From the Guidelines
The chemical mediator primarily involved in a spilled hot water burn is B. Bradykinins. When hot water contacts the skin, tissue damage occurs, triggering an inflammatory response. During this process, bradykinins are released from plasma proteins and act as potent vasodilators and pain mediators. They increase vascular permeability, causing the redness, swelling, and pain characteristic of burns. While prostaglandins also play a role in the inflammatory cascade following burns, bradykinins are particularly important in the immediate response to thermal injury. Serotonin is primarily a neurotransmitter involved in mood regulation, and thromboxane is mainly involved in platelet aggregation and vasoconstriction. Understanding bradykinins' role in burn pathophysiology helps explain why cooling the burn immediately with cool (not cold) water helps reduce the inflammatory response and subsequent tissue damage, as supported by studies on burn management 1.
Key points to consider in the management of thermal burns include:
- Cooling the burn with cool water to reduce pain, edema, and depth of injury, as recommended by the American Heart Association and American Red Cross guidelines for first aid 1
- Avoiding the use of ice directly on the burn to prevent tissue ischemia
- Recognizing the importance of bradykinins in the inflammatory response to thermal injury, and how cooling the burn can help mitigate this response.
It is essential to prioritize evidence-based practices in the management of thermal burns to minimize morbidity, mortality, and improve quality of life for affected individuals. The most recent and highest quality study on burn management 1 supports the use of cooling as a critical component of initial burn care.
From the Research
Chemical Mediators in Burn Injuries
The chemical mediator involved in a spilled hot water burn can be identified by examining the pathophysiological changes that occur in patients with severe burns.
- The body's general response to serious thermal injury is characterized by increased vascular permeability immediately after injury and subsequent hypovolemic shock 2.
- The increased vascular permeability is mediated by histamine and numerous vasoactive substances, including serotonin, bradykinin, prostaglandins, leukotrienes, and platelet activating factor 2.
- Hyper-metabolism is mediated by hormones such as catecholamines, glucagon, and particularly cortisol 2.
- Inflammatory mediators play a major role in both the local burn wound and the systemic response to burn injury, with oxidant and arachidonic acid metabolites involved in the initial burn edema process 3.
- Prostaglandin E is produced in large amounts by patients suffering severe trauma, including thermal injuries, and may exert some beneficial effects in traumatized patients by altering their metabolism 4.
Specific Chemical Mediators
Based on the available evidence, the chemical mediators that may be involved in a spilled hot water burn include: