One speaks of a burn or scald whenever heat effects of more than 45 degrees Celsius occur on the body. In this case, the cells are not only damaged, but can even die in the worst case.
What is a burn (scald)?
Redness of the skin on the top of the hand after scalding with hot water. If heat, i.e. temperatures of more than 45 degrees Celsius, affects the body, its cells are damaged and one speaks of a burn or scald. A distinction is made between four degrees of severity:
Depending on how long the heat acts on the body and how high the temperatures are. A first-degree burn is already called a sunburn – the typical symptom here is reddened skin. In this case, only the top layer of the epidermis is affected. In the second-degree burn, in addition to redness and swelling, blisters usually appear. If both epidermis and dermis are affected by the injury, it is called a third-degree burn – in this case the skin is completely destroyed. In this case, the skin is whitish to brownish in color. The worst form of the disease is the fourth-degree burn – muscles, tendons, bones and joints are affected in addition to the skin. The skin itself is black in color due to charring.
Causes
Between 10,000 and 15,000 people are treated in hospitals each year for burns – making this a thoroughly common injury. More than two-thirds of injuries occur in the home or even on the road, while about one-third of burns are due to accidents at work. In most cases, scalds are caused by hot water. Burns, in turn, can be caused by exposure to flames or explosions as well as by radiation or electric current.
Symptoms, complaints and signs
Blistering of the hand and arm after pouring boiling water over them after an accident. In burns and scalds, symptoms depend on the severity of the injury. Four degrees of injury are distinguished. In the first-degree burn, only the outermost layer of skin is affected. The symptoms are that the skin is painful, red and dry and also slightly swollen – such as after a sunburn or contact with hot liquids or objects, it should heal in a short time. Second degree superficial burn manifests with severe pain, a red burn, moist surface. Burn blisters may also form. If we talk about another second-degree burn, the wound is deeper. Since the burn blisters may be open, there is a risk of infection. In this type of burn, it is possible for the skin to scar. It may take more than three weeks to heal. Third-degree burns are so severe that the entire skin structure is destroyed. Due to the destruction of the nerve endings, the patient does not feel pain, but numbness. Scars are also formed here. This can be caused by contact with electricity, fire or chemicals. A fourth-degree burn can involve complete destruction of the affected body part and is therefore also called charring.
Diagnosis and course
The physician makes the initial diagnosis by checking not only the actual skin site of the burn, but also the patient’s cardiovascular and respiratory functions. The course of a burn depends, of course, basically on the severity of the injury – age as well as any previous illnesses, however, also play a not insignificant role. The initial treatment at the scene of the accident is also crucial – the healing process clearly depends on this. In the case of very severe burns, lifelong follow-up treatment may be required.
Complications
A burn or scald can result in various complications. This is especially true for deeper burns or when the body surface is extensively affected. Acute sequelae of a severe burn or scald include infection and loss of fluid. In addition, there is a risk of developing burn disease. In some cases, this can even take on life-threatening proportions.Another possible risk of a burn is inhalation trauma, which is caused by inhaling soot. In this case, the affected person suffers from breathing problems, coughing and oxygen deprivation. Treatment requires the supply of oxygen or even artificial respiration. Various pre-existing conditions can also play a role in the severity of complications. These include severe metabolic diseases, diabetes mellitus, nicotine addiction or alcoholism. If extensive burns or scalds occur, this entails a more difficult healing process, which is particularly true for older patients. Also among the effects of a burn are permanent impairments to quality of life. These are possible even if, for example, only five percent of the facial skin is affected. This means that there is a risk of severe scarring, the extent of which cannot be predicted. If the joints are affected by the burn, movement restrictions are possible. Furthermore, sensation or touch impairments may occur.
When should you see a doctor?
