Chemical Mediator in Spilled Hot Water Burns
Prostaglandins are the primary chemical mediator involved in the inflammatory response of a scald burn injury from spilled hot water. 1
Pathophysiology of Burn Injury
Thermal burns trigger an inflammatory cascade that involves the release of various chemical mediators, with prostaglandins being the predominant mediators in the inflammatory response 1
When hot water contacts the skin, tissue damage occurs, leading to the release of inflammatory mediators that initiate the inflammatory response and pain signaling 1
The burn injury causes the release of damage-associated molecular patterns (DAMPs) from damaged tissue, which activate toll-like receptors and trigger the excessive secretion of cytokines and inflammatory mediators 2
Role of Prostaglandins in Burn Inflammation
Prostaglandins play a crucial role as vasodilators in the inflammatory response to burns, potentiating plasma exudation and contributing to the characteristic swelling and edema 3
They are synthesized by the enzyme cyclooxygenase (COX), particularly the inducible COX-2 enzyme which is responsible for producing proinflammatory prostaglandins at the burn site 4
In burn injuries, prostaglandins contribute to the inflammatory response that can lead to capillary leak, pain, and other systemic effects 5
Other Chemical Mediators in Burns
While bradykinins are involved in the inflammatory response and can increase vascular permeability, they are not the primary mediator in thermal burns 3
Serotonin functions more as a transmitter in the inhibitory pain system rather than as a primary inflammatory mediator in burns 1
Thromboxane, another prostanoid, is present but is not the predominant mediator in thermal burns 1
Clinical Implications
The inflammatory response in burns is persistent, with inflammatory mediators remaining elevated at the burn site for up to 46 days after injury 6
Understanding the role of prostaglandins in burn inflammation is important for pain management strategies, as they are targets for non-steroidal anti-inflammatory drugs (NSAIDs) 4
Cooling the burn site can help reduce pain and limit burn depth progression by affecting the inflammatory cascade and prostaglandin release 5
Management Considerations
For small to moderate burns, cooling the burn can limit deepening and reduce pain by modulating the prostaglandin-mediated inflammatory response 5
Short-acting opioids and ketamine are effective for managing burn-induced pain that results from prostaglandin and other inflammatory mediator activity 5
Non-pharmacological treatments such as cooling limited burned surfaces and covering burns with appropriate dressings can improve pain control by affecting the local inflammatory response 5