Kinds of burns

Thermal burns can occur as a result of exposure to various external heat sources (flames, liquids, solid objects and gases). Fire can also cause inhalation of toxic combustion products.

Radiation burns are most typical as a result of prolonged exposure to solar ultraviolet radiation (sunburn) or after prolonged or intensive exposure to other sources (for example, a solarium), and also after X-ray irradiation or non-sun radiation.

Chemical burns are the result of exposure to concentrated acids or alkalis (for example, liquor, cement), phenols, cresols, mustard gas or phosphorus. Necrosis of the skin and underlying tissues as a result of this exposure can develop for several hours.

Burns of the respiratory tract and inhalation of smoke often occur simultaneously, but are also possible separately. When inhaling smoke, toxic combustion products and in some cases high temperature damage respiratory tract tissues. High temperature affects usually only the upper respiratory tract, since the total thermal load of the incoming gas reaches in most cases only up to the upper respiratory tract. The exception is steam, which often burns the lower respiratory tract. Many of the toxic chemicals that are generated in conventional household combustion (for example, hydrogen chloride, phosgene, sulfur dioxide, toxic aldehydes, ammonium) irritate and damage the lower and sometimes upper respiratory tract. Some toxic combustion products, usually carbon monoxide and cyanides, damage the cellular respiration of the entire body.

Usually the symptoms of upper respiratory tract infection develop within minutes, but sometimes several hours; swelling of the upper respiratory tract can cause stridor. Symptoms of the lower respiratory tract (shortness of breath, wheezing, sometimes coughing and chest pain) usually develop within 24 hours.

Inhalation of smoke should be suspected in patients with respiratory symptoms that persist in the burning environment and with soot in the sputum. Burns around the mouth and scorched nose hair can also indicate this, unless they are caused by a flash of open fire (for example, from a gas grill burner). The diagnosis of upper respiratory tract infection is based on endoscopic findings (laryngoscopy and bronchoscopy), which is sufficient for a complete examination of the upper respiratory tract and trachea and which can reveal edema and the presence of burning air in the respiratory tract. However, in some cases in the early stages of the endoscopic picture is normal, and the lesion develops later. Endoscopy is performed as soon as possible, usually by a flexible endoscope. Diagnosis of the lower respiratory tract infection is based on chest radiography, oximetry, or gas composition; The diagnosis may not be verified until 24 h.

All patients with suspected inhalation damage are given 100% O2 with a face mask until the diagnosis is clarified. Patients with airway obstruction or respiratory failure require endotracheal intubation or another type of respiratory protection and artificial ventilation. Patients with edema and significant charring of the upper respiratory tract should be intubated as soon as possible, as it will be more difficult to do with increasing edema. Patients with lower respiratory tract infection may require masked O2, bronchodilators and other supportive measures.

Electric burns are the result of exposure to tissue heat generated by electricity; It can cause extensive damage to deep tissues with minimal skin changes.

Incidents involving burns (for example, a jump from a burning building, being under ruins, an automobile accident) can lead to other injuries.

Burns cause protein denaturation and coagulation necrosis. Platelet aggregation, vasospasm and critically depleted blood supply (called the stasis zone) around the coagulated, burned tissue can also cause necrosis. Around the zone of stasis, tissues are hyperemic and inflamed. Damage to the normal epidermal barrier opens the possibility for bacterial invasion and external fluid loss. Damaged tissues often swell, leading to even greater losses of fluid volume. Due to damage to the epidermis, thermoregulation is impaired, the leakage of liquid increases heat loss with evaporation, which together significantly increases heat loss.

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