors advice regarding changing of dressing, and taking medications.
• Apply pressure garment as directed for severely burn patient.
• Take anti inflammatory medication.
• Take nutritious diet and drink plenty of water.

The formation of scar after burn limits the person ability to function and effects their body image. It fgorms over the joints and results in formation of contractures. It causes itching and skin breakdown. Scarring results in social isolation, depression and lower the quality of life. They are more sensitive to chemicals and sun. During growth and development of this 2 year child, burn will life a life long painful experience. It will effect him mentally, physically and socially. The formation of scar will make the child socially withdrawn and lack of self confidence. It may also delay the milestones of the child that effects his growth pattern.