Types of Burns

There are three types of burns that can result from a variety of mechanisms. Types of burns include first, second and third degree burns. These burns may also be referred to as superficial, partial and full-thickness burns. Types of burns may also be classified according to the mechanism of burn injury.

Superficial Burns

These types of burns cause superficial erythema (redness) and swelling and may be quite painful. The skin will blanch upon pressure. These types of burns involve only the outermost layer of skin, or the epidermis. Treatment generally involves cooling the burn with running water or the application of cool cloths and application of an over-the-counter burn ointment or a soothing agent, such as aloe cream or gel. These types of burns heal quickly and do not result in scarring. A physician should be consulted if superficial burns are extensive, especially in children or the elderly.

Partial-Thickness Burns

Partial-thickness burns affect both the epidermis and the dermis to varying degrees. Superficial partial-thickness burns do not involve the full thickness of the dermis, while deep partial-thickness burns may involve the dermis more extensively. Depending on how much of the dermis is affected, these types of burns may result in scarring and may require skin grafting to heal. It may be difficult to determine whether a burn affects the dermis superficially or more deeply; the difference lies partially in healing time, as superficial partial-thickness burns will heal more quickly, often in less than 3 weeks. These types of burns will cause blisters. Blisters should never be punctured but should be left intact, as rupturing them may increase the risk of infection. These types of burns may cause permanent disfigurement. They may also be quite painful, as nerves are intact and undamaged.

Full-Thickness Burns

Full-thickness burns extend down into the hypodermis, or subcutaneous tissue. These types of burns may affect underlying bone, nerves, tendons and other structures. These burns in themselves are generally not painful; however, there may be surrounding areas of partial-thickness burns that are painful. These burns will require surgery to close and may result in permanent disfigurement and disability, especially if they occur over a joint. The risk for complications, especially infection, is very high and these types of burns may be life-threatening if they are extensive. These types of burns should be cared for in specialized burn centers.

Mechanism of Burn Injury

Burns may be caused by several different mechanisms, each with their own complications:

Scalds- these types of burns result when skin comes into contact with hot liquids (spilled liquids or food, hot bathwater)

Contact burns- these burns result from contact of the skin with hot items, including flames

Chemical burns- these burns result from contact of the skin with chemicals, or by ingestion of chemicals

Electrical burns- these types of burns result when a person comes into contact with a source of electrical energy; includes burns caused by electrocution and lightning strike

Radiation burns- these types of burns result from contact with a source of radiation; may include overexposure i.e. sunburn

Burns may be classified according to the tissue damaged (first, second or third degree) and also according to the mechanism of burn injury. Knowing the types of burns allows health professionals to tailor their treatment accordingly and predict which patients require more specialized care, as well as which patients are more at risk for complications.

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How do doctors prevent nausea and vomiting?

Most people undergoing chemotherapy receive anti-nausea (anti-emetic) medications to prevent nausea and vomiting. These drugs, given alone or in combination, can be taken in pill form or administered through a vein in your arm. Your doctor advises which to use based on the treatment you are receiving.

Anti-nausea medications are typically given before treatment begins and on a scheduled basis for several hours or days after treatment. You may receive additional medications if you develop nausea and vomiting after chemotherapy.

Your doctor determines which anti-nausea medications to use based on your specific situation, for example, what type of chemotherapy drugs you are receiving.

Drugs used to prevent nausea and vomiting include:

• Aprepitant (Emend)
• Dexamethasone
• Dolasetron (Anzemet)
• Dronabinol (Marinol)
• Droperidol (Insapsine)
• Granisetron (Kytril)
• Haloperidol (Haldol)
• Methylprednisolone (Medrol)
• Metoclopramide (Reglan)
• Nabilone (Cesamet)
• Ondansetron (Zofran)
• Palonosetron (Aloxi)
• Prochlorperazine (Procomp)

Drugs used to treat anxiety associated with chemotherapy nausea include:

• Alprazolam (Niravam, Xanax)
• Lorazepam (Ativan)
• Midazolam

Doctors take this proactive approach to prevent nausea and vomiting because these side effects can be difficult to control once they begin. Nausea and vomiting can make you feel miserable, add to your fatigue and distress, and make you reluctant to stick to your treatment schedule. If you are unsure about taking anti-nausea medication when you are not feeling nauseated, talk to your doctor about the risks and benefits of these drugs.

