Running Head: Severe Body Burns

How Severe Burns Affect the Muscular, Integumentary, and Nervous Systems

December 15, 2009

Severe Body Burns The purpose of this paper is to review the possible damage and some of the treatments available for muscular, integumentary, and nervous system after patients have received severe burns to their body. Over 2 million people are badly burned every year, with fire accounting for one fourth of the burns (Cakir & Yegen, 2004). While the muscular, integumentary, and nervous systems are three separate systems they rely on one another and other system of the body to maintain homeostasis in the body. The nervous system uses nerve impulses to communicate and control body functions. The nervous system sends a nervous impulse which the muscular system responds to by contracting a muscle to produce movement or generate heat to maintain the core body temperature (Thibodeau & Patton, 2008). The integumentary system protects all of the underlying systems, but also allows the body to respond to stimuli such as nerve impulses sent from the nervous system. While other systems of the body are also affected by a severe burn, this paper will focus primarily on the muscular, integumentary, and nervous systems. The muscular systems primary functions are to produce movement, maintain posture, and generate heat the body needs to maintain its core temperature (Thibdeau & Patton, 2008). When a serious burn occurs it is very important to regulate the core body temperature, to help prevent the body from going into shock. The integumentary systems primary functions are protection, temperature regulation, and sensing organ activity (Thibdeau & Patton, 2008). The risk of infection is significantly greater when the skin is severely damaged due to the loss of skins protective covering of the body. The primary functions of the nervous system include communication and integrations of body functions, control of body functions, and recognition of sensory stimuli (Thibdeau & Patton, 2008). When a full thickness burn occurs there is no pain due to the damage to the nerve endings from the burn. Burns are classified by the damage that occurred by the burn. There are three classifications of burns first degree, second degree, and third degree. A first degree burn affects the epidermis and causes pain and redness (University of Maryland Medical Center, 2007). An example of a first degree burn would be if someone were to touch a hot curling iron for a few seconds. Although a blister does not appear the top few layers of skin may peel away after a few days. Second degree burns go into the dermis and cause pain, redness, and blistering of the skin (University of Maryland Medical Center, 2007). Deep second degree burn damage sweat glands, hair follicles, and sebaceous glands. However, in a second degree burn the dermis is not completely destroyed (Thibdeau & Patton, 2008). An example of a second degree burn would be scalding burns from hot liquids. The most sever burns are classified as third degree burns. Third degree burns destroy both the epidermis and dermis completely, and damage the underlying bones, muscles, and tendons (University of Maryland Medical Center, 2007). An example of a third degree burn would be receiving a burn from the flame of a fire. There are several complications that accompany burns. One common threat after receiving a burn is infection. Without the protection of the skin the risk of infection is significant. Potential sings of infection include change of color of skin, swelling, change in thickness of burn, discharge, and fever (University of Maryland Medical Center, 2007). When the body is dehydrated it can affect the way all the major organs perform their function in the body. Yet another complication of a severe burn is a compromised immune system. Without the protection of the skin the body no longer has an effective barrier against infections (Jaroff & Park, 1997). In severe burns the muscles area is also affected. The muscular system is damaged in a severe burn by both the initial injury and the lack of use of muscles after a severe burn. After a severe burn, a person usually has a higher metabolism, rapid protein breakdown, and it is harder for the body to make new muscle tissue (Harder, 2001). Medications such as Beta-blockers and good nutrition are very important in helping to stop muscle breakdown after a severe burn occurs from prolonged physical inactivity (McEntire, Herndon, Sanford, & Suman, 2006). Due to the weakening of muscles from prolonged inactivity in a severely burned person they will have to have physical therapy to help strengthen the muscles after initial injury has healed. It is thought by researchers at the University of Texas Medical Branch in Galveston that beta-blockers administered during the healing process may help avoid muscle loss in burn patients (Harder, 2001). Catabolism which is the release of energy from food molecules that supplies the body with the energy needed to do work (Thibdeau & Patton, 2008) is also helpful in the regeneration of muscle tissue. Along with the muscular system the integumentary system is affected by a severe burn. The integumentary system is affected by loss of protection, infection, and regulation of temperature and blood pressure. With the loss of the protection of the skin it is very difficult for the body to maintain a normal body temperature and keep the internal organs hydrated (Jaroff & Park, 1997). When a large or deep burn occurs and the skin is destroyed there is not an effective barrier against infection, the immune system has to work harder to ward off germs (Jaroff & Park, 1997). When a large or deep burn occurs bacteria can more readily enter the body, and cause an infection. The massive response from the immune system can cause a dangerous drop in the blood pressure that can result in shock (Jaroff & Park, 1997). Toxin absorbed from the burned tissue can cause septicaemic shock (Bari, Choudhury, Khanz & Nessa, 2002). The burn team must focus on stabilizing the blood pressure before they try to control the pain to ensure proper blood supply to the internal organs (Bari, Choudhury, Khan & Nessa, 