Learning medicine is hard work! Osmosis makes it easy. It takes your lectures and notes to create
a personalized study plan with exclusive videos, practice questions and flashcards, and so
much more. Try it free today! A burn is the damage that happens after something
really hot like a fire, hot water or steam, or even a hot object comes into contact with
skin. But burn injuries can also be caused by extreme
cold; electricity; some chemicals, like strong acids; or radiation, like from the sun or
medical treatments. Ultimately burns cause damage and inflammation
of the skin. The skin plays an important role in protecting
underlying muscles, bones, ligaments and internal organs; forming a barrier to infectious pathogens;
and preventing water loss from the body. Now, the skin is divided into three layers–the
epidermis, dermis, and hypodermis. The epidermis forms the thin outermost layer
of skin, and it’s made up of several layers of keratinocytes – which make and secrete
glycolipids, which help to prevent water from easily seeping into and out of the body. Underneath the epidermis is the thicker dermis
layer that contains the nerves and blood vessels. But the dermis is divided into two layers
– a thin papillary layer just below the epidermis, and a deeper reticular layer. The papillary layer contains fibroblasts which
produce a connective tissue protein called collagen. The fibroblasts are arranged in finger-like
projections called papillae; each of which contains blood vessels and nerve endings. Nerve endings found in this layer sense pain
and fine touch, which allows you to feel something like a feather touching your arm. The reticular layer of the dermis is even
thicker than the papillary layer. The collagen in the reticular layer is packed
very tightly together, making it excellent tissue support. In addition, fibroblasts in the reticular
layer secrete elastin–which is a stretchy protein that gives skin its flexibility. The reticular layer also contains the skin’s
accessory structures like oil and sweat glands, hair follicles, lymphatic vessels, and nerves
– and all of the blood vessels that serve these tissues. A type of nerve ending found here detects
pressure or vibration, which allows you to feel someone grabbing your arm. Finally, just below the reticular layer is
the hypodermis. It’s made of fat and connective tissue that
insulates and pads the deeper tissue; and anchors the skin to the underlying muscle. When the skin is burned, it damages cells
and the proteins within them. And the number of skin layers affected determines
the burn degree. So, in first-degree burns, also called superficial
burns, the burn only affects the epidermis. In second-degree burns, the burn affects the
epidermis and the dermis. If only the papillary layer is burned, it’s
considered a second-degree superficial partial thickness burn. But if the burn reaches the deeper reticular
layer but doesn’t extend through the entire layer, then it’s considered a second-degree
deep partial thickness burn. In third-degree burns, also called full-thickness
burns, the entire epidermis and dermis are affected. And finally, fourth-degree burns extend into
the hypodermis. When a skin layer is affected, it means that
the skin cannot function effectively, and common complications are infections, especially
from Pseudomonas aeruginosa, and water loss through the damaged skin. As burns heal, macrophages move into the tissue
to remove dead cells and fibroblasts create new collagen to heal the damaged skin. The more extensive the area with new collagen,
the more extensive the scar. So, scars are common in second degree deep
partial thickness burns and third- and fourth-degree burns. Symptoms of a burn depend on the degree of
the burn. In first-degree burns; the affected area becomes
red, dry, and painful. These areas also tend to blanch, turning white
as blood flow is restricted with compression. Second-degree superficial partial thickness
burns can be red with clear blisters; wet, as if they are weeping; and are even more
painful than first-degree burns, but still blanch. A second-degree deep partial thickness burn
may vary in color from yellow or white to red; have blisters; and can be wet or dry. Because of damage to blood vessels and nerve
endings, burns of this degree may not blanch and there may only be pain due to pressure
because of nerve damage. A third-degree burn can appear waxy white
to leathery grey or black; and dry. Again, blanching doesn’t occur and the pain
may only feel like deep pressure – in other words, they can be relatively painless. Additionally, the elastin damage causes the
burn to be stiff or inelastic. Finally, fourth-degree burns are charred black;
dry; have pain only from deep pressure but can be painless from complete destruction
of nerve endings; and have patches of dead skin. Having said that, the margins of all burns,
often have lots of damaged nerve endings and that can be painful. The diagnosis of a burn is often based on
the burn’s appearance and the amount or type of pain, but sometimes tissue biopsies
are obtained to accurately determine which layers are affected. In adults, the severity of burns is calculated
using the rule of nines. The rule of nines evaluates several distinct
sections of the body’s total surface area for the presence and degree of burns. Eleven of the sections each make up 9% of
the body’s surface area and are: the head; right arm; left arm; chest; abdomen; upper
back; lower back; the front of the left leg; and the back of the left leg; and the same
for the right leg. A final section, the groin, accounts for the
missing 1% of the body’s surface area. The treatment for a burn is determined by
what caused the burn, the rule of nines, and the locations of the burns on the body. In general, immediate treatment typically
includes preventing further burning; like flushing the burn with cool, but not ice-cold,
running water. After that, it’s important to manage pain
with medication. Minor burns, like first- and second-degree
superficial thickness burns can heal on their own over a few days or weeks by keeping them
bandaged, and clean with soap and water. Sometimes lotions to prevent drying or topical
antibiotics can be used. If blisters form, it’s best to leave them
alone because the intact skin helps to prevent infections. For more serious burns, like electrical and
chemical burns; or second- or third-degree burns in sensitive areas like the face, hands,
and genitalia – hospitalization in specialized burn centers is often needed. In those situations, it’s important to replenish
lost fluids and electrolytes, and to prevent infections with antibiotics. Surgical procedures like skin grafting, excision
of dead skin, or amputation, especially in third- or fourth- degree burns, may also be
needed. So, to recap: A burn is injury, protein denaturation
and cellular damage that occurs in the skin caused by extreme heat or cold; electricity;
some chemicals; or radiation. The degree of burn, is determined by whether
the epidermis, dermis or hypodermis are affected and each degree has specific symptoms. The rule of nines; the cause of the burn,
and location of the burn can help determine treatments. In general, treatments include minimizing
the initial burn and pain management. Minor burns don’t typically require treatment
beyond keeping the area clean, moist and bandaged. But severe burns may require more extensive
medical intervention, particularly hospitalization at specialized burn centers, to prevent infections and dehydration.

33 Replies to “Burns”

  1. This came just at the right time for me! Just today I was studying for a presentation I'll give on burns next week. Very useful!

  2. The only thing I heard when seeing this video: "Got to let it burn, burn, burn…" thanks Elli Goulding 😅

  3. The only thing I heard when watching this video was: "I got to let it burn, burn, burn". Thanks Ellie Goulding… 😅👍

  4. Good video as always by Osmosis but it could’ve better if Parkland formula for IV fluids like Ringer Lactate could also be included as there are new updates in calculating the required IV fluids via the above formula. ♥️

  5. Good but…i wish you'd talked about the exact amount of fluid needed for resuscitation using the parkland formula or any other method

  6. In your presentation at 0.38 minute you stated "burn can be caused by strong acid" but the true statement should be "by chemical exposure" that you stated correctly in your recap.

  7. great video… if an update is to come can include Curling's ulcer and treatment with ranitidine, tetanus prophylaxis and facial burns recognition and importance of early recognition… i understand tho that it may be difficult to keep it in short time but as always covered a lot of ground in a short time so kudos again… you guys are my go to

  8. The Classification is not exactly right, 3rd degree burn already extends into the hypodermis (subcutaneous tissue) while 4th degree burn goes beyond to affect deeper structures, such as muscle, fat, fascia or bone.

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