injuries and poisoning
Burns
Treatment of Burns
For minor burns, cooling the wound with room temperature water for several minutes, followed by wound care and dressing For severe burns, hospitalization and treatment of complications as well as burns Before burns are treated, the burning agent must be stopped from inflicting further damage. For example, fires are extinguished. Clothing—especially any that is smoldering (such as melted synthetic shirts), covered with a hot substance (for example, tar), or soaked with chemicals—is immediately removed. Hospitalization is sometimes necessary for optimal care of burns. For example, extensive partial or full-thickness burns require treatment with intravenous fluids; elevating a severely burned arm or leg above the level of the heart to prevent swelling is more easily accommodated in a hospital. In addition, burns that prevent people from carrying out essential daily functions, such as walking or eating, or that cause severe pain, often make hospitalization necessary. Full-thickness burns, burns occurring in the very young or the very old, and burns involving the hands, feet, face, or genitals are usually best treated at burn centers. Burn centers are hospitals that are specially equipped and staffed to care for burn victims. Superficial minor burns are immediately cooled with room temperature water for several minutes, if possible. Chemical burns may need to be rinsed for longer periods. The burn is carefully cleansed to prevent infection. If dirt is deeply embedded, doctors can give analgesics or numb the area by injecting a local anesthetic and then scrub the burn with a brush. . The salves prevent infection and form a seal to prevent further bacteria from entering the wound. A sterile bandage is then applied to protect the burned area from dirt and further injury. A Diphtheria-Tetanus-Pertussis Vaccine is given if needed. Care at home includes keeping the burn clean to prevent infection. In addition, many people are given analgesics (pain relievers), sometimes Opioid Pain Relievers , for at least a few days. The burn can be covered with a nonstick bandage or with sterile gauze. The gauze can be removed without sticking by first being soaked in water. Most people who sustain small burns attempt to treat them at home rather than visit the doctor. Indeed, simple first-aid measures may be all that is necessary to treat small, shallow burns that are clean. In general, a clean burn is one that affects only clean skin and that does not contain any dirt particles or food. Running room temperature water over the burn can help relieve pain. Covering the burn with an over-the-counter antibiotic ointment and a nonstick, sterile bandage can help prevent infection. Generally, a doctor’s examination and treatment are recommended if a tetanus vaccination is needed. Likewise, a doctor should examine a burn if it has any of the following characteristics: Is larger than the size of the person’s open hand Contains blisters Darkens or breaks the skin Involves the face, hand, foot, genitals, or skinfolds Is not completely clean Causes pain that is not relieved byacetaminophen Causes pain that does not decrease within one day after the burn was sustained As with more superficial burns, deep minor burns are usually treated with antibiotic salves. Sometimes doctors do not use antibiotic salves but instead apply special sterile dressings that can be left in place for several days to a week. Some of these dressings contain silver, which helps kill bacteria. Other dressings are slightly porous—just enough to allow fluid to drain from the burn but not enough to let bacteria through. Any dead skin and broken blisters should be removed by a health care practitioner before the antibiotic salve or dressing is applied. In addition, keeping a deeply burned arm or leg elevated above the heart for the first few days reduces swelling and pain. Compression dressings, such as elastic wraps, may also help reduce swelling and improve wound healing. The burn may require admission to a hospital or frequent re-examination at a hospital or doctor’s office, possibly as often as daily for the first few days. Askin graftmay be needed to replace burned skin that will not heal. Other skin grafts help by temporarily covering and protecting the skin as it heals on its own. In a skin grafting procedure, a piece of healthy skin is taken from sources including an Unburned area of the person’s body (autograft) Dead person (allograft) Animal (xenograft) Autograftscan be solid pieces of skin or meshed grafts. For a meshed graft, doctors use a tool to make multiple, regularly spaced, small incisions in the piece of skin. The incisions allow the donor skin to be stretched to cover a much larger area (often several times the area of the original piece of skin). Meshed grafts are used in areas where appearance is less of a concern and when burns involve more than 20% of the body surface and donor skin is scarce. Meshed grafts heal with an uneven gridlike appearance, sometimes with excessive scarring. After any dead tissue is removed and the wound is clean, a surgeon sews or staples the skin graft over the burned area. Artificial skin can also be used. Autografts are permanent. provide temporary protection to skin that is healing but are rejected after 10 to 21 days by the person’s Overview of the Immune System , and will need to be removed. After allografts and xenografts are removed, an autograft will be needed if the wound is full-thickness (third-degree) and is too large to heal by itself. Burned skin can be replaced anytime within several days of the burn. Physical and occupational therapyusually are needed to prevent immobility caused by scarring around the joints and to help people function if joint motion is limited. Stretching exercises are started within the first few days after the burn. Splints are applied to ensure that joints that are likely to be immobile rest in positions that are least likely to lead to contractures. The splints are left in place except when the joints are moved. If a skin graft has been used, therapy is not started for less than 1 to more than 3 days after the graft is attached so that the healing graft is not disturbed. Bulky dressings that put pressure on the burn can prevent large scars from developing. Severe, life-threatening burns require immediate care. People who have gone into shock as a result of dehydration are given oxygen through a face mask. are given, beginning immediately, for people who have Dehydration , Asurgical procedureto cut open eschars that cut off blood supply to a limb or that impair breathing may be needed. This procedure is called escharotomy. Escharotomy usually causes some bleeding, but because the burn causing the eschar has destroyed the nerve endings in the skin, there is little pain. Skin careis extremely important. Keeping the burned area clean is essential, because the damaged skin is easily infected. Cleansing may be accomplished by gently running water over the burns periodically. Wounds are cleansed and bandages changed at various intervals (usually once per day or less frequently), depending on the type of dressing. As with deep minor burns, skin grafts are needed to cover burns that will not heal. that includes adequate amounts of calories, protein, and nutrients is important for healing. People who cannot consume enough calories may drink nutritional supplements or receive them by way of a tube inserted through the nose into the stomach (a Inserting a feeding tube through the nose ), or less often nutrition may be given intravenously. Additional vitamins and minerals are usually given. Physical and occupational therapyare needed. Depression None 