Burns | अग्निदग्ध : जलने पर क्या करें, भेद, लक्षण व चिकित्सा

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals. Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns.

अग्नि स्निग्ध अथवा रूक्ष द्रव्य का आश्रय पाकर जलाती है। अग्नि से सन्तप्त हुआ स्नेह पदार्थ छोटी-छोटी सिराओं में प्रवेश करने की क्षमता रखने से त्वचा आदि में प्रविष्ट होकर शीघ्र जला देता है इसलिये ‘स्नेहदग्ध‘ में अधिक वेदनाएं होती हैं। १५॥

Types of Burns (अग्निदग्ध के भेद):-

असावधानी से हुए अग्निदग्ध (Burn) के चार भेद किए गए हैं-

नाम	लक्षण
प्लुष्ट	जहाँ अतिमात्रा में त्वचा का रङ्ग विकृत हो जाए। और झुलस-सा जाए, उसे ‘प्लुष्ट’ कहते हैं। इसे वाग्भट ने ‘तुत्थ’ कहा है।
दुर्दग्ध	जहाँ पर जलने से भयङ्कर फफोले (छाले) पड़ जाएं तथा चोष (चूसने को सी पीड़ा), दाह, राग (लालिमा), पाक (पूतीभवन) और वेदना ये तीव्र हों तथा अधिक समय में जिसकी शान्ति हो उसे ‘दुर्दग्ध’ कहते हैं।
सम्यग्दग्ध	जहाँ पर व्रण नीचा न हो तथा उसका रङ्ग ताड़ के फल के समान हो एवं सुसंस्थित (समान) हो तथा त्वचा, मांस, सिरा के दाह लक्षणों से युक्त हो उसे ‘सम्यग्दग्ध’ कहते हैं।
अतिदग्ध	‘अतिदग्ध’ में जले हुए मांस के टुकड़े लटकते दिखाई देते हैं, शरीर के अङ्गों या सन्धियों का विश्लेष (Dislocation) या विघटन हो जाता है, सिरा, स्नायु, सन्धि, अस्थि इनका अधिक मात्रा में विनाश हो जाता है तथा ज्वर, दाह, पिपासा और मूर्च्छा ये उपद्रव उत्पन्न हो जाते हैं। इसका बना व्रण देरी से भरता है तथा भर (रोपित हो) जाने पर भी विरूप-सा हो जाता है।

1. Thermal injury
   • Scald- spilling of hot liquids
   • Flame burn
   • Flash burn due to exposure of natural gas, alcohol, combustible iquids.
   • Contact burns- contact with hot metals/ objects/ materials.
2. Electrical Injury
3. Chemical burn- acid/ alkali
4. Cold injury- frost bite
5. Sun burn
6. Ionising radiation

Classification of Burns:-

[A]. Depending on the Percentage of a burn (Burns severity classification)-

• Mild (minor) – Partial thickness burns <15% in adults or 10% in children.
  • Full thickness burns less than 2% can be treated on outpatient basis.
• Moderate – 2nd degree of 15 -25% burns, 3rd degree between 2-10% burns.
  • Burns not involving eyes, ears, face, hand, feet, perineum
• Major (severe)- second degree burns, more than 25%
  • in children > 20%
  • All 3rd degree burns of 10% or more
  • Burns involving eyes, ears, feet, perineum
  • All electrical & inhalation burns
  • Burns with fractures/ mechanical trauma

[B]. Depending on thickness of skin involved-

1. I degree- epidermis- red and painful
   • No blisters
   • Heals rapidly in 5-7 days by epithelialisation without scarring
   • Shows capillary filling
2. II degree– Affected area mottled, red painful with blisters,
   • Heals by epithelialisation in 14-21 days
   • Superficial second degree burn
   • Deep second degree burn.
3. III degree- Affected area- charred, parchment like, painless and insensitive with thrombosis of superficial vessels.
   • Requires grafting
   • Charred, denatured, insensitive contracted full thickness burn is called as eschar.
4. IV degree- involves underlying tissues as well as deeper tissue, possibly involving muscle and bone.

[C]. Depending on thickness of skin-

• Partial thickness burn- either I / II degree burn
• Full thickness burn- III degree burn

Wallace’s rule of Nine (Rule of 9):-

	Adults	Children	Infants
Head and neck	9%	18%	20%
Front of chest and abdominal wall	9*2=18%	18%	20%
Back of chest and abdominal wall	9*2=18%	18%	20%
Lower limb	18*2=36%	13.5*2= 27%	20%
Upper limb	9*2=18%	18%	20%
Perineum	1%	1%	–

Assessment:-

• Wallace’s rule of 9
• Using the Lund and Browser chart

Clinical features-

• History
• Pain
• Burning
• Anxious status
• Tachycardia (Increased heart rate)
• Tachypnea
• Fluid loss

Sepsis in Burn patient-

Due to Streptococcus, Pseudomonas, Staphylococci, other gram negative organisms

Causes of death in Burns-

• Hypovalaemia & shock
• Renal failure
• Pulmonary oedema and ARDS
• Septicaemia
• Multiorgan failure
• Acute airway block in head & neck burns

Management of burns:-

1. Initial management-

• Clothing should be removed
• Cooling of the part by running water for 20 min.
• Cleaning the part to remove dust, mud etc.
• Chemoprophylaxis- tetanus toxoid, antibiotics
• Covering with dressing
• Comfortable with sedation and painkiller.

2. Definitive treatment-

• Admit the patient in burn unit
• Maintain ABC (Airway, Breathing and Circulation)
• Emergency endotracheal intubation
• Do not use succinylcholine

First Aid:

Basic guidance on first aid for burns is provided below.

What to do-

• Stop the burning process by removing clothing and irrigating the burns.
• Extinguish flames by allowing the patient to roll on the ground, or by applying a blanket, or by using water or other fire-extinguishing liquids.
• Use cool running water to reduce thetemperature of the burn.
• In chemical burns, remove or dilute thechemical agent by irrigating with large volumes of water.
• Wrap the patient in a clean cloth or sheet and transport to the nearest appropriate facility for medical care.

What not to do-

• Do not start first aid before ensuring your own safety (switch off electrical current, wear gloves for chemicals etc.)
• Do not apply paste, oil, haldi (turmeric) or raw cotton to the burn.
• Avoid prolonged cooling with water because itwill lead to hypothermia.
• Do not apply ice because it deepens the injury.
• Don’t apply any material directly to the wound as it might become infected.
• Avoid application of topical medication until the patient has been placed under appropriate medical care.
• Do not open blisters until topical antimicrobials can be applied, such as by a health-care provider.