CHENNAI: The survival rate of victims of burn injuries has increased with advancements in intensive care unit (ICU) facilities, cosmetic procedures and skin graft techniques. Even patients who suffer 70% burn injuries can be saved now, say doctors. Supportive treatment, pain relief management, physiotherapy, occupational therapy, psychological support, nutrition, among other factors help in the survival rate of burn cases, doctors add.
“Allograft, taking skin from cadaver and giving a temporary patch on the burnt skin, is important. This allows the wound to heal fast and it is very useful in treating acute burn illness. This has improved outcomes of the patients,” Dr P Nellaiappar, head of burns and plastic surgery department, Government Kilpauk Medical College Hospital, Chennai.
“Hyperbaric Oxygen Therapy is also a new treatment, where the patient is passed into a machine and it will supply oxygen to all the tissues, which will help in healing,” said Nellaiappar. Before starting treatment for burns, taking two aspects into consideration is very important - the percentage of the surface of the skin burnt and the depth of the burns, the doctor added.
“We now have lot of artificial skin substitutes called dermal substitutes even in cases of major burns. These can be used to save lives by replacing large areas of the skin that are deeply burned. Not only lives, the ultimate outcome also will be better. In burn injury a lot of scarring and disability is possible, and these substitutes will help prevent all that to a great extent,” said Dr Satish Kumar, head of plastic surgery department, Sri Ramachandra Institute of Higher Education and Research.
Apart from wound management, it has importance in ICU management of burn injuries. “People might think only skin is burnt, but once the skin gets burnt deeper, all the organs in the body will malfunction. Good ICU facilities are a very important component to keep the person alive, like ECMO,” said Satish.
“Hot air inhalation will burn lungs as well. It will cause dehydration and also prevent the heart from pumping properly. To manage all these, they need good intensive care. Advanced drugs and skin graft techniques will help the wound heal faster. They also need psychological support as they may face post traumatic stress disorder (PTSD) in the long term also. Advancements in the cosmetic surgeries has helped people live with confidence,” said Satish.
“As soon as the patient is admitted, the vitals are first checked and also critical points will be checked. Nose, mouth, eyes, genitals and others are critical points. Catheter will be inserted to measure the urine output, to know if all body functions are performing normally,” said Nellaiappar. “For example, the urine output of a person with 50kg body weight should be 50ml per hour. Through IV fluids, the person’s hydration and nutrition part should be taken care of. Advanced medicines, ointments and gadgets help in higher recovery rate,” added Nellaiappar.
“As people who suffer burns are more prone to any kind of infections as they live without skin, they need regular monitoring for infections and a dedicated ICU exclusively for burns patients,” said Dr Mahendran, senior consultant and head of critical care dept, SIMS Hospital, Chennai. People who suffer burn injuries around the face might face breathing problems if their air passage is affected. “Swelling in the face, black lips are indications that their airway is injured. They might need oxygen support. People with severe burns are managed in the ICU and require usual ICU care,” he added.
A guide to giving first aid
A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals.
Thermal (heat) burns occur when some or all the cells in the skin or other tissues are destroyed by hot liquids (scalds),hot solids (contact burns),flames (flame burns).
Depth of burns
Calculation of surface area of burn
Surface area of the palm is approximately equal to 1% of Total Body Surface Area (TBSA).
First aid
Basic guidance on first aid for burns: