Burns are injuries caused by the excessive heat of an agent in any physical state.
They are one of the most common household injuries, especially among children. Most people can recover without serious health consequences, depending on the cause and degree of the burn. More serious burns require urgent medical attention to avoid complications and death.

Causes of burns:

-boiling water, steam
-fire, flame
-hot oils
-solid hot objects (contact burns)
-chemical burns
-ionizing radiation, excessive sun exposure

All the mentioned factors work by leading to coagulation of cell proteins and intercellular mass and consequently to tissue necrosis. Electricity and chemicals, in addition, directly damage the cell membrane.

When examining and diagnosing, it is necessary to determine the name of the injury (combustio - flame, ambustio - water, steam, electrocutio - electricity, causoma - caustic matter, etc.); injury location (body part); the magnitude of the injury expressed as a percentage; depth of burns expressed in degrees.

The type of burn is not based on the cause. Boiling water, for example, can cause all three degrees of burns, depending on how hot the water is and how long it has been in contact with the skin. Chemical and electrical burns require urgent medical attention because they can affect the inside of the body, even if the skin damage is minor.

The intensity of damage depends on:

-temperature of the causative agent
-time of action on the organism

The skin is made up of epithelial and connective tissue. The epidermis is a superficial layer and has a great ability to regenerate from the deeper layers of the skin, skin appendages and from the edges of the wound. The dermis is a layer of connective tissue that represents 9/10 of the thickness of the skin and its damage leads to fibrous changes that are permanent.

Tissue changes occur in three zones:


Zone of necrosis - is definitely damage, which must be removed in order for the body's reparative mechanisms to work.
Trail zone - tissue around the necrosis that we try to preserve as much as possible during treatment because it shows a tendency towards extinction and deepening of the burn.
Zone of hyperemia - surrounding undamaged tissue with a reaction to changes in the first two zones.

The body's response to injury

The body's response to a burn (injury) can be local, regional, and systemic.

Locally at the site of the burn, there is destroyed tissue, released mediators, inflammation, infection may be present and through reparative processes with epithelialization as the final phase of the acute response.

The regional response includes the appearance of severe edema on the head and neck, eating disorders of the extremities as a consequence of circular collapse, cellulitis (phlegmon) as a consequence of infection.

The systemic response is most significant especially in burns that cover a large area of ​​the body (> 15%) because they can be life-threatening. Such burns lead to "burn disease". The person loses a significant amount of plasma and disrupts circulation. The proliferation of inflammatory mediators in the body leads to vasodilation of capillaries and additional fluid loss, which can lead a person to a state of shock.
Also, inhalation injuries that significantly endanger the patient's life are possible. Burns that lead to the appearance of eschar (burnt devitalized tissue) on the neck and chest endanger the breathing of the injured person. The infection can turn into sepsis at any time, which is also life-threatening.
If the burn affects the neck and head, edema can occur within 12 to 24 hours, which completely changes the personal description of the injured person. There is a deformation of the face, closing the eyes, the person cannot look. When the burn occurs indoors, damage to the upper parts of the respiratory system can occur, symptoms are hoarseness, cough, stridor, wheezing, etc.

The most important, but not the only elements in determining the severity of the clinical picture of burns are the size of the injury as well as its depth.

The size and extent of the injury are determined as the percentage of damaged skin in relation to the total body surface area (TBSA). In practice, the "rule of nine" and the "rule of the palm" are used for basic orientation. In the "rule of nine", the body of an adult is divided into 11 regions of relatively equal area. Each represents 9% TBSA. These parts are: the upper extremity, the front of the lower extremity, the back of the lower extremity, the head and neck and the front and back of the trunk (18% forward and rear).

The rule of nine is most often used in the assessment of large burns, but in the case of smaller ones the rule of the palm is much more precise. The palm area of ​​the observed person is approximately 1% of the body surface. The fingerless palm corresponds to an area of ​​0.5%. These rules do not apply to children because the ratio of body parts is different than that of adults. The depth of the burn is not easy to estimate and a definitive estimate of the depth of the burn is made within 24 to 48 hours.

