combustion

Combustion: description

A burn is a skin damage caused by direct heat. Contact with hot liquids is called scalding. Hot or heated objects trigger so-called contact burns. Accidents involving chemicals can cause chemical burns or chemical burns. Damage caused by electric current is called electrical burn. UVA or UVB and X-rays cause so-called radiation burns.

Burning frequency

Every year, approximately 350,000 people in Germany are treated with burns by established physicians and around 15,000 are hospitalized in hospitals. About ten percent of them require intensive care treatment. According to Federal Health Reporting, around 17,000 people were burned or burned in the hospital in 2013. 372 people succumbed to their burn injuries. The most common were burns of the hand.

Typically, adult burns are caused by flames or hot gases (such as deflagration after an explosion). Children and the elderly, on the other hand, are the most likely to scald. Burns usually occur in the home or at work.

Structure of the skin

The outermost layer is the epidermis. The superficial horny layer with its protective film of sebum and sweat prevents the penetration of bacteria, fungi and foreign substances. In addition, the epidermis protects the body from drying out. It is easily worn, but constantly replicated by deeper cells. A mild burn is usually limited to the epidermis. At the border to the underlying dermis also the outermost defense cells of the immune system are settled.

Directly under the epidermis lies the dermis (corium, dermis). Here run finely ramified skin-supplying blood vessels, muscle strands and nerves. The upper cells of the dermis are more active than the lower ones. Therefore, a superficial sclera burn heals easier than a deeper reaching. Below it is the hypodermis (subcutis), which consists of fatty tissue and is traversed by larger blood vessels and nerves.

Depending on the depth of a burn, burns are divided into four degrees of combustion:

1st degree combustion

In a 1st degree burn, the burn is limited to the epidermis, usually only to the superficial stratum corneum. She heals without consequences.

Combustion: 2nd degree

A 2nd degree burn damages the skin to the uppermost layer of corium. Read all important information about 2nd degree combustion here

3rd degree burns

Grade 3 burns damage the entire epidermis and extend into the subcutaneous tissue.

4th degree combustion

A 4th degree burn charred all skin layers and often also seized the underlying muscle tissue with bones, tendons, and joints.

Combustion: symptoms

The symptoms of burning or scalding depend primarily on their depth: the lower the burn injury, the more the sensation of pain is lost. For particularly deep burns, some patients therefore no longer have any pain (analgesia) at all, since the nerve endings are as burned as the remaining skin tissue. The severity of a burn or scald depends not only on the temperature, but also on the duration of exposure.

Blisters form as the epidermis separates from the underlying dermis. The epidermal cells swell and die (vacuolating degeneration). An open burn sneezes through fluid leaking from the bloodstream. Dead tissue appears white in the early stages and later transforms into black-brown scab.

In general, severe burns usually affect the entire organism. The dead tissue can cause kidney failure through certain mechanisms. Due to the loss of body fluids and proteins via the burn injury, the tissue is no longer sufficiently supplied with blood and supplied with oxygen. Patients complain of dizziness or even lose consciousness.

Ultimately, a major burn injury can result in a life-threatening shock (burn shock). Typical symptoms include markedly low blood pressure, a very fast-paced heart (palpitations, tachycardia), cold, pale arms and legs, and metabolic disorders. The reduced blood flow of the organs can eventually lead to their failure.

Depending on the degree of burn the following symptoms may occur:

combustion rate	symptoms
I	Pain, swelling (edema), redness (erythema)
II a	severe pain, redness, blistering
II b	little pain, redness, blistering
III	no pain, skin appears black, white or gray and leathery, there is an irreversible death of tissue (necrosis).
IV	completely black charred areas of the body, no pain

scalding

Tough (viscous) fluids store heat better and often cause more damage to skin than scalding water, for example. There are usually different degrees of combustion simultaneously. Frequently, so-called “trace marks” are recognizable.