What additional measures can you take to prevent nausea and vomiting?

1. You can take steps to reduce your risk of nausea and vomiting. For example: Eat small meals. Stagger small meals throughout the day rather than eating fewer, larger meals. If possible, do not skip meals. Eating a light meal a few hours before treatment also may help.
2. Eat what appeals to you. It is best, however, to avoid foods that are sweet, fried or fatty. In addition, cool foods may give off less bothersome odors. Cook and freeze meals in advance of treatment to avoid cooking when you are not feeling well. Or have someone else cook for you.
3. Drink lots of fluids. Try cool beverages such as water, unsweetened fruit juices, tea or ginger ale that has lost its carbonation. It may help to drink small amounts throughout the day, rather than larger amounts less frequently.
4. Avoid unpleasant smells. Pay attention to what smells trigger nausea for you. For some, a specific smell, such as the smell of something frying or a greasy smell, may cause nausea. Other people may experience nausea when smelling any strong odor. Limit exposure to unpleasant smells. Fresh air may help.
5. Make yourself comfortable. Rest after eating, but do not lie flat for a couple of hours. Try wearing loose fitting clothing and distracting yourself with other activities.
6. Use relaxation techniques. Examples include meditation and deep breathing.

These self-care measures may help you prevent nausea and vomiting, but they cannot take the place of anti-nausea medications. If you begin to feel nauseated despite the medications, call your doctor. Treatments may include additional medications, though your individual treatment will depend on what is causing your signs and symptoms.

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Not everyone experiences nausea and vomiting during chemotherapy. Find out if you are at risk of these side effects and what you and your doctor can do to prevent them.

Nausea and vomiting are common side effects of chemotherapy treatment for cancer. However, in most cases, these side effects can be controlled with preventive medications and other measures. If you are considering chemotherapy, you and your doctor can take steps to prevent or decrease nausea and vomiting associated with chemotherapy. This can help make you more comfortable during your cancer treatment.

Who is at risk of nausea and vomiting during and after chemotherapy?

Whether you will experience nausea and vomiting as a result of chemotherapy depends on what chemotherapy drugs you receive, whether you receive other cancer treatments — such as radiation — during your chemotherapy treatment, and whether you have experienced nausea and vomiting in the past.

Chemotherapy drugs that cause nausea and vomiting

Certain chemotherapy drugs are more likely than are others to cause nausea and vomiting. Some medications associated with significant risk of these side effects include:

• Altretamine (Hexalen)
• Busulfan (Busulfex, Myleran)
• Carmustine (Bicnu)
• Cisplatin (Platinol)
• Cyclophosphamide (Cytoxan)
• Dacarbazine
• Doxorubicin (Adriamycin)
• Epirubicin (Ellence)
• Estramustine (Emcyt)
• Etoposide
• Ifosfamide (Ifex)
• Lomustine (Ceenu)
• Mechlorethamine (Mustargen)
• Procarbazine (Matulane)
• Streptozocin (Zanosar)
• Temozolomide (Temodar)

If you will be receiving one of these chemotherapy drugs, preventive measures are available to help you avoid these side effects.

Whether a drug will cause nausea and vomiting also depends on the amount you receive. Some drugs may be less likely to cause side effects at lower dosages. Ask your doctor whether your treatment plan is likely to cause nausea and vomiting.

Personal factors that may increase your risk

Not everyone reacts to chemotherapy in the same way. Certain factors may make you more vulnerable to treatment-related nausea and vomiting. You may be more vulnerable if one or more of the following apply to you:

• You are a woman.
• You are younger than 50.
• You have experienced nausea and vomiting with previous treatments, or you have a history of motion sickness.
• You have a high level of anxiety.
• You experienced morning sickness during pregnancy.
• You are prone to vomiting when you are sick.
• You have a history of drinking little or no alcohol.

In addition, if you expect that your treatment will cause nausea and vomiting, there is a chance that it will. You can become so convinced that nausea and vomiting will occur that it does occur. This might happen if you think, like many people do, that all cancer treatments cause these side effects, which is not true. Your doctor can tell you specifically whether the treatment you will receive is likely to cause nausea and vomiting.

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