What are the causes of third degree burns. How can you recognize the symptoms of severe burns. What treatment options are available for third degree burns. When should you seek immediate medical attention for burn injuries.

Understanding Third Degree Burns: Definition and Classification

Third degree burns, also known as full-thickness burns, represent the most severe category of burn injuries. These burns extend through all layers of the skin, potentially damaging underlying tissues. Unlike first or second degree burns, third degree burns always require medical intervention, including skin grafts.

Burns are classified based on the extent of damage they cause to the skin and surrounding tissues:

• First degree burns (superficial burns): Affect only the outermost layer of skin
• Second degree burns (partial-thickness burns): Damage the top two layers of skin
• Third degree burns (full-thickness burns): Destroy all layers of skin and may damage underlying tissues
• Fourth degree burns: Extend into fat
• Fifth degree burns: Reach muscle tissue
• Sixth degree burns: Extend to the bone

Why are third degree burns considered more dangerous than other types? The complete destruction of skin layers in third degree burns eliminates vital protective barriers, increasing the risk of infection and other complications. Additionally, these burns often damage nerve endings, which can lead to a deceptive lack of pain at the burn site.

Common Causes of Third Degree Burns: Identifying Risk Factors

Third degree burns can result from various sources, each presenting unique dangers. Understanding these causes can help in prevention and prompt recognition of severe burn injuries.

Thermal Burns

Thermal burns are among the most common causes of third degree burns. They occur when skin comes into contact with extremely hot substances or objects:

• Flames: Direct exposure to fire, such as in house fires or fuel explosions
• Scalding liquids: Contact with boiling water, oil, or other hot fluids
• Hot objects: Prolonged contact with heated metals or other materials

Chemical Burns

Certain chemicals can cause severe tissue damage upon contact with the skin:

• Strong acids or alkalis: Industrial chemicals, cleaning products, or battery acid
• Solvents: Some organic compounds can dissolve skin tissues

Electrical Burns

Electrical burns often result in third degree injuries due to the high energy involved:

• High-voltage electrical accidents: Industrial or power line incidents
• Lightning strikes: Though rare, these can cause severe burns

Radiation Burns

While less common, radiation exposure can lead to third degree burns:

• Prolonged sun exposure: Extreme cases of sunburn
• Radiation therapy: Rare complications from cancer treatments
• Nuclear incidents: Exposure to radioactive materials

How can you reduce the risk of third degree burns? Implementing safety measures such as proper handling of hot substances, using protective equipment when working with chemicals or electricity, and avoiding prolonged sun exposure can significantly decrease the likelihood of severe burn injuries.

Recognizing Third Degree Burn Symptoms: Key Indicators

Identifying a third degree burn quickly is crucial for proper treatment. Unlike less severe burns, third degree burns often present with unique and sometimes counterintuitive symptoms.

Visual Appearance

The appearance of a third degree burn can vary, but common characteristics include:

• Skin discoloration: The affected area may appear white, grey, black, brown, or yellow
• Charred appearance: The skin might look burned or charred
• Waxy or leathery texture: The burn site often has a distinctive texture

Sensory Changes

Paradoxically, third degree burns may not be as painful as less severe burns:

• Lack of pain: Due to nerve ending damage, the burn site might be numb
• Decreased sensation: The affected area may have reduced sensitivity to touch or temperature

Other Physical Signs

Additional symptoms that may indicate a third degree burn include:

• Swelling: The area around the burn may become significantly swollen
• Dry appearance: Unlike second degree burns, third degree burns often appear dry
• Loss of skin elasticity: The burned skin may not blanch when pressed

Why might a third degree burn be less painful than a first or second degree burn? The destruction of nerve endings in the deeper layers of skin can result in reduced pain sensation, making it crucial to assess the burn based on visual and other physical signs rather than pain level alone.

Immediate First Aid for Third Degree Burns: Critical Steps

While professional medical care is essential for third degree burns, immediate first aid can help minimize further damage and prepare the victim for treatment.

