Burns and scalds in veterinary practice

Burns and scalds in veterinary practice

INTRODUCTION

Burns are injuries cause pain, scarring and deformity to skin and tissues.

The purpose of the study to identify the cause of burns, types, complications, symptoms, pathogenesis and pay attention to treatment

The causes of burn are various and different and may be: Thermal derived from any source of heat, Radiation caused by long and direct exposure to ultraviolet rays, Chemical caused by strong acid, gases or strong alkali. or electrical derived from cell membrane electroporation.

Burns classified to three main degrees as following: First degree burns are in the epidermis only. Second degree involves a part of the dermis and can be (Superficial or deep) and Third degree burns reach through the whole layer of dermis.

Signs of burns depend on burn depth:

  • First degree: burns are red and painful.
  • Superficial second degree: burns blanch with heat.
  • Deep second degree: burns may be white, purple, or red and white spotted.
  • Third degree: It may be white, black and burnt, rusty and leathery, or bright red.

The pathogenesis of burn is that heat leads to denaturation of protein and necrosis

Complications of burn are two types: systemic (Hypovolemia, Infection and metabolism abnormalities) or local (eschar and scarring).

The purpose of treatment to relief pain and achieved by local and systemic routs.

Prognosis of burns depends on the severity of the injury.

Definition:

It is a skin injury and other tissues arising from heavy exposure to temperature, radiation or chemicals. When burning etiology is hot oil or stems this is called scald condition

Etiology:

  • Thermal burns: can derive from any external source of heat (flame, hot solid, hot liquid and Stem). Fires lead to smoke inhalation toxicity.
  • Radiation burns: most commonly caused by long and direct exposure to solar ultraviolet (sun burn). Or caused by the other sources of ultraviolet radiation (tanning beds). Or from the exposure to x-ray or non-solar radiation.
  • Chemical burns: the skin and tissues suffering from necrosis derived from strong acids, strong alkalis, phenols, and Mustard gas, phosphorus and petroleum products like gasoline.
  • Electrical burns: are the result of cell membrane electroporation and generation of heat associated with the large electron currents. Despite limited apparent cutaneous injury, electrical burns frequently cause significant deep tissue damage to conductive tissues like muscles, nerves, arteries and veins.

Events associated to burning such as crashing of a motor vehicle or jumping from burn building may result in further injury.

Classification of burns:

  1. First degree: burns are in the epidermis only. and This form of burning is characterized by injury to the shallow layers of the epidermis, heat burn, pronounced hyperemia and mild skin edema. The slight sunburn is an example, and the superficial layers desquamate and subtitled by deeper germ layers
  2. Second degree: this type of burning involves a part of the dermis which can be superficial or deep. Superficial: The papillary (most superficial) dermis is involved in superficial partial-thickness burns. These burns treated within 1 to 2 weeks and normally the scarring is minimal. Healing is achieved by epidermal cells lining sweat gland ducts and hair follicles; these cells expand to the surface, and then move across the surface to reach neighboring glands and follicles.
  3. Deep: include the deeper dermis and require about 2 weeks to recover. Healing takes place only from hair follicles, and scar tissue is usual and may be extreme.
  4. Third degree: Burns reach through the whole dermis and into the underlying fat. Treatment takes place only at the periphery; these burns require excision and skin grafting, only if small.

Signs and symptoms:

depend on burn depth.

  • First degree: such burns are red, widely blanched with light pressure, and are painful and sensitive. Neither vesicles nor edema grow.
  • Superficial second degree: such burns blanch with heat, and are sensitive and painful. Within 24 hours vesicles grow. The vesicle bases are pink, and produce a fibrinous exudate afterwards.

Deep second degree: those burns may be white, purple, or red and white spotted. They are less painful and sensitive than superficial ones.

  • a pinprick is often viewed as more pressure than sharpness. Vesicles may grow. These burns are commonly dry.
  • Third degree: It may be white, black and burnt, rusty and leathery, or bright red. Pale burns of third degree may simulate normal skin except that the skin does not blanch to the pressure. Usually third degree burns are anesthetic. Hair can be easily pulled out of its follicles. No vesicles usually grow. Sometimes it takes 24 to 48 hours to develop features which distinguish third degree from deep second degree burns.

Pathogenesis:

Heat from burns causes denaturation of proteins, and therefore coagulative necrosis. Platelets accumulate around the coagulated tissue, constriction of vessels, and slightly perfused tissue (known as the stasis zone) can spread around the injury. Tissue is hyperemic and swollen in the stasis region.

Damaged tissues often become edematous, increasing the volume loss. Heat loss may be major because of the absence of thermoregulation of the affected dermis, particularly in exposed wounds.

