Burn

The characteristics of a burn depend upon its depth. Superficial burns cause pain lasting two or three days, followed by peeling of the skin over the next few days. Numbness or tingling may persist for a prolonged period of time after an electrical injury. Burns may also produce emotional and psychological distress. ==Cause==

Burns are caused by a variety of external sources classified as thermal (heat-related), chemical, electrical, and radiation. In the United States, the most common causes of burns are: fire or flame (44%), scalds (33%), hot objects (9%), electricity (4%), and chemicals (3%). Most (69%) burn injuries occur at home or at work (9%), Scald injuries are most common in children under the age of five This is a particular risk for adolescent males. In the United States, for non-fatal burn injuries to children, white males under the age of 6 comprise most cases.  Thermal burns from grabbing/touching and spilling/splashing were the most common type of burn and mechanism, while the bodily areas most impacted were hands and fingers followed by head/neck. Most chemical burn deaths are secondary to ingestion. Formic acid may cause the breakdown of significant numbers of red blood cells. Lightning may also result in electrical burns. Risk factors for being struck include involvement in outdoor activities such as mountain climbing, golf and field sports, and working outside. Sun exposure is the most common cause of radiation burns and the most common cause of superficial burns overall. There is significant variation in how easily people sunburn based on their skin type. Skin effects from ionizing radiation depend on the amount of exposure to the area, with hair loss seen after 3 Gy, redness seen after 10 Gy, wet skin peeling after 20 Gy, and necrosis after 30 Gy. Redness, if it occurs, may not appear until some time after exposure. Non-accidental In those hospitalized from scalds or fire burns, 310% are from assault. It is created when an extremity, or sometimes the buttocks are held under the surface of hot water. Deliberate cigarette burns are most often found on the face, or the back of the hands and feet. In Pakistan, acid burns represent 13% of intentional burns, and are frequently related to domestic violence. Self-immolation (setting oneself on fire) is also used as a form of protest in various parts of the world. == Pathophysiology ==

At temperatures greater than , proteins begin losing their three-dimensional shape and start breaking down. This results in cell and tissue damage. This results in increased leakage of fluid from the capillaries, Increased levels of catecholamines and cortisol can cause a hypermetabolic state that can last for years. This is associated with increased cardiac output, metabolism, a fast heart rate, and poor immune function. ==Diagnosis==

Burns can be classified by depth, mechanism of injury, extent, and associated injuries. The most commonly used classification is based on the depth of injury. The depth of a burn is usually determined via examination, although a biopsy may also be used. Size The size of a burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full thickness burns. Severe burn injury represents one of the most devastating forms of trauma. Despite improvements in burn care, patients can be left to suffer for as many as three years post-injury. ==Prevention==

Historically, about half of all burns were deemed preventable. with recommendations including the limitation of the sale of fireworks to children. ==Management==

Resuscitation begins with the assessment and stabilization of the person's airway, breathing and circulation. In the United States, 95% of burns that present to the emergency department are treated and discharged; 5% require hospital admission. Hyperbaric oxygenation may be useful in addition to traditional treatments. Intravenous fluids In those with poor tissue perfusion, boluses of isotonic crystalloid solution should be given. This should be begun pre-hospital if possible in those with burns greater than 25% TBSA. While inadequate fluid resuscitation may cause problems, over-resuscitation can also be detrimental. The formulas are only a guide, with infusions ideally tailored to a urinary output of >30 mL/h in adults or >1mL/kg in children and mean arterial pressure greater than 60 mmHg. Blood transfusions are rarely required. due to the associated risk of complications. It is reasonable to manage first-degree burns without dressings. Silver sulfadiazine (a type of antibiotic) is not recommended as it potentially prolongs healing time. There is insufficient evidence to support the use of dressings containing silver or negative-pressure wound therapy. Silver sulfadiazine does not appear to differ from silver containing foam dressings with respect to healing. Medications Burns can be very painful and a number of different options may be used for pain management.60% TBSA). , guidelines do not recommend their general use due to concerns regarding antibiotic resistance and the increased risk of fungal infections. The use of steroids is of unclear evidence. Allogeneic cultured keratinocytes and dermal fibroblasts in murine collagen (Stratagraft) was approved for medical use in the United States in June 2021. Surgery Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small full thickness burn) should be dealt with as early as possible. Circumferential burns of the limbs or chest may need urgent surgical release of the skin, known as an escharotomy. It is uncertain if it is useful for neck or digit burns. There is no evidence that the use of copper sulphate to visualise phosphorus particles for removal can help with wound healing due to phosphorus burns. Meanwhile, absorption of copper sulphate into the blood circulation can be harmful. Alternative medicine Honey has been used since ancient times to aid wound healing and may be beneficial in first- and second-degree burns. There is moderate evidence that honey helps heal partial thickness burns. The evidence for aloe vera is of poor quality. and a review from 2007 found tentative evidence of improved healing times, a subsequent review from 2012 did not find improved healing over silver sulfadiazine. A 2014 review found only three randomized controlled trials for the use of plants for burns, two for aloe vera and one for oatmeal. The number of randomized control trials for aloe vera had increased to nine by 2024, when a review found a significant improvement in healing time but not pain relief. There is little evidence that vitamin E helps with keloids or scarring. In low income countries, burns are treated up to one-third of the time with traditional medicine, which may include applications of eggs, mud, leaves or cow dung. Surgical management is limited in some cases due to insufficient financial resources and availability. Metabolism in burn patients proceeds at a higher than normal speed due to the whole-body process and rapid fatty acid substrate cycles, which can be countered with an adequate supply of energy, nutrients, and antioxidants. Enteral feeding a day after resuscitation is required to reduce risk of infection, recovery time, non-infectious complications, hospital stay, long-term damage, and mortality. Controlling blood glucose levels can have an impact on liver function and survival. Risk of thromboembolism is high and acute respiratory distress syndrome (ARDS) that does not resolve with maximal ventilator use is also a common complication. Scars are long-term after-effects of a burn injury. Psychological support is required to cope with the aftermath of a fire accident, while to prevent scars and long-term damage to the skin and other body structures consulting with burn specialists, preventing infections, consuming nutritious foods, early and aggressive rehabilitation, and using compressive clothing are recommended. ==Prognosis==

The prognosis is worse in those with larger burns, those who are older, and females. Pneumonia occurs particularly commonly in those with inhalation injuries. Following a burn, children may have significant psychological trauma and experience post-traumatic stress disorder. To treat hypertrophic scars (raised, tense, stiff and itchy scars) and limit their effect on physical function and everyday activities, silicone sheeting and compression garments are recommended. In the developing world, significant burns may result in social isolation, extreme poverty and child abandonment. ==Epidemiology==

In 2015 fire and heat resulted in 67 million injuries. This makes it the fourth leading cause of injuries after motor vehicle collisions, falls, and violence. About 90% of burns occur in the developing world. Lightning results in the death of about 60 people a year. In Europe, intentional burns occur most commonly in middle aged men. The highest rates occur in women 16–35 years of age. Intentional burns are also a common cause and occur at high rates in young women, secondary to domestic violence and self-harm. ==History==

Cave paintings from more than 3,500 years ago document burns and their management. and the 1500 BCE Edwin Smith Papyrus describes treatments using honey and the salve of resin. Guillaume Dupuytren expanded these degrees into six different severities in 1832. The first hospital to treat burns opened in 1843 in London, England, and the development of modern burn care began in the late 1800s and early 1900s. == References ==