Ensure Safety

Before providing aid, ensure the safety of both the victim and yourself:

• Remove the person from the source of the burn if safe to do so
• Extinguish any flames on clothing by having the person stop, drop, and roll
• Turn off electrical sources if dealing with an electrical burn

Check Vital Signs

Assess the victim’s condition:

• Ensure the person is breathing
• Check for signs of shock, such as pale, cool, and clammy skin
• If necessary, begin CPR if the person is not breathing and you are trained to do so

Protect the Burn Area

Take steps to protect the burned area from further damage:

• Remove any clothing or jewelry near the burn site, unless it’s stuck to the skin
• Cover the burn loosely with a clean, dry cloth or sterile bandage
• Do not immerse large severe burns in water, as this can lead to hypothermia
• Avoid applying any creams, ointments, or butter to the burn

Seek Emergency Medical Care

Call emergency services immediately or arrange for transportation to a hospital burn unit.

Why is it important not to remove clothing stuck to a burn? Attempting to remove adhered clothing can cause further tissue damage and increase the risk of infection. Medical professionals will safely remove such items in a controlled environment.

Medical Treatment for Third Degree Burns: Professional Interventions

Treatment of third degree burns requires specialized medical care, often in a dedicated burn unit. The approach to treatment depends on the severity, location, and extent of the burn.

Initial Assessment and Stabilization

Upon arrival at a medical facility, the immediate priorities are:

• Assessing airway, breathing, and circulation
• Administering fluids to prevent or treat shock
• Providing pain management
• Evaluating the extent of the burn using methods like the “rule of nines”

Wound Care and Infection Prevention

Proper wound care is crucial to promote healing and prevent complications:

• Cleaning and debriding the burn area to remove dead tissue
• Applying antimicrobial dressings to prevent infection
• Regularly changing dressings and monitoring for signs of infection

Surgical Interventions

Most third degree burns require surgical treatment:

• Escharotomy: Incising the burn eschar to relieve pressure and improve circulation
• Skin grafting: Transplanting healthy skin to cover the burned area
• Reconstructive surgeries: May be necessary to improve function and appearance

Supportive Care

Comprehensive care for severe burn patients includes:

• Nutritional support to aid healing
• Physical therapy to maintain joint mobility and prevent contractures
• Psychological support to address trauma and adjustment

How does skin grafting help in the treatment of third degree burns? Skin grafts provide a new protective covering for the burned area, reducing the risk of infection and helping to restore function to the affected body part. They also promote faster healing and can improve the cosmetic outcome of the burn injury.

Complications of Third Degree Burns: Potential Risks and Long-term Effects

Third degree burns can lead to various complications, both immediate and long-term. Understanding these risks is crucial for comprehensive care and rehabilitation.

Immediate Complications

Several acute complications can arise from severe burns:

• Shock: Due to fluid loss and the body’s inflammatory response
• Infection: Increased risk due to compromised skin barrier
• Respiratory problems: Especially in cases of inhalation injury
• Compartment syndrome: Swelling that can compromise blood flow to limbs

Long-term Physical Complications

Even after initial recovery, burn survivors may face ongoing challenges:

• Scarring and contractures: Can limit mobility and require further surgeries
• Thermoregulation issues: Due to damage to sweat glands
• Sensory changes: Altered sensation or chronic pain in affected areas
• Increased skin cancer risk: In areas affected by severe burns

Psychological Impact

The emotional and psychological effects of severe burns can be significant:

• Post-traumatic stress disorder (PTSD)
• Depression and anxiety
• Body image issues
• Social adjustment difficulties

Why is comprehensive rehabilitation essential for third degree burn survivors? Rehabilitation addresses not only the physical healing of burns but also helps patients cope with the psychological impact and adapt to potential lifestyle changes. It plays a crucial role in maximizing functional recovery and improving quality of life post-injury.

Prevention Strategies: Minimizing the Risk of Severe Burns

While accidents can happen, many severe burns are preventable. Implementing safety measures and increasing awareness can significantly reduce the risk of third degree burns.