Burn levels

There are three primary types of burns: first, second and third degree. Each degree is based on the severity-degree of skin damage, starting with the first as the least degree of damage.

Damage includes:
⦁ Degree: light red leather, without bumps
⦁ Degree: bumps of different sizes, some thickening
⦁ Grade: inelastic, stiff, thickened skin, white or brown.

There are also 4th degree burns, which include all the symptoms of 3rd degree burns but also extend beyond the skin into the tendons and bones.

Burns therapy

Treatment of burns includes therapy of the burn itself, treatment of systemic disorders within the "burn disease" and treatment of complications that occur during the disease and treatment.

⦁ application of general, standard first aid measures (A - airway, B - breathing, C - circulation),
⦁ remove the injured person from the harmful agent,
⦁ prevent further harmful effects of the same,
⦁ protect the injured area,
⦁ if it is possible to cool the injured area
⦁ if there are signs of accompanying shock, act according to the possibilities (warming of the body, administration of analgesics, oral administration of fluid with caution due to intestinal paresis).

In the treatment of burns, it is not advisable to apply any means of folk and official medicine on the burnt surface! This facilitates the subsequent treatment of burns and prevents secondary wound contamination. In accordance with the severity of the burn, provide adequate transport of the injured to the health institution.

1st degree burns

First-degree burns do not require serious treatment. However, it is important to examine the injured person and rule out deeper burns. Such a person is advised to avoid existing heat sources that have led to the injury. Local treatment with cold compresses and a mild moisturizer is needed. Analgopyretics may be taken as needed.

They cause minimal damage to the skin, they are also called superficial burns. Signs include redness, minimal inflammation or swelling, pain, and dryness of the skin and peeling during healing that lasts up to 10 days, without scarring.
However, it is necessary to consult a doctor if the burn affects a larger area of ​​skin, and the face and large joints such as
knees, ankles, elbows, shoulders, feet ..

First-degree burns are usually treated with home care, the earlier it starts, the faster the healing process.

Treatment includes:

-natapanje rane u hladnoj vodi pet minuta ili duže
-uzimanje acetaminofena ili ibuprofena za ublažavanje bolova
-nanošenje lidokaina (anestetika) sa aloe vera gelom ili kremom za umirenje kože
-upotrebu antibiotske masti i labave gaze za zaštitu pogođenog područja

Ne koristiti led, jer to može pogoršati štetu. Nikada ne stavljati pamučne kuglice na opekotinu, jer se mala vlakna mogu zalijepiti na povredama i povećati rizik od infekcije. Takođe, izbegavati kućne lijekove poput putera i jaja, jer oni nisu dokazano efikasni.

Zašto je češkanje opekotine štetno?

Češkanje rane od opekotine možda može olakšati inicijalni bol povezan sa povredom, ali će u konačnici usporiti proces zarastanja. Štaviše, u nekim slučajevima, češkanje rane od opekotine može uzrokovati promrzline na već oštećenom i osjetljivoj koži.

Opekotine 2. stepena

Su mnogo ozbiljnije od opekotina 1. stepena jer se oštećenje proteže izvan površnog sloja kože. Ova vrsta opekotina dovodi do pojave bula , koža postaje ekstremno crvena i upaljena. Neke se bule otvore davajući opekotini mokar izgled. S vremenom,preko rane može da se razvije , debelo, mekano tkivo nalik na krastu, zvano fibrinozni eksudat.
Zbog delikatne prirode ovih rana , održavanje rane čistom i adekvatno bandažiranje je neophodno za prevenciju infekcije. Ovo također pomaže da se opekotina brže zaliječi.
Nekima treba više od 3 sedmice da zarastu , ali većina zarasta unutar 2-3 sedmice bez ožiljaka, ali često sa pigmentnim promjenama kože.

