Warning:
• The first emergency gesture is to cool the burned area (not burnt: risk of hypothermia), so as to minimize the propagation of heat in depth, and thereby deepening burn.
• Any skin burn extent greater than 15% (adult), 10% (children and old), 5% (infant), requires medical transport to a specialized center.
• Any local act on a burned area is very painful: we must resort to painkillers, tranquillizers possibly, minimize the dressing changes (in the absence of local suppuration), and formally proscribe dry dressings (grip) and very absorbents (drying and adhesion).
• Edema is always an evocative sign of deep burn (reaching the dermis, vascularized tissue).
• Any burn unhealed at J15 must be shown to a specialist, for the eventual realization of a transplant, and especially for the prevention of sequelae (skin contractures, hypertrophic scars), the initiation of a specialized rehabilitation.
• Burns 2nd degree deep can end by the long heal spontaneously from preserved islands (deep) of basal layer, but it is then, in most cases, a healing very poor in origin of significant sequelae.
Having in mind the histo-physiology of the skin:
The skin consists of two parts:
– The epidermis is an epithelial tissue lining: it is a layered structure, dense, keratinized and dynamic, which provides coverage (protection); he constantly renews a unidirectional way from his deep, but very active thin layer, called ‘basal layer’ of Malpighi; after injury, it is sufficient to continue the dead ends of the hair follicles, surrounded by basal layer, for a regeneration (of varying quality) can take place spontaneously;
– The dermis is a supporting connective tissue: it is a vascular structure, hydrated, which provides nutrition and mechanical properties of tensile strength and elasticity; it regenerates a multi-directionally in the form of a granulation tissue after lesion.
Assess the extent of the percentage burned area:
This can be done through the “Rule of 9” of Wallace:
– Face and scalp = 9%
– Upper limb = 9%
– A front trunk (anterior or posterior) = 18%
– Perineum = 1%
– Lower limb = 18%.
When burned area corresponds to only a fraction of one of these five areas, its scope can be evaluated using as “standard surface” the palm of the burned area which is about 1%.
Assess the depth of the burn degree:
– An isolated erythema corresponds to 1 degree.
– A blister (broken or not) is the 2nd degree. The distinction between 2nd degree superficial, intermediate and deep, is made based on the appearance of the fabric in the blister:
– A pink fabric or hemorrhagic sign in principle a superficial 2nd degree, or through especially if edema;
– A heterogeneous tissue staining, stippling (red, white, or brown) and edematous, sign in principle a deep second degree. However, the exact diagnosis of depth in
the case of a second degree burn is not sometimes possible to J3 or J4:
– A thin eschar (dry crust, insensitive, formed of mortified tissue) indicates a second intermediate degree;
– Thicker eschar reflects a deep second degree.
– A thick eschar (dry crust, insensitive, formed of mortified tissues), brown or white, is the 3rd degree.
Worrying severe evolving risks:
– Burns 1st degree, 2nd degree superficial, intermediate, recover without sequelae, except a few small pigmentation disorders.
– Burns 2nd degree deep and 3rd degree are formidable because they seriously expose:
– The short-term risk of pressure ulcer infection, with the fear of sepsis and septic shock;
– The risk to medium and long-term skin retraction and hypertrophic scar, in the months following healing (spontaneous evolution in the absence of treatment).
Order 1: 1 degree burn
– Analgesic,
– BIAFINE [trolamine], multiple applications in a thick layer, so as to saturate the skin (dressing maintained for about 3 days).
Ordinance No. 2: burn 2nd degree superficial or intermediate
– Analgesic, plus possibly a tranquilizer,
– Excision blisters and
– STERLANE, for cleaning serosities,
– Rinsing with sterile water or saline and either
– Biseptine [Chlorhexidine gluconate, benzalkonium chloride, benzyl alcohol] pursuant followed by coverage of a type of dressing “skin substitute” (spontaneous detachment during healing: beschitin-w) or
– FLAMMAZINE [silver sulfadiazine], applied in thin layer, repeated every 3 days (after washing with sterile water or saline) during the dressing change.
No.3: slightly extended burn of deep 2nd degree or 3rd degree
– Analgesic, plus possibly a tranquilizer,
– STERLANE, for cleaning serosities,
– FLAMMAZINE [silver sulfadiazine], applied in thin layer, repeated every 2 to 3 days (after washing with sterile water or saline) during the dressing change.
Ordinance No. 4: fairly extensive burns to extent of deep 2nd degree or 3rd degree
– Analgesic (beware of tranquilizers in extended forms with general signs)
– 20% hibitane [chlorhexidine] diluted 1 / 2000e (preparation of 1 liter of solution:
2.5 ml of pure product + sterile distilled water) pursuant covered with a bandage, and
– Systematically sending in a specialized center for advice, leading either to outpatient treatment or a treatment in hospital.
Ordinance No. 5: Specialized rehabilitation severe burns serving functional area
– Early Compression,
– Equipment “skin in maximum capacity,”
to avoid the flanges constitution.