inhalation trauma

Inhaling hot gases or air mixtures can also damage the respiratory tract. This so-called inhalation trauma usually has an unfavorable effect on the general healing process of the patient. Burns on the head and neck, burned nose and eyebrow hair and soot traces in the ear, nose and throat area indicate such damage. Concerned are mostly hoarse, get bad air and cough soot.

electric combustion

Electric burns occur when the body is exposed to electrical current, for example, by lightning. As the body provides natural resistance to the current, heat develops – the greater the resistance, the greater the heat. Since the bones provide a great resistance, therefore, usually located nearby muscle tissue is destroyed. The severity of electric combustion also depends on the type of current, the current flow and the contact duration. In most cases, only a small, inconspicuous skin wound appears, at the electrical current has entered the body.

Incineration: causes and risk factors

Burns and scalds occur when the body is exposed to intense heat. From temperatures above 44 degrees Celsius tissue is destroyed. With long-lasting heat, even values ​​above 40 degrees Celsius are enough. In addition to the temperature, the duration of the heat is significantly involved in the formation of a combustion.

Possible causes of burning or scalding are:

• open fire, flames, explosion: classic burning
• hot water, water vapor, oil and other liquids: scalding
• hot metal, plastic, coal, glass: contact burning
• Solvents and cleaning agents, concrete, cement: chemical combustion
• Electricity in the home, power lines, lightning: Electric combustion
• Sunbathing, solarium, radiation treatment by UV and X-rays: radiation burning

necrosis

Due to the acting heat, the cell protein of the body cells clots. The cells are destroyed and the surrounding tissue can die off (coagulation necrosis). Finally, pro-inflammatory messengers (prostaglandins, histamine, bradykinin) and stress hormones are released, which make the blood vessel walls more permeable (permeability increase). Liquid flows from the bloodstream into the tissue and causes it to swell, causing edema. The fluid leakage from the blood vessels is highest in the first six to eight hours and can last up to 24 hours.

Effects on the body

In the course of edema, the amount of circulating blood (volume deficiency, hypovolemia) in the bloodstream decreases. As a result, organs are no longer supplied with sufficient blood. Ultimately, kidney failure and intestinal deficiency can lead to cardiovascular failure and death.

afterburning

Due to the water retention, the tissue surrounding the burn can no longer be adequately supplied with oxygen and further cell damage occurs. Doctors refer to this as “afterburning”. Due to the persistent fluid flow into the tissue, the extent of combustion can usually only be fully assessed after one day.

Combustion: diagnosis and examination

For the first assessment of a burn, eye diagnosis is usually sufficient. However, the circumstances are important under which there was a burn injury. Your doctor will therefore ask you questions about your complaints as well as the circumstances of the accident:

• How did it burn?
• What caused the burn, such as an open fire or a hot object?
• Has the incineration occurred at home or at work?
• Did you burn yourself with hot water or hot fat, so you suffered a scald?
• Was there smoke around you, poisonous gases or soot in the air?
• Do you have pain?
• Are you dizzy or have you briefly lost consciousness?

Your doctor or dermatologist (dermatologist) is the right contact person for mild burns. Severe burns must be treated by an ambulance and then by surgeons.

Physical examination

After the medical examination, the doctor thoroughly examines the body. In severe burns, for example, after a clothing fire, the burn victim is completely stripped. In addition, the physician will measure blood pressure, heart rate, and the frequency of breaths, as well as monitor the performance of the heart, which may be particularly affected by power accidents. Finally, the doctor stops the lung (auscultation), takes blood and makes an X-ray of the lungs.

Needle sample

Distinguishing 2nd degree combustion from 3rd degree is usually difficult at the beginning and can only be achieved after about 24 hours. The stitch helps with a needle. In a third-degree burn, the patient feels no pain.

blood test

Certain blood levels provide information about inflammation, blood loss and lack of fluid as well as respiratory function. In an inhalation trauma is usually a high proportion of carbon monoxide in the blood, which inhibits especially the oxygen transport. In addition, inflammatory messengers (eg interleukins IL-1, -2, -8 and tumor necrosis factor alpha) in the blood can be detected in severe burns. Since a burn victim loses proteins over the burn wound, the protein content in the blood is reduced in severe burns. While the sodium content is usually reduced, the potassium content increases due to cell damage.

