Ninguno

ABC of burns Introduction
Shehan Hettiaratchy, Peter Dziewulski
Burns are one of the most devastating conditions encountered in medicine. The injury represents an assault on all aspects of the patient, from the physical to the psychological. It affects all ages, from babies to elderly people, and is a problem in both the developed and developing world. All of us have experienced the severepain that even a small burn can bring. However the pain and distress caused by a large burn are not limited to the immediate event. The visible physical and the invisible psychological scars are long lasting and often lead to chronic disability. Burn injuries represent a diverse and varied challenge to medical and paramedical staff. Correct management requires a skilled multidisciplinary approachthat addresses all the problems facing a burn patient. This series provides an overview of the most important aspects of burn injuries for hospital and non-hospital healthcare workers.

This is the first in a series of 12 articles

How common are burns?
In the United Kingdom about 250 000 people are burnt each year. Of these, 175 000 attend accident and emergency departments, and 13 000 of theseare admitted to hospital. Some 1000 patients have severe enough burns to warrant formal fluid resuscitation; half of these are children aged under 12 years. In an average year 300 burn deaths occur. These UK figures are representative of most of the developed world countries, although some, such as the United States, have a higher incidence. Burns are also a major problem in the developing world.Over two million burn injuries are thought to occur each year in India (population 500 million), but this may be a substantial underestimate. Mortality in the developing world is much higher than in the developed world. For example, Nepal has about 1700 burn deaths a year for a population of 20 million, giving a death rate 17 times that of Britain.

Top: Child with 70% full thickness burns,which required resuscitation, intensive care support, and extensive debridement and skin grafting. Left: The same child one year later at a burns camp, having made a good recovery. A reasonable outcome is possible even with severe burn injuries

Causes of burns Chemical and electrical 5% Scalds 40% 55% Flame

Incidence of burns by age >65 years old 10% 20% 10% 60% 5-14 years old

1-4 years oldWhat are the causes of burns?
Most burns are due to flame injuries. Burns due to scalds are the next most common. The most infrequent burns are those caused by electrocution and chemical injuries. The type of burns suffered is related to the type of patient injured. It is therefore useful to break down burn aetiology by patient groups as this reveals the varying causes of injury. In mostgroups there is a male predominance. The only exception is in elderly people, among whom more women are injured because of the preponderance of women in that population.

15-64 years old

Causes of burns (left) and incidence of burns by age (right)

Who gets burnt?
Young children—Children aged up to 4 years comprise 20% of all patients with burn injuries. Most injuries (70%) are scalds due tochildren spilling hot liquids or being exposed to hot bathing water. These mechanisms can lead to large area burns. Because of changes in the design and material of night clothing, flame burns are less common than they were. Boys are more likely to be injured, a reflection of the behavioural differences between boys and girls.

Scald in young child caused by spilling hot liquid. Most of the burnis superficial, except for the patch on the shoulder, which required a skin graft and which healed well

Older children and adolescents—10% of burns happen to children between the ages of 5 and 14. Teenagers are often injured from illicit activities involving accelerants, such as petrol, or electrocution. Working age—Most burns ( > 60%) occur in patients aged 15-64. These are mainly due to...