Burn Definition

Burns are one of the most common household injuries that they are characterized by severe skin damage that causes the affected skin cells to die. Most people can recover from burns without serious health consequences, depending on the cause and degree of injury. More serious burns require immediate emergency medical care to prevent complications and death.

Burns Causes

•     Thermal burns

•     Radiation burns

•     Chemical burns

•     Electrical burns

Burns Classifications

1.      First-degree (superficial) burns:
   Superficial or epidermal burns involve only the epidermal layer of skin. They don’t blister but are painful, dry, red, and blanch with pressure.

2.      Second-degree (partial thickness) burns:
   They involve the epidermis and part of the dermis layer of skin. They are characterized as either superficial or deep.

•     Superficial partial thickness: These burns characteristically form blisters within 24 hours between the epidermis and dermis.

•     Deep partial thickness: These burns extend into the deeper dermis and are characteristically different from superficial partial-thickness burns. These types can damage hair follicles and glandular tissue.

      3.  Third-degree (full thickness) burns:
They destroy the epidermis and dermis. Skin appearance can vary from waxy white to leathery gray to charred and black.

     4.    Fourth-degree (Extension to deep tissues) burns:

These burns are deep and potentially life-threatening injuries that extend through the skin into underlying soft tissue and can involve muscle and/or bone.

Burns Symptoms and Signs

Signs of burns depend on the severity or degree of the burn.

Firs-degree burns

•     Red-painful skin

•     No blisters

Second-degree burns

•     Red-painful skin

•     Blisters

•     Swelling

Third-degree burns

•     White, black, deep red or charred skin

•     May be painful but could be numb

Fourth-degree burns

•     No feeling in the area

•     Destroyed skin tissue, fat, muscle and possibly bone

Burns Treatment

Most minor burns can be treated at home. They usually heal within a couple of weeks.
For serious burns, after appropriate first aid and wound assessment, your treatment may involve medications, wound dressings, therapy and surgery. The goals of treatment are to control pain, remove dead tissue, prevent infection, reduce scarring risk and regain function.
Some medical treatments may include:

•     Fluids to prevent dehydration

•     Pain and anxiety medications

•     Burn creams and ointments

•     Drugs that fight infection

•     Plastic surgery

•     Skin grafts

Nutrition Therapy in Burns

Nutritional support is a key component of burn care and it must also accommodate the surgical and medical needs of the patient. The primary goal of nutrition support following severe burn injury is to meet the distinctive demands placed upon the body by hyper-metabolism.

Objectives of nutritional management

•     Provide nutrition via enteral route within 6 - 18 hours post burn injury

•     Maintain weight within 5 % - 10 % of pre-burn weight

•     Prevent signs and symptoms of micronutrient deficiency

•     Minimize hyperglycemia

•     Minimize hypertriglyceridemia

Minor burns

•     No need of IV fluid resuscitation

•     Maintain on high energy, high protein diet.

Moderate to major burns

•     Enteral nutrition should begin as soon as possible    8-48 hours after burn occurs.

•     PN can supplement enteral nutrition if caloric requirements cannot be met.

Energy and macronutrient requirements

• Recommended daily energy intake is as follows: for adults, 25 kcal/kg plus 40 kcal per each percent of burn area; for children, 1,800 kcal plus 2,200 calories per m2 of burn area.

• High-carbohydrate, low-fat diets for these patients result in less proteolysis and more improvement in lean body mass when compared with a high-fat regimen.                                                       

• Protein and fluid needs must also be considered carefully. Protein oxidation rates are 50% higher in burn patients, and protein needs are about 1.5-2 g/kg and Children need 2/5-4 g/kg/day.                                                           
  Water loss can be as much as 4 L/m2/day and a range of 30-50 mL/hour is given depending on the size of the burn, degree of hypernatremia, and urine output.

Micronutrient supplements

Levels of the fat-soluble vitamins A and E and carotenoids fall below normal in burn injury patients.

•    Vitamin C, zinc, and copper help burns heal.

•     Vitamin E, vitamin C, and selenium are antioxidants. They help to reduce the body’s stress response after an injury.

•     Vitamin C, vitamin D, and zinc help to prevent and treat infections.