2002). Severe burns also affect the nervous system as well as the muscular and integumentary systems. The nervous system is affected by both damage and pain. After the initial resuscitation, pain is classified as background pain or pain associated with the procedures performed (Gallagher, Colin, & Kinsella, 2000). Many of the life saving procedures performed on burn victims are very painful. Burns are classified as partial thickness or full thickness burns. First and second degree burns are called partial thickness burns, while third degree burns are called full thickness burns because the nerve endings are damaged but still function, while pain is absent from full thickness burns because the nerve endings have been destroyed (Gallagher, Colin, & Kinsella, 2000). Even the nerve endings in a full thickness burn will grow back. However, when the nerve endings grow back it will lead to pain and altered sensations (Gallagher, Colin, & Kinsella, 2000). In partial thickness burns there is an increased sensitivity to pain due to sensitization of the peripheral nociceptors, and the continued stimulation of the nociceptors (Gallagher, Colin, & Kinsella, 2000). Burn victims may continue to not only suffer a lot of physical pain, but may also suffer emotional pain as well. There are several treatments available to treat the severely burned including psychological treatments. Psychological treatments may help a burn victim deal with reoccurring nightmares and the disfiguration that being severely burned can cause. Along with psychological treatments medical treatments such as using synthetic skin, amniotic membranes, and artificial fat are being used to treat burn victims. Modern treatments have improved survival to 50% in patient that has a total body surface area burn of 98% (Muller & Herndon, 1994). Synthetic skin made from bovine collagen, silicon, and other ingredients mimic normal skin. When using synthetic skin, a surgeon will remove any burned skin, clean the area, cover the area with the synthetic skin, then after it sets for approximately two weeks the thin silicone top layer is replaced a very thin piece of the patient’s own skin (Wolfe & Morgan, 1997). In burn victims who can not have an early excision, the raw surface is covered with amniotic membrane to contamination of the wounded area. Later in the healing process the amniotic membrane is replaced with an autograph (Bari, Choudhury, Khan, & Nessa, 2002). Artificial fat can be used to fill voids left after surgery for a patient with a severe burn. The patient can usually serve as a donor, with tissue removed from a healthy place on the body (USA Today Magazine, 1993). With all of these advances in treatment the outlook for a severely burned patient keeps getting better. Although recovering from a severe burn may have many complications and risks, doctors are saving more severely burned patients every day. Many patients with severe burns look to cosmetic procedures to help correct their disfigurement, it has been suggested by several studies that hypnosis may help lower anxiety and help people with burns relax more (University of Maryland Medical Center, 2007). Someone who has 70% of their body burned has a 1 in 2 chance of survival today, while in the 1970s a person with 40% of their body burned had a 1 in 2 chance of survival (Jaroff & Park, 1997). The burn victims that incurred failure of two or more organ subsystems have a 98% mortality rate. However, the major cause of death in 75% f the deaths is infection (Cakir, Yegen, 2004). Prompt treatment to stop the burning process, hydrate the body, and regulate the blood pressure is necessary to increase the chances of survival in burn victims. Several major hospitals have burn centers that are set up to cover all needs of critically burned victims. Modern advances in treatment along with prompt treatment and burn centers like the Shiners Burn Center, is significantly increasing the chances of survival in severely burned victims. With proper education and preventative care to educate people of the risk factors that cause severe burns several accidents causing burns may be avoided.
References
Periodical, Bari, M., Kahn, A. & Nessa, A. (2002). Role of Human Foetal Membranes (Amniotic Membrane) In Management of Burn Wounds. Annals of Burn and Fire Disasters, XV(4). Retrieved on October 30, 2009, from Academic Search Premiere database.
Periodical, Cakir, B. & Yegen, C. (2004). Systemic Responses to Burn Injury. Turkish Journal of Medical Sciences, 34(4), 215-226. Retrieved on October 30, 2009, from Academic Premiere database.
Periodical, Harder, B.. (2001). Beta-blockade guards burn victims’ muscle. Science News, 160(17), 263. Retrieved on October 30, 2009, from Academic Search Premiere database.
Periodical, Gallagher, G., Rae, C., & Kinsella, J. (2000). Treatment of Pain in Severe Burns. American Journal of clinical dermatology, 1 (6), 329-335. Retrieved on October 30, 2009, from Academic Search Premiere database.
Periodical, Jaroff, L., & Park, A. (1997). To Hell and back. Time, 150(19), 64. Retrieved on October 30, 2009, from Academic Search Premiere database.
Periodical, Mc Entire, S., Herndon, D., Sanford, A., & Suman, O. (2006). Thermoregulation during exercise in severely burned children Pediatric Rehabilitation, 9(1), 57-64. Retrieved on October 30, 2009, from Academic Search Premiere database.
Periodical, Muller, M. & Herndon, D. (1994). The challenge of burns. Lancet, 343(8891), 216. Retrieved on October 30, 2009, from Academic Search Premiere database.
Book, Thibodeau, G., & Patton, K. (2008). Structure 7 Function the Body, 13th Edition. St. Louis, Mo. Mosby Elsevier.
Internet, University of Maryland Medical Center. (2007). Burns. University of Maryland Medical Center website. Retrieved on October 30, 2009, from http://www.umm.edu/cgi-bin/prontpage.cgi
Periodical, USA Today Magazine. (1993). Artificial fat aids skin replacement. USA Today Magazine, 121 (2577), 3. Retrieved on October 30, 2009, from Academic Search Premiere database.
Periodical, Wolfe, Y., &, Morgan. P. (1997). Slip into a new skin. Prevention, 49(7), 137. Retrieved on October 30, 2009, from Academic Search Premiere database.