Thermal Burns

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Last Medical Review: March 27, 2020
Medically Reviewed by Dr. David Costa Navarro
Thermal Burns Treatment (March 27, 2020)
Thermal (Heat or Fire) Burns (March 27, 2020)

What are thermal burns

Burns are injuries caused by destructive effects on the skin caused by heat (open flame, hot bodies or overheated liquids, sunlight), by chemicals (e.g. muriatic acid, ammonia) or by electric current. In this sheet we will talk about heat burns while for some other types of burns refer to the respective sheets (Solar burns, Chemical burns).

Most heat burns are due to failure to comply with elementary safety rules.

It’s important:

  • do not light fires with the help of flammable liquids such as alcohol;
  • be very careful in the kitchen when there are small children in the house who can burn themselves with pots of boiling water, hot oil etc.

How they manifest

Depending on the severity, burns are classified into 3 groups:

  • 1st degree burns: they are the mildest, with simple redness, burning and pain on contact. There are no blisters. They heal quickly and leave no scars on the skin.
  • 2nd degree burns: in addition to the surface layer of the skin, the immediately underlying layer of tissue is also affected. They are very painful and there are liquid-filled blisters. Less severe burns heal within a few weeks, deeper ones require longer times, healing is often difficult and permanent scars remain.
  • 3rd degree burns: they are the most serious as the area is completely destroyed in its thickness in the affected area. However, their appearance is often less impressive than 2nd degree burns. There is no pain from the destruction of the nerve receptors and there are no blisters. Healing takes a long time and leaves permanent scars (keloids) sometimes disfiguring to the point of having to resort to plastic surgery.

The severity of the burn also depends on the extent, the affected area and the cause that produced it.
A 3rd degree but small burn does not represent a danger to life. Conversely, a very extensive 2nd degree burn can have a very serious prognosis.
The affected area is also important, especially if it affects joints or skin areas subject to stretching or delicate parts. Burns affecting the face, eyes, ears and genitals always require specialist evaluation.
Other factors that affect the severity of the damage are the type and specific heat of the burner. Generally the burns from liquids are more extensive, those from solids (for example, the muffler of the motor) localized but deeper. Regardless of the extension, all caustic and electrocution injuries that are always subject to medical observation are considered ” important ”.

It is easy to understand the importance of exposure time. Injuries of equal intensity (1st degree) are caused by contact for 6 hours with temperatures of 45 °C, for 2 minutes at 51 °C, for a single second at 60 °C. The contact of a single second with a body at a temperature of 65 °C is sufficient to cause a 2nd degree burn.

What are the risks

The burn can become infected. In severe cases there may be fever, passage of bacteria in the blood and spread of the infection to other parts of the body. Particularly at risk are infants and the elderly over 60 years, especially if they carry chronic diseases (for example, diabetes).

What should be done

  • First aid aims to cool and cleanse the burned area. Prolonged immersion (at least 10 minutes) in cold water reduces redness and swelling, decreasing the extent of damage and simultaneously relieving pain. If the burnt part is covered with clothing, remove them with extreme care: better cut the fabric rather than take it off.
  • The mildest burns (1st degree) do not require special interventions. Most of the time repeated compresses with cold water are sufficient to reduce pain. If this is not enough, it may be useful to apply an anesthetic cream (eg ortho-dermatine), bearing in mind the risk of possible contact sensitization. If the pain is very intense, a non-steroidal anti-inflammatory drug with analgesic activity such as aspirin, ibuprofen (e.g. Moment) or diclofenac (e.g. Novapirina) or paracetamol (e.g. Tachipirina) can be used. oral. Subsequently, to relieve burning and itchy residues, a low-power cortisone cream such as hydrocortisone (eg Lenirit) can be used, provided that the skin is intact and only for a short period of time.
  • The most serious burns (superficial 2nd degree) must be cleaned and disinfected with an antiseptic solution based on chlorhexidine (e.g. Neoxene), electrolytic chloride oxidant (e.g. Amuchina 10%) or povidone iodine (e.g. Betadine) after removing any fragments of skin destroyed by the burn. Dyes, boric acid solutions or denatured alcohol are not recommended.
  • If bubbles form, they must be opened by piercing them with a sterile needle (passed to the flame), allowing the liquid to flow out, without however removing the skin that forms the roof of the bubble. The bladder skin can be gently removed after a few days by cutting it with carefully disinfected scissors.
  • The area should be medicated with a fatty gauze (eg Adaptic, Jelonet, Non-ad), covered with sterile gauze and then bandaged with a bandage, without ever compressing the affected part too much. Also Fitostimoline and Connettivina gauze should be considered nothing more than simple fatty gauze: in fact, the alleged adjuvant effect of the tissue repair processes of the active ingredients contained in them has not been demonstrated.
  • At the beginning, the dressing will have to be renewed daily to detect the progress of the repair processes; then every 3-4 days until healing usually takes 2 weeks, always thoroughly disinfecting the part. The careful cleansing and disinfection of the lesions avoids the risk of infections and makes the use of topical antibiotics unnecessary.
  • It is important to remember that:
    • the oil burn must not be sprinkled, because it prevents a thorough cleaning of the lesion and, by hindering the dispersion of heat, it favors the maceration of the skin and increases the risk of infections;
    • do not use antibiotic creams without first consulting your doctor;
    • do not use boric acid, denatured alcohol, coloring substances, all toxic to cells.
  • In the most severe burns (2nd and 3rd degree) the treatment is of medical relevance. Do not apply products of any kind on the burn and drink water if the person feels intense thirst. Immediately transport the subject to an emergency room.

When to seek medical attention

  • For all 2nd and 3rd degree burns.
  • For burns that affect delicate parts of the body, such as the face or abdomen.
  • If high fever appears, above 39 °C.
  • In case of delay in healing despite the interventions performed.
  • In case of infection of the burnt part.
  • When the patient is elderly, has diabetes or is a child under 3 years of age.

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