Home Safety

Creating a safer home environment is crucial for burn prevention:

• Install and maintain smoke detectors
• Keep flammable materials away from heat sources
• Set water heater temperatures to a safe level (below 120°F or 49°C)
• Use caution when cooking, especially around hot liquids and oils

Workplace Safety

In industrial or high-risk work environments:

• Follow proper safety protocols when handling chemicals or hot materials
• Wear appropriate personal protective equipment (PPE)
• Ensure proper electrical safety measures are in place
• Participate in regular safety training and drills

Fire Safety Education

Educating individuals and families about fire safety can prevent severe burns:

• Teach children about fire dangers and establish escape plans
• Practice proper use of fire extinguishers
• Avoid smoking indoors and dispose of cigarettes properly
• Exercise caution with fireworks and bonfires

Sun Protection

While rare, severe sunburns can lead to third degree burns:

• Use broad-spectrum sunscreen with adequate SPF
• Wear protective clothing and seek shade during peak sun hours
• Be especially cautious at high altitudes or near reflective surfaces like water or snow

How can education play a role in preventing severe burns? By raising awareness about burn risks and teaching proper safety measures, education empowers individuals to create safer environments and make informed decisions, significantly reducing the likelihood of severe burn injuries.

Third degree burns: Causes, symptoms, and treatment

Third degree burns, or full-thickness burns, are a type of burn that destroys the skin and may damage the underlying tissue. They are more severe than first or second degree burns and always require skin grafts.

Third degree burns are a serious injury requiring immediate medical help. Unlike less severe burns, which can be very painful, full-thickness burns may not hurt. This is because the burn may damage nerve endings in the skin responsible for sensing pain.

In addition, the burn site may appear

• white
• grey
• black
• brown
• yellow
• charred
• waxy or leathery

A person with a third degree burn will require hospitalization. Treatment will vary depending on the extent, severity, and location of the burn.

If an individual suspects they have a third degree burn, they should seek immediate medical attention. Without treatment, these burns and resulting complications can be fatal.

In this article, learn more about third degree burns, including the symptoms, treatment, and when to speak with a doctor.

Third degree burns are a severe type of burn that extends through every layer of skin. This type of burn can destroy:

• the epidermis, the outer layer of skin
• the dermis, the layer beneath the epidermis
• the hypodermis in some cases, which is the subcutaneous tissue and the innermost layer of skin

Doctors categorize burns according to the damage they cause to the skin and surrounding tissue. Types of burns include:

• First degree burn: Also known as superficial burns, these are the most common type. This burn damages the outermost layer of skin and typically heals on its own within 1 week. A common example is sunburn.
• Second degree burn: Also known as partial-thickness burns, this type damages the top two layers of skin. Second degree burns may require a graft and typically leave scars.
• Third degree burn: These burns completely damage the skin, including hair follicles and sweat glands. They may also damage the underlying tissue and always require a skin graft.
• Fourth degree burn: This type of burn extends into fat.
• Fifth degree burn: This burn type extends into muscle.
• Sixth degree burn: This type of burn extends to the bone.

Third degree burns will typically result from contact or exposure to the following:

• flames
• flash from an explosive blast
• chemicals such as acids
• electricity
• scalding liquids
• contact with an extremely hot object for an extended period

Any severe burn will typically be apparent and will require treatment at the hospital.

Common symptoms

Common symptoms of full-thickness burns may lead to:

• skin discoloration, which can include the skin becoming:
  • white
  • grey
  • black
  • brown
  • yellow
• skin appearing
  • dry
  • leathery
  • waxy
• swelling
• a lack of pain due to damage to nerve endings

Shock

Severe burns can also result in potentially fatal complications. For example, the body may go into shock.

Normally, the body produces an inflammatory response to protect itself from injury, infection, or other threats. However, in some cases, such as with severe burns, the body may overreact, and the inflammatory response may cause more harm.

Shock typically causes damage because the extreme inflammatory response results in tissues and organs not receiving enough oxygen. Several organs, such as the lungs, heart, and brain, are particularly susceptible to damage by “burn shock.”

Infections

Infection is another major concern with third degree burns. The severe damage to the skin makes the body more susceptible to pathogens.

Burns can also weaken the immune system, meaning the body is less capable of fighting off infection. In particular, acquiring pneumonia and sepsis infections are common and potentially fatal complications.