If mild discomfort is experienced after contact with a heat source or open fire, cooling of the affected area of the body should be attempted to provide relief. Redness of the skin and mild pain can be minimized by holding the physical regions under cold running water. A doctor is not needed if there is already a marked improvement or freedom from symptoms after a few minutes. In case of more severe burns, a doctor is always needed. If the upper layers of the skin become detached, severe pain develops or blisters appear on the skin, a check-up visit to a doctor is required. Restrictions of the movement possibilities, the loss of the grasping function or the general mobility as well as losses of the physical forces indicate acute need for action. If the entire body or parts of it have been in or directly next to a hot heat source for several minutes, a medical examination of the complaints is advisable. Dysfunctions, a numbness of the skin or shortness of breath must be examined and treated. If the affected person spends a long time in an environment with direct sunlight, the complaints may also occur. A doctor is needed so that the extent of the disorder can be determined. A sudden feeling of malaise, dizziness and changes in heart rhythm are other signs that need to be clarified.
Treatment and therapy
The treatment of a burn depends on the depth of the injury. It is usually possible to assess this accurately only a few days after the actual accident. For the treatment of a burn very important is the initial care at the accident site. Cooling the injured skin area with water at a temperature of about 15 to 25 degrees Celsius should be the first measure to prevent a so-called “afterburn” of the skin. Ice water, on the other hand, should not be used at all; the cooling should also not last longer than 20 minutes, again to rule out hypothermia. In addition, the injured person should be wrapped in a blanket, ideally a rescue blanket. If it is necessary to have the injured person admitted to a hospital, further treatment will take place here. Here, the main focus is initially on pain therapy and fluids are now also administered to the patient. It is also important that the injured person has received a vaccination against tetanus. For burns that affect more than 15 percent of the body’s surface area, patients are usually taken to a special center for severe burn patients. In some cases, usually burn level three and above, skin grafts become necessary. If large areas of skin are burned, the patient may need to be placed in an induced coma.
Prevention
Prevention of burns and scalds is very important, especially for young children. Especially in the household, most accidents occur here. Prevent such accidents with the appropriate safety measures. But adults can also prevent burns – in particular, sunburn can be avoided by avoiding the blazing sun, especially at midday. Just as many accidents occur during barbecues – here, too, special care is required when handling alcohol.
Aftercare
Depending on the degree and location of the burn, the patient may need physiotherapy after treatment to regain or improve mobility. This treatment can already be started in the form of physiotherapy during inpatient treatment in the hospital. In the case of particularly severe burns that required skin grafts, further surgery may be required after acute treatment to make corrections. After acute treatment, dressings must be changed regularly. Scarring occurs with most burns. If extensive scars occur, they must be followed up with compression or massage. This is especially important for areas of the body with high elasticity, such as the hands. The scar tissue can also be treated by further skin grafts. Regular greasing of the scars and application with medical baths specially adapted to the scar tissue are also useful. In addition to the physical impairment, the affected person may also experience psychological problems. These can be post-traumatic stress reactions. In the case of severe burns, psychological counseling is therefore advisable. In addition, there may be persistent pain, which should be treated by pain therapy. Acupuncture is often applied here.
This is what you can do yourself
In the case of a burn, the cause of the burn should first be determined. However, there must no longer be any acute danger in this case. Clothing that is already burned should not be removed from the skin. Also, cooling of the burn should in any case only be done after consultation with the doctor. Only minor burns or scalds can be cooled with cold water and then with ice packs. The affected area must be covered sterilely. After the burn has subsided and medical treatment has been administered, if necessary, the affected area should be spared. Depending on the severity of the burn, it may take several days to weeks for the injury to completely heal. Until then, the affected area should be treated regularly with suitable ointments. If the skin is sensitive, natural remedies made from aloe vera are a good choice. The use of alternative remedies should be discussed with the general practitioner or dermatologist in charge. Larger burns require special treatment. Massages and the application of special antinarcotic creams counteract the skin changes. Accompanying this, the cause of the burn must be determined. Preventive measures will prevent re-burning.