First degree of burns is manifested by serous or serofibrine exudation and regeneration happens of epithelium. While those of third degree show inflammatory reaction with pus formation.

Disorders in the circulation of paranchymatous organs after few hours of prolonged burns, particularly liver and lung. This disruption may be due to peripheral blood vessel vasodilatation and increased permeability leading to edema and hypovolemia. The affected tissue quickly infested with suppurative dermatitis caused by bacteria. Finally, there comes sepsis or shock.

Systemic reactions such as:

  • Hypovolemic shock affect kidney function
  • Respiratory disorder due to smoke inhalation
  • Blood loss leads to hem concentration disorder
  • Toxicity and shock

Complications of burns: there are two types of complications caused by burns

  1. Systemic: the severity of systemic complications depends on the percentage of the total body surface area (TBSA). and include:
  2. Hypovolemia: caused by loss of body fluids as a result of burn leads to hypoperfusion of affected tissues and may cause shock. Damage of blood vessels may also lead to hypoperfusion.
  3. Infection: bacterial invasion is an important cause of toxicity and sepsis even in small burns. The most common bacteria are staphylococci and streptococci at the first days of infection and gram negative bacteria after 7 days.
  4. Abnormalities in metabolism: include hypoalbuminemia as a result of hemodilution and loss of protein extravasculary. And may cause acidosis due to shock and may cause hypomagnesemia, hypophosphatemia and hypokalemia.
  5. Hypothermia: caused by large amounts of cool intravenous fluids and usage of cool emergency treatment especially in extensive burn.
  6. Local complications:

Eschar: dry, damaged and dead tissue caused by burns. As a result of edema, a constricting eschar prevents the tissue expansion; then, tissue pressure increases, causing local

  1. ischemia which affects the viability of the extremities distal to the eschar.
  2. Scarring: as a result of healed deep burn. Depend on the scar expansion and infection may increase scarring.

Treatment: Goals of treatment targeted at pain relief, circulatory disorder correction, prevention of bacterial invasion, and use of stimulants for healing.

  1. Local treatment:
  2. In case of chemical substance, the wound is washed with soap and water after sufficient analgesia, and any loose debris is eliminated. To prevent causing hypothermia, water should be room temperature or warmer.
  3. Evacuation of blisters to enable the escape of its contents and to alleviate pressure-related pain.
  • Removal of Tissue Burned or Necrotic.
  1. Burn surface swapped with

 

  1. Antimicrobial salts (e.g. 1% silver sulfadiazine), industrial silver dressings (e.g., Nano crystalline silver dressings with continuous release), or biosynthetic wound dressings (also known as artificial skin products). Topical salves have to be changed each day.
  2. Iodine tincture.
  3. Saturated picric acid solution acts as analgesic and antiseptic.
  4. Tannic acid 2% acts as astringent.
  5. Antiseptic ointments such as cocaine ointments.
  6. It can be used with solcoseryl ointment or cod liver oil to stimulate a cure.
    1. Systemic treatment:
    2. for counteracting histamine effect, antihistaminic drug must be applied (Avil)
    3. If there are signs of respiratory failure and the animal is exposed to large levels of smoking, bronchodialer can be used as a minophylline, or tracheotomy is indicated if the dyspnea is too serious.
    • Administration of broad spectrum antibiotic to control bacterial infection especially streptococci and staphylococci.
    1. Administration of analgesics like cortisone as it is analgesic, antihistaminic and anti-inflammatory but it has side effects such as immunosuppression and retard healing .so flunixine meglumine is considered one of the best analgesic and anti-inflammatory.
    2. It is important to counteract the effect of toxemia and depression by administration of hypodermic caffeine as a stimulant.
    3. Nutritional support to pre-exist under feeding is suggested. Support is provided with a feeding tube as soon as possible.
    • It is important to correct hypovolemia by using fluid therapy. The best of fluids is ringer lactate. And it is dose depend on dehydration degree.
      Maintenance

      dose

      45-55 ml/ kg 2-4 ml/ kg/ hour
      1. Surgery: Indicated for burns that are not supposed to heal within 2 weeks, including most burns of deep partial thickness and all burns of full thickness. Eschars are removed as soon as possible, preferably within 2-4 days to avoid sepsis and to encourage early grafting of wounds.

      prognosis:

      • Depending on the severity of the injury instead of the degree of burning, shock may occur if more than 40 percentage of the skin affected, but if more than 50 percentage of the skin is injured, the prognosis is poor.
      • First degree needs 9-12 days for healing.
      • Second and third degrees need 28 days or more for healing.

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