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A Therapeutic Look at Third Degree Burns

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Normally one might think of fire when they think of third degree burns, but they can be caused by chemical contact with the skin, and scalding injuries also. Serious burn injuries could be caused by electrical burns. There is many ways to obtain such a serious injury. No matter how the injury happened, there is always a threat of impending shock, circulatory collapse, heart failure, respiratory failure, renal (kidney) failure, and infection.

Hospital burn units are filled with patients that have suffered third degree burns. Sometimes people are so severely burned that pieces of flesh fall off in the caretaker’s hands. There is no pain where the flesh is so severely burned because the nerve endings have been burned away. There may though be severe pain in the surrounding tissues around the perimeter of third degree burns. At the time of the burn injury pain is of the least concern.

Many burn patients die each year, and it isn’t always the burn that kills them, but the heart and circulatory failure, and other system failures that take place secondary to the burn injury. When the skin is burned away the body fluids start to leave the body. The fluid that makes up the plasma of the blood starts to shift from the circulatory system and exit the body through the surrounding tissues and drain through the burn injury. Approximately 80 percent of the people that have suffered third degree burns have had some kind of heart involvement.

Not only is it the heart that is involved, but the heart is involved because all of the body systems are involved. The person that suffers burn injury may also suffer kidney damage, respiratory problems such as pneumonia. Many burn patients suffer from shock, which is caused by a massive fluid loss. The fluid loss then causes impaired blood flow and decreased oxygenation of the body tissues. The brain, the heart, the kidneys and the nervous system all take a hit when someone suffers third degree burns. Most people that die from third degree burns don’t die from the injury, they die from the complications.

Third degree burns often burn down to the fat layers and even farther into the muscle tissues and sometimes down into the bone. When such an injury occurs the capillaries are burned away, and thus most of the body’s fluids leave through this route. It is almost like opening a flood gate and letting water out. All the body’s systems take a huge hit due to third degree burns.

Sepsis is a major concern with burns. When the skin is burned away there is no barrier to protect us from the bacteria that lives in the air and on every surface. When the skin is burned away there is basically no immune system for a while to fight off infection. Burn patients are placed in isolation to protect them from contamination.

The treatment for burns is often the painful part. The first order of treatment of third degree burns is to remove the eschar (hardened dead skin and burned tissues) which is like a hard scab covering the burn. In order for the live tissue to heal, the dead tissue must be debridement of the dead tissue. Debridement is often done while the patient is soaking in a whirlpool bath or in the operating room. IV’s have to be administered. Usually an electrolyte solution of Ringers Lactate is administered. Antibiotics are administered intravenously. Often the burns are treated with ointments or a special cream such as silver nitrate.

Once the debridement has been done there is lots of pain; pain medications are often given via an intravenous pump that delivers a specific dose at specified times. The patient with burn injuries needs a special high protein diet with supplemental snacks in between; burn injuries require a much caloric energy to heal. There may be many treatments to follow, such as skin grafting and surgical reconstruction for functional and cosmetic reasons.



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