Bronchoscopy of airway burns

For burns of the respiratory tract, the doctor will perform a lung scan. Over a flexible, thin tube with a camera at the end of the doctor can make deeper regions visible. In an inhalation trauma there are traces of soot and whitish-gray spots, which indicate the death of cells. Examination of lung mucus (tracheal secretions) may also indicate burns if, for example, soot particles are found.

Estimation of the extent of combustion

Especially in the first days after a major burn, the doctor will closely monitor the course and perform some examinations again. To estimate the extent of a burn, the doctor goes to Wallace according to the so-called nine-rule. According to the survey, each of the arms occupies nine percent of the surface of the body, the legs, trunk and back each occupy 18 percent (two times nine percent), the head and neck nine percent, and the genital area one percent.

According to the rule of the palm, the palm of a patient’s hand is about one percent of the total body surface area.

Both of these rules are only rough estimates that need to be adapted especially to infants and babies. For example, the head of an infant accounts for 20 percent of the body area, while the trunk and back take only 15 percent each.

Associated injuries

During the physical examination, the doctor will pay attention to further injuries such as broken bones or internal bleeding and, if necessary, will arrange further examinations, for example computed tomography or ultrasound. If there is a suspicion of infection of the burn wound with bacteria, a smear of the wound is taken and the exact pathogen determined. Basically, adequate tetanus vaccine protection is important. After the primary vaccination, a booster dose should be given at the latest every ten years.

Combustion: treatment

What to do in case of burns. Read here everything important about the treatment of burns and how you can treat scalding.

Combustion: disease course and prognosis

The healing process in a burn depends primarily on the depth and extent of the burned body surfaces. Pre-existing conditions, a high age of the person affected and accompanying injuries such as organ damage reduce the chances of recovery. Infants and children are more prone to complications than adults.

Burning becomes life-threatening, especially if an adult is damaged by about 15 percent of the body surface (at least grade 2b) – children are already threatened at eight to ten percent. If left untreated, severe burns ultimately lead to cardiovascular failure and death.

Estimation of the prognosis

There are two systems that can be used to estimate the healing process of a burned person. The obsolete Banx index adds the percentage of the burned body surface to the patient’s age. For values ​​over one hundred, according to this index, the probability of survival is below ten percent.

More precisely, the so-called ABSI score, which takes several factors into account. In addition to age and extent, the presence of respiratory tract burn, third-degree burns and the patient’s gender also play a role. But the ABSI score also disregards certain risk factors. Because according to recent medical studies reduce accompanying or pre-existing conditions such as diabetes, wound healing disorders and increased susceptibility to infections, obesity (obesity) and nicotine and alcohol consumption, the probability of survival.

prognosis

Depending on the depth of the burn, healing may take several weeks or months. A 2nd degree burn heals after about a month, with pronounced scars. If tissue has to be transplanted (transplantation), not only clear scars but also different skin tones can occur. Heavy burn injuries must be treated in specialized centers. In 2013, nearly 13 percent of the 2050 severely burned patients died.

Prevent burns

Many burn accidents are caused by careless action. Prevention is particularly important in the case of burns due to electricity. Thus, safety measures at workplaces at risk are constantly being improved. Clarification on safety precautions and regular maintenance should also protect against electrical burns.

Even in the household, you can prevent burns with a few simple measures. Always switch off the electricity before starting electrical work and use flammable substances such as spiritually. Do not smoke in bed. For small children in the home, you should close hot, open oven doors and keep cooking pots or burning candles out of reach. This will reduce the risk of scalding or combustion.