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Updated: June 22, 2013 17:35 IST

A burning question

SUDHA UMASHANKER
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Burn injuries are on the rise every year.
Special Arrangement Burn injuries are on the rise every year.

With the number of burn injuries increasing every year, experts talk about about treatment options.

It is a perfectly avoidable problem, yet it remains a burning issue. And the numbers only reinforce that. According to an article in the Indian Journal of Burns (Vol. 13 December 2005), the total number of burns cases is approximately 30 lakhs every year and the total deaths from burn injuries and accidents is about 10 lakhs every year. What adds fuel to the fire is the gender ratio of patients: a sizeable number of victims are women and children who suffer scald injuries.

Dr. Prema Dhanraj, Director of Agni Raksha and Professor/HOD, Plastic and Reconstructive Surgery, Raja Rajeswari Medical College Hospital, Bangalore, says, “A burn is a skin injury caused by heat, electricity, chemicals, light, or radiation. Children have thinner skin that burns more quickly than adults.”

Burns are categorised in degrees depending on how many layers of skin and tissue are affected. In turn the temperature, duration of heat exposure, the depth of the burn and extent of the area affected determine the seriousness of the burn.

First degree burns involve only the epidermis. There is minimal tissue damage. The wounds heal in five to seven days without scarring.

Second degree burns involve the epidermis and portions of the dermis and other structures such as sweat glands and hair follicles. There is blister formation, pain and swelling. The wound heals in about two weeks and scarring occurs.

In third degree burns, the skin is charred or is translucent white in colour. There is complete destruction of tissue and structures. Although there is no sensation of pain, patients complain of pain from the surrounding second degree burn. The wounds may require excision (this is labour intensive and requires availability of blood) and skin grafting. Healing time is more than three weeks.

Fourth degree burn involves subcutaneous tissue, tendons and even bone.

Human hair too gets destroyed in a fire accident. When hair roots are burnt, baldness is permanent.

Recovery from a serious burn is a long and arduous process in which good blood supply and nutrition can help. Dr. Santosh Kumar, Burns and Plastic Surgery Department, Tata Main Hospital, Jamshedpur, says, “The more superficial the burn, the more the blisters and greater the pain. Beyond 40°C, the protein from which skin is made gets coagulated and there is total destruction of tissue. Most acid burns also produce this effect due to rapid conversion of protein to salt.”

Apart from the shock, there are many complications that could set in during the post-injury phase. Dr. P.K. Bilwani, Director, Gujarat Burns Hospital and Research Centre Ahmedabad, says, “The earliest complication is loss of fluids and electrolytes, which can be prevented by giving electrolyte-rich fluids intravenously. Isolation, aseptic dressings and good nursing can keep infections at bay. Contracture can be prevented by proper positioning of joints and pressure garments can address keloid formation.”

But there are some situations that are critical in themselves. Burns with inhalational injury (thermal burns in closed rooms) cause the most fatalities. Here, hot air goes into the respiratory tract and leads to burning of the upper respiratory tract that in turn leads to an obstructed airway. At the other end of the spectrum, high voltage electric burns may lead to amputation of limbs and eye burns may lead to corneal opacities, blindness and permanent opening of eye lids.”

Which brings us to acid injuries. Dr. Prema says, “Acid burn is unique because of the chemical’s continuous tissue-damaging effect till it is completely washed off or neutralised.” The more concentrated the acid the deeper the burn. While the injuries may be treated what takes a complete battering is the psyche of the patient. Dr Prema, herself a victim of burns, explains, “The extent of physical, emotional and psychological trauma depends on the kind of burns, the nature of disfigurement, the manner in which the accident occurred (self-inflicted or otherwise). Many burn survivors fear rejection and retreat into a shell. They need to be handled with sensitivity and must be helped to deal with their fears and anxieties, recognise their strengths, and learn coping skills from positive role models who have survived similar ordeals.”

First aid tips

Flame burns:

Pour cold water on burns (except in electrical burns ) for at least 20 minutes.

If running water is unavailable, wet two towels and use them alternately every two minutes.

Do not wrap body with blankets as it conserves heat and causes more damage

Do not rub ice or apply milk cream or any other cream on the burn

Do not allow patient to run, as this adds oxygen to fire and increases flames

Remove burnt clothes and cover with a clean sheet to keep body warm

Remove jewellery as it can stop blood flow

Give sips of water with a pinch of salt

Acid burns:

Remove clothes and wash burned area with copious amounts of water. At least 20-30 minutes of washing is necessary to dilute the chemicals

If the eye is involved, prise open and water wash thoroughly under the eyelids to remove trapped chemicals

Electrical burns:

Switch off mains. Use dry wood to push patient away from current source.

Preventive tips

Keep children away from kitchen

Don't leave hot liquids on the table

In case of hot liquid burns, remove soaked clothes at once and pour cold water over affected area

Avoid cooking at floor level or storing condiments behind the stove

Do not keep mosquito coil near the bed or smoke in bed

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