‘’THERMAL TRAUMA’’ PATHOPHYSIOLOGY, CAUSES, DIAGNOSIS, TREATMENT, PREVENTIONS AND THE OUTCOMES.
Thermal trauma is any burn related injury that can potentially lead to serious outcomes. There are various causes of thermal trauma which includes; fire, radiant heat, radiation, hot cooking oil, boiling water, chemical or electrical contact that can affect a person in many ways based on factors from anatomical and physiological factors. Scalds are the most common type of thermal burn suffered by children, but for adults thermal burns are most commonly caused by fire. Burns are generally classified from first degree up to fourth degree but the American Burn Association (ABA) has categorised thermal burns as minor, moderate, and major, based almost solely on the depth and size of the burn.
This is a typical image of a thermal trauma patient been rushed down to our hospital
Before been giving medical attention
During wound care and management
After wound care management
WHAT ARE THE PATHOPHYSIOLOGY?
The skin is the largest organ of the body, making up about 16% of a person’s weight. The main skin functions are protection (infection, temperature changes, physical forces, chemicals, etc.), body temperature regulation, preventing fluid loss, and cosmetic/identity. Two primary layers comprise the skin, the thinner outer layer called the epidermis, and the deeper, thicker layer called the dermis. There are various other structures within the skin like hair follicles, sebaceous glands, sweat glands, capillaries, and nerve endings.
Thermal burns cause both local injuries and a systemic response. The local injuries can be roughly separated into three zones of injury analogous to a circular target pattern which includes;
- Zone of coagulation is the area that sustained maximum damage from the heat source. Proteins become denaturated, and cell death is imminent due to destruction of blood vessels, resulting in ischemia to the area. Injury at this area is irreversible (coagulative necrosis & gangrene) 
- Zone of stasis surrounds the coagulation area, where tissue is potentially salvageable. This is the main area of focus when treating burn injuries.
- Zone of hyperemia is the area surrounding the zone of stasis. Perfusion is adequate due to patent blood vessels, and erythema occurs due to increased vascular permeability.
WHAT ARE THE CAUSES OF THERMAL BURNS?
There are several causes of thermal burns which includes;
- Hot liquids and steam
- Hot object
- Radiation, such as that from X-rays
- Electrical current
- Chemicals such as strong acids
HOW PATIENT ARE BEEN DIAGNOSED OF THERMAL TRAUMA IN OUR FACILITY
For burn treatment, our medical personnel’s assess the severity of your burn by examining your skin. We might recommend that you be transferred to a burn centre if your burn covers more than 10 percent of your total body surface area, is very deep, is on the face, feet or groin, or meets other criteria established by the American Burn Association.
We also check for other injuries and might order lab tests, X-rays or other diagnostic procedures.
TREATMENT OPTIONS IN ADEBAYO HOSPITAL
Most minor burns can be treated at home. They usually heal within a couple of weeks.
For serious burns, after appropriate first aid and wound assessment, your treatment may involve medications, wound dressings, therapy and surgery. The goals of treatment are to control pain, remove dead tissue, prevent infection, reduce scarring risk and regain function.
People with severe burns may require treatment at specialised burn centres. They may need skin grafts to cover large wounds. And they may need emotional support and months of follow-up care, such as physical therapy.
After you have received first aid for a major burn, your medical care may include medications and products that are intended to encourage healing.
- Water-based treatments. We use techniques such as ultrasound mist therapy to clean and stimulate the wound tissue.
- Fluids to prevent dehydration. You may need intravenous (IV) fluids to prevent dehydration and organ failure.
- Pain and anxiety medications. Healing burns can be incredibly painful. You may need morphine and anti-anxiety medications — particularly for dressing changes.
- Burn creams and ointments. If you are not being transferred to a burn centre, your care team may select from a variety of topical products for wound healing, such as bacitracin and silver sulfadiazine (Silvadene). These help prevent infection and prepare the wound to close.
- Dressings. We may also use various speciality wound dressings to prepare the wound to heal. If you are being transferred to a burn centre, your wound will likely be covered in dry gauze only.
- Drugs that fight infection. If you develop an infection, you may need IV antibiotics.
- Tetanus shot. Your doctor might recommend a tetanus shot after a burn injury.
PHYSICAL AND OCCUPATIONAL THERAPHY
If the burned area is large, especially if it covers any joints, you may need physical therapy exercises. These can help stretch the skin so that the joints can remain flexible. Other types of exercises can improve muscle strength and coordination. And occupational therapy may help if you have difficulty doing your normal daily activities.
Surgical and other procedures
You may need one or more of the following procedures:
- Breathing assistance. If you’ve been burned on the face or neck, your throat may swell shut. If that appears likely, your doctor may insert a tube down your windpipe (trachea) to keep oxygen supplied to your lungs.
- Feeding tube. People with extensive burns or who are undernourished may need nutritional support. Your doctor may thread a feeding tube through your nose to your stomach.
- Easing blood flow around the wound. If a burn scab (eschar) goes completely around a limb, it can tighten and cut off the blood circulation. An eschar that goes completely around the chest can make it difficult to breathe. Your doctor may cut the eschar to relieve this pressure.
- Skin grafts. A skin graft is a surgical procedure in which sections of your own healthy skin are used to replace the scar tissue caused by deep burns. Donor skin from deceased donors or pigs can be used as a temporary solution.
- Plastic surgery. Plastic surgery (reconstruction) can improve the appearance of burn scars and increase the flexibility of joints affected by scarring.
LIFESTYLE AND HOME REMEDIES
To treat minor burns, follow these steps:
- Cool the burn. Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases. Don’t use ice. Putting ice directly on a burn can cause further damage to the tissue.
- Remove rings or other tight items. Try to do this quickly and gently, before the burned area swells.
- Don’t break blisters. Fluid-filled blisters protect against infection. If a blister breaks, clean the area with water (mild soap is optional). Apply an antibiotic ointment. But if a rash appears, stop using the ointment.
- Apply lotion. Once a burn is completely cooled, apply a lotion, such as one that contains aloe vera or a moisturizer. This helps prevent drying and provides relief.
- Bandage the burn. Cover the burn with a sterile gauze bandage (not fluffy cotton). Wrap it loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
- Take a pain reliever. Over-the-counter medications, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others), can help relieve pain.
- Consider a tetanus shot. Make sure that your tetanus booster is up to date. Doctors recommend that people get a tetanus shot at least every 10 years.
WHAT ARE THE PREVENTIONS OF THERMAL BURNS ?
TAKE BURN SAFETY PRECAUTIONS TO PREVENT INJURIES AT HOME
Many ordinary things at home including bath water, food, and electrical outlets can causes child hood burns. To prevent burns at home;
- Reduce water temperature
- Avoid hot spills
- Establish ‘NO’ zones
- Keep hot devices out of the reach of children
- Choose fire resistant fabrics
- Address outlets and electrical cords
- Keep appliances unplugged when not in use
- Keep a fire extinguisher nearby
- Keep your cooking area free of inflammable materials
- Keep your cooking gas, electric cookers e.t.c out of the reach of children
95% of people hospitalized for thermal burns survive. Survival rates have increased steadily over the last half century due to the advances in treatment and better management of burns case s. Patients with uncomplicated burns cases have a 99.7% survival rate.
For further enquiries visit us at Adebayo living tower hospital.
” I C T Department”
ADEBAYO LIVING TOWER HOSPITAL