Treatment includes:

-As with 1st degree burns: avoid cotton balls and questionable home remedies.
- Soak skin under open cold water for 15 minutes or longer
- analgesia (acetaminophen or ibuprofen)
- application of antibiotic cream

The goal of burn treatment is to reduce wound contamination and provide the most favorable conditions for spontaneous healing. Cleaning is performed in conditions of antisepsis and asepsis. First, the clothes, dirt, traces of the substance that led to the injury, if any, are removed. This is followed by cleaning with a non-aggressive antiseptic (povidone, asepsol, etc.). The procedure is repeated until the wound is cleansed. It is then rinsed with copious amounts of saline and approached to howling.
Second-degree burns are covered with a five-layer bandage, greasy gauze, wet gauze, dry gauze, sterile cotton wool and a sterile bandage. Oily gauze (vaseline) enables easier drainage of fluid from the wound to the upper layers, better epithelialization and less painful subsequent dressing. The wet gauze is soaked in physiological solution, a solution of rivanol, povidone, boric acid, etc. It works by locally cooling the injured area and absorbing the secretion evenly as it dries. Dry gauze absorbs secretions and protects the wound from the penetration of infection. Sterile cotton wool enhances this effect, evenly pressing the wrapped surface. The sterile bandage compresses all the mentioned layers evenly.
The bandage placed in this way enables optimal conditions for spontaneous healing, epithelialization, and with supervision and occasional controls it can remain unchanged for up to 12, 14 days. The burns by then complete spontaneous epithelialization and are considered cured. The bandage is changed earlier if wetting occurs (allows infection to occur), infections occur. Signs of infection are redness, increased pain, swelling, fever, chills, weakness and malaise. If necessary and depending on the isolated bacteria, penicillins can be used in the treatment of the infection.
Be sure to seek emergency medical attention if the burn covers a larger area such as:
face, arms, buttocks, groin, feet.

3rd degree burns

Excluding 4th degree burns, 3rd degree burns are the most severe. They cause the most damage by affecting every layer of the skin. It is a mistake to believe that they hurt the most. With this type of burn, the damage is so extensive that there may not be any pain due to nerve damage.

Depending on the cause, symptoms may include:
-wax and white
-dark brown
-dry, dead dermis with visible thrombosed blood vessels of the skin
-elastic, rigid (as treated leather)

Without surgery, these wounds heal with severe scarring and contractures. Skin transplantation is necessary.
Never treat third-degree burns on your own. CALL AN EMERGENCY MEDICINE IMMEDIATELY. While waiting for medical treatment, raise the injury above heart level. Do not take off your clothes, but make sure that the clothes are not glued to the burn.

Treating severe burns is extremely expensive, probably the most expensive in medicine. The suffering of the injured person and his relatives is pronounced and long-lasting, and the outcome is very uncertain. Surviving patients usually carry lifelong consequences and require a number of reconstructive surgeries and rehabilitation procedures. Sometimes rehabilitation lasts a lifetime, and the working and living ability of these people is significantly reduced.

Certain occupations carry a higher risk of burns, but most burns actually do occur at home. The most sensitive are newborns and young children. Preventive measures at home include:

⦁ keep children away from the kitchen while cooking
⦁ turn the pot handles towards the back of the oven
⦁ put a fire extinguisher in or near the kitchen
⦁ test smoke detectors once a month
⦁ replace smoke detectors every 10 years
⦁ keep the boiler temperature below 120 degrees
⦁ check the water temperature before bathing
⦁ remove-lock matches and lighters
⦁ install electrical outlet covers
⦁ check and remove electrical cables with exposed wires
⦁ Keep chemicals out of reach and wear gloves when using
⦁ Use sunscreen every day and avoid strong sun
⦁ Remove smoking products

It is also essential to have an escape plan in case of fire and practice it with the family. In case of fire, crawl under the smoke. This will reduce the possibility of losing consciousness and being trapped in the fire.