Burns are one of the important health problems of our country. One of the most important causes of death due to accidents in the childhood age group is burns. In our country, 6500-7,000 children consult a doctor every year due to burns. Half of childhood burns occur on less than 10% of the body surface. 4-5% of children's burns must be treated by being admitted to a burn center. Mortality occurs in 3-4% of all burns. As the percentage of burns increases, the death rate also increases.
As awareness of burns in the family increases, the incidence of burns decreases. Burns can be significantly reduced with parental education and preventive health services.
Causes of burns in children?
The most common cause is burns due to spilled hot water. Following this, flame and electrical burns may also occur due to contact with the iron or stove. Burns due to spilled chemicals and lightning strikes are other causes of burns that can be seen in children.
Although burns in children generally occur due to accidents, child abuse should definitely be kept in mind. It has been reported that 15% of child burns involve parental neglect or abuse.
What are the conditions that determine the damage in burns?
The width and depth of the burned part of the burn are related to tissue damage. determines the damage. The degree of heat, contact time, thickness of the skin and the cause of the burn are very important. While hot liquid burns are more superficial, flame and electrical burns are deeper. To determine the amount of burn, the burn surface and depth must be known.
What is burn depth and how is it determined?
Burn depth shows how deep the burn reaches from the skin surface. Burns are divided into three groups according to their depth.
- First degree (superficial) burns: Only the superficial part of the skin, called the epidermis, is burned. This is the case with sunburns or low-temperature heat burns. Burn-related skin changes in color and pain occur. It heals spontaneously within 7-10 days without leaving a scar.
- Second Degree Burns:
- Second degree superficial burns: The damage to the epidermis and skin The superficial (papillary) part of the dermis, which is the second layer, is half is. The burn area is blistered (blister), red in color and swollen.
- Second-degree deep burns: The entire two layers of the skin, the epidermis and the dermis, are burned. The burn area is watery and swollen.
- Third-degree burns: The entire skin and the underlying fatty tissue are burned. The sense of sensation is completely lost. In some cases, fascia, muscle tissue and bone tissue may also be burned.
Determination of the burn surface:
Burn surface It is determined according to the rule of nines in adolescence and adults. Both arms and head are evaluated as 9%, legs and front and rear trunk are evaluated as 18%, and perineum and genital area are evaluated as 1%. The rule of 9s does not fully reflect burns in children; these rates vary depending on age.
What is a major burn?
- More than 10% of 2° burns under the age of ten.
- More than 20% of 2° burns over the age of ten
- More than 5% 3° burns
- Burns on the face, hands, feet, genital and perineal areas and over the joints
- Chemical burns
- With significant electrical burns lightning burns
- Inhalation burns (burns in the respiratory tract due to inhalation of hot air)
Major burns must go to hospitals with burn centers or burn doctors and are usually treated by hospitalization. It is necessary.
What are the changes caused by a burn in the body?
Burn causes local and systemic changes in the body.
What are the first procedures to be performed in case of a burn?
It varies depending on the type of burn and the agent. However, in general, the child is removed from the cause of the burn. It is then quickly investigated whether there is a life-threatening emergency. If there is a life-threatening situation regarding the airway and circulation, these should be corrected first. Burned clothing and metal jewelry are removed. The burn area is cooled immediately. Water at room temperature is poured onto the burn area. Heat loss should be prevented in case of major burns. If there are problems such as frequent breathing or noisy breathing, the patient should be given 100% oxygen. Intravenous access should be established and appropriate fluid therapy should be started. Painkillers should be given and the child should be taken to a burn center as soon as possible.
In chemical burns, the chemical agent that causes the burn is removed from the child. The burn area is washed with plenty of water and the chemical substance is prevented from contaminating the surrounding tissues. No chemical agent is used to neutralize the chemical substance. Because heat is released during this reaction and increases the burn.
Minor (small) cheeks:
The burn is less than 10-20% of the body surface, flammable. If the contact with the substance is minimal and the flammable substance is not a chemical agent, these are called minor burns.
Should blisters (bulla) in the burn area be burst?
Minor burns If the bullae have not burst spontaneously, and especially if they are in the palm, they cannot be burst. The skin layer over the bulla creates a barrier against environmental conditions and infection. There is no need to dress unruptured bullae every day. The water in the bulla is absorbed spontaneously within about a week. Meanwhile, epithelialization (wound healing) begins at the burn site. It is necessary to open large blisters and clean the dead tissue on them.
Burn treatment
- First degree, such as sunburn. Superficial burns heal on their own within 10 days at most. The aim here is to complete this process painlessly, painlessly and comfortably. For this, the burn area is cooled with tap water immediately after the burn. Afterwards, applying cream or ointment is sufficient. There is no need to close the wound. These drugs reduce the feeling of pain and ache caused by drying and stretching of the skin. Painkillers may be given to prevent pain. However, it is not necessary to apply creams containing local anesthetic. Since the integrity of the skin is disrupted, the absorption of these substances may be uncontrolled, and side effects of these drugs on the heart and circulatory systems may occur. It is not necessary to use antibiotics. They heal without leaving a scar within 1-2 weeks.
- For the major burns mentioned above, it is necessary to consult a specialist. These are treated on an outpatient or inpatient basis upon the doctor's recommendation. Nowadays, advanced wound dressings are available. Rather than hurting the child by dressing every day, it would be more appropriate to apply closed dressings every 4-5 days.
- In case of second-degree superficial burns, the treatment is for second-degree superficial burns, after cleaning the burn wound with sterile physiological saline, then applying special dressing-covering materials. The burn is covered and bandaged. Depending on the type of wound dressing covered, dressing is applied once between two and seven days. They usually heal within 2 weeks without leaving a scar.
- In second-degree deep and larger burns, surgical procedures such as surgical removal of dead tissues, bringing normal skin from another place and stitching it to the area may be needed. These treatments should be performed in burn centers and burn hospitals. Healing takes more than 3 weeks. If the eschar tissues cannot be sufficiently epithelialized after removal, it is necessary to perform graft operations.
- In third degree burns: The skin is completely necrosed. The nerve endings are also burned and there is no pain. There is no chance of recovery, they heal with eschar excision and graft operations.
Types of Dressings Used in Burn Treatment:
All burns should be washed with plenty of isotonic, large burns should be washed with plenty of isotonic. The roof of the bullae can be excised. Small bullae can be left untouched. Types of dressings used in burns;
Burn dressing has three purposes;
- To protect the wound against microorganisms in the external environment
- Preventing heat and fluid loss through evaporation
- Ensuring patient comfort by reducing pain.
Preventing the development of hypertrophic scar and contracture:
There is a possibility of hypertrophic scar development, especially in the healing of 2nd degree deep and 3rd degree burns, whether by epithelialization or grafting. As scar maturation is completed, its color changes, it softens, and its swelling decreases to normal skin level. This process lasts between 6-24 months. If epithelialization (closure of the wound);
