Medical burns

Burns are injuries caused by extremes of heat or cold, electricity, chemicals, light, radiation, or friction. There is a high degree of variation in terms of the severity of burns, the type of tissue affected, and resulting complications. Damage from burns can occur in muscle, bone, blood vessel, dermal, and epidermal tissue. Subsequently, burns may be very painful due to injury to nerves. Based on the location and severity of the burn, a number of potentially fatal complications may be experienced. These include shock, infection, electrolyte imbalance, and respiratory distress. Unless treated by dermal regeneration, burns can result in scars and other deformities that may be psychologically damaging.

Severity of Burns

Burns may be classified to indicate their severity by using two commonly recognized systems. Burn severity can be classified by either the degree system or by the “burn thickness” system, based on the layers of tissue involved.

Superficial thickness—first degree

First degree burns are usually limited to redness (erythema), a white plaque, and minor pain at the site of injury. These burns involve only the epidermis. Minor radiation burns, such as sunburns, can be included as first-degree burns. These are easily remedied with dermal instruments, and biosynthetic ointments.

Partial thickness (superficial)--second degree

Second degree burns manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.

As with burns of this category and those more severe, great care must be taken to ensure cleanliness of the wound, leading up to and during the time of treatment. The environments of burns often provide ideal conditions for bacteria and other pathogens to cause severe and life-threatening infection within surprisingly short time frames.

Partial thickness (deep)--third degree

Third degree burns occur when the epidermis is lost with damage to the subcutaneous tissue (tissue beneath the skin). Burn victims will exhibit charring and extreme damage of the epidermis, and sometimes hard eschar (dead tissue) will be present. Third-degree burns result in scarring and victims will also exhibit the loss of hair shafts and keratin (ie. fingernails). These burns may require dermal (skin) or vascular (muscle) regeneration.

Full thickness—fourth degree

Fourth degree burns damage muscle, tendon, and ligament tissue, thus result in charring and catastrophic damage of the hypodermis. In some instances the hypodermis tissue may be partially or completely burned away as well as this may result in a condition called compartment syndrome (deoxygenization of nerves and blood vessels), which threatens both the life and the limb of the patient. There is no sensation as the nerves are destroyed. Extensive tissue regeneration must be performed within a short time frame, otherwise, amputation is required if the burn does not prove to be fatal.

Subdermal—fifth degree

Fifth degree burns result in complete destruction of epidermis, dermis, Subcutaneous fat, and underlying tissue and possibly fascia (connective tissue), bone or muscle. These burns secrete a purple fluid, the eschar is hard and leathery, and there is also no sensation as the nerves are destroyed. Death is usually certain unless these burns occur on an outer extremity (arm or leg). In the case of an outer extremity burn, massive tissue regeneration is required. If regeneration is not possible within a short time frame, amputation is practically unavoidable.

Causes of Burns

Burns may occur from a wide range of causes. Sufficient irritation to the dermal layer will cause damage, and as such, burns can occur from sources such as chemicals, electrical currents, radiation, combustion reactions, and hot fluids.

Chemical Burn

Most chemicals that cause severe chemical burns are strong acids or bases. Chemical burns are most often created by caustic substances such as sodium hydroxide (NaOH), and silver nitrate (AgNO3). More serious burns occur from compounds such as sulfuric acid (H2SO4) and nitric acid (HNO3). Hydrofluoric acid (HF) can cause burns down to the bone, and often its effects are not immediately evident. Such compounds are carefully and jointly monitored aboard Star Fleet vessels and outposts by the Science, Security, and Support departments.

Electrical burns

Electrical burns are caused by an exogenous electric shock. Common causes of electrical burns include workplace injuries, electrical explosions, or being defibrillated or cardioverted without a conductive layer. Lightning is a rare cause of electrical burns. The internal injuries sustained may be disproportionate to the size of the burns seen, and the extent of the damage is not always obvious. Such injuries may lead to cardiac arrhythmia, cardiac arrest, and unexpected falls with resultant fractures.

Radiation burns

A radiation burn is damage to the skin or other biological tissue caused by exposure to radio frequency energy, plasma energy, or ionizing radiation.

The most common type of radiation burn is sunburn caused by UV radiation. High exposure to X-rays, as they were once used during diagnostic medical imaging or radiotherapy, can also result in radiation burns.

As ionizing radiation interacts with cells within the body and damages them, the body responds to this damage, typically resulting in erythema (redness around the damaged area). Radiation burns are often associated with cancer and other similar illnesses due to the ability of ionizing radiation to interact with and damage DNA, occasionally inducing a cell to become cancerous. Certain medical instruments can be improperly used to create surface and internal burning.

Depending on the photon energy, gamma radiation can cause very deep gamma burns, with Cobalt-60 internal burns common. Beta burns tend to be shallow as beta particles are not able to penetrate deep into the person; these burns can be similar to sunburn.

Radiation burns can also occur with high power radio transmitters at any frequency where the body absorbs radio frequency energy and converts it to heat. Starfleet Medical Command (SMC), as well as the Starfleet Corps of Engineers (SCE), consider 50 watts to be the lowest power above which conventional radio signals must evaluate emission safety. Frequencies considered especially dangerous occur where the human body can become resonant, at 35 MHz, 70 MHz, 400 MHz, and 1 GHz.

Scalding

Scalding is caused by hot liquids or gases, most commonly occurring from exposure to high temperature tap water. Scalding commonly causes blisters. A blister is a "bubble" in the skin filled with serous fluid (benign bodily fluids) as part of the body's reaction to the heat and nerve damage. The skin on the blister "roof" is dead. Steam is a common gas that causes scalds. The injury is usually regional and usually does not cause death. More damage can be caused if hot liquids enter an orifice. However, deaths have occurred in more unusual circumstances, such as when people have accidentally broken a steam pipe. The demographics that are of the highest risk to suffering from scalding are young children, with their delicate skin, and the elderly over 65 years of age. Scalds may be easily treated with dermal instruments and biosynthetic ointments.

Management of Burn Patients

If the patient was involved in a fire accident in an enclosed space, then it must be assumed that he or she has sustained an inhalation injury until proven otherwise, and treatment should be managed accordingly. At this stage of management, it is also critical to assess the airway status. Any suspicion of burn injury to the lungs (e.g. through smoke inhalation) is considered a medical emergency.

Regardless of the cause, the first step in managing a person with a burn is to stop the burning process at the source, and cool the burn wound, but not the patient. It is essential to avoid the "lethal triad" of hypothermia (body temp. goes below metabolic rate), acidosis (increased acidity in the bloodstream, ie. gases) and coagulopathy (blood clotting disorder). For instance, with dry powder chemical burns, the powder should be brushed off first. With other burns the affected area should be rinsed thoroughly with a large amount of clean water or through sonic cleansing. Cold water should not be applied to a person with extensive burns, however, as it may result in hypothermia.

To help ease the suffering of a burn victim, they may be placed in a special burn recovery bed which evenly distributes body weight and helps to prevent painful pressure points and bed sores. Survival and outcome of severe burn injuries is remarkably improved if the patient is treated in a specialized burn center/unit rather than a standard biobed.

Burn Wound Management

All burn wounds should be cleaned and debrided before dressings are applied. Debridement is the removal of devitalised tissue, debris and any contamination of the wound surface. Small blisters can be drained but larger blisters should probably be removed. No burn should be dressed until thorough cleaning and debridement has been performed. Chemical burns should be irrigated until the skin pH returns to normal. Biosynthetic dressings may speed healing tremendously.

Pain management

A number of different options are used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and narcotics. A local anesthetics may help in managing pain of minor first-degree and second-degree burns

Alternative Treatment

Honey has been used since ancient times to aid wound healing and may be beneficial in first and second degree burns.