A doctor can usually diagnose the severity of a burn by examining the affected area. They may also ask questions about the cause of the burn, any other injuries, and whether the person has any other medical conditions.

The doctor may determine the severity of the burn by accounting for:

• the patient’s age
• the percentage of total body surface area burned (TBSA) using the rule of nines
• the type of burn
• which body parts are involved

A doctor may classify a severe burn under the following criteria:

• more than 10% TBSA in children or older adults
• more than 20% TBSA in adults
• more than 5% third degree
• significant burns to the:
  • face
  • eyes
  • ears
  • joints
  • genitalia

According to the World Health Organization (WHO), any third degree burn requires immediate hospitalization and treatment. Individuals with this type of burn usually receive treatment at a special burn unit.

Following a third degree burn, people should immediately try to arrange medical assistance.

While waiting for emergency care, a person can ensure an individual with a third degree burn:

• is out of harm’s way
• is breathing
• has restrictive items and clothing near, but not on, the wound removed

People can also cover the area with a sterile bandage, attempt to separate fingers and toes if burned, and, if possible, elevate the burned area above the heart.

The treatment a person receives will depend on the extent, severity, and location of the burn. The cause of the burn and a person’s health will also determine which treatment they receive.

Treatment for third degree burns may include:

• Surgery: Third degree burns typically require multiple surgeries to remove burned tissue from the burn site.
• Skin graft: As third degree burns do not heal by themselves, a skin graft is often necessary. A doctor may use a combination of natural skin grafts, artificial skin products, or laboratory-grown skin.
• Intravenous fluids: Some people may receive extra fluids to maintain their blood pressure and prevent shock.
• Medication: A person will likely receive several different medications, such as antibiotics and pain medication, to prevent infection and ease pain.
• Tetanus shot: As tetanus bacteria are more likely to trigger infections through burn wounds, a person may receive a tetanus shot to prevent this.

Third degree burns are serious and require immediate medical attention. Without treatment, they can be fatal. The WHO estimate that burns cause roughly 180,000 deaths every year, while non-fatal burn injuries are a leading cause of morbidity.

Children and older adults are particularly at risk. Research suggests that after car accidents and drowning, burns are the most frequent cause of childhood death.

The American Burn Association provide resources allowing people to search for their nearest burn center in the United States.

Treatment for third degree burns continues after a person leaves the hospital. While the recovery period differs for everyone, people commonly report feeling pain, fatigue, and itching.

People will still require wound care, which involves cleansing and dressing the wounds. This may require a nurse or doctor, or for the person with burns to learn how to clean and dress wounds. A friend or family member could also assist.

Individuals may require rehabilitation and counseling to help with their ability to perform daily tasks, with any potential issues communicating, and improve their mental health.

The healing time of a burn injury depends on the:

• burn extent
• burn depth
• location of the burn
• person’s age
• presence of other injuries or conditions

Due to medical advances, people are now capable of recovering from burn injuries that were previously fatal. However, individuals will often have permanent impairments and scarring.

Third degree burns are deep, severe burns that completely damage the skin. Causes can include exposure to flames, explosions, or strong chemicals.

People with third degree burns need immediate medical attention from a special burn unit. This can help prevent serious complications such as infection or shock.

The Pharmacist’s Introduction to Burns Resuscitation — tl;dr pharmacy

Steph’s Note: I love it when we have experts willing to share their brain with us at tl;dr – especially when it’s about a topic that isn’t really covered in the usual pharmacy school curriculum. What a treat to have this knowledge at our fingertips from people who work it firsthand!

This week is no exception. Dr. Josef Nissan is back yet again (check out his literal compendium of previous posts, including most recently sodium bicarbonate in cardiac arrest and SIADH), and this time he’s here to teach us about burn patients. Now you may be thinking that you’re not going to work at some ginormous health care institution with a burn center so you won’t ever need to know this stuff, but as you’ll see, there are definitely nuggets that any pharmacist can take away from this topic. Teach us, Joe!

Oh, and for all of you worried about gruesome pics with this topic, take comfort and read on. I didn’t use any because I do actually want you to learn the material rather than getting grossed out and clicking off this site. For those of you lookie loos who like working in the ER, Google at will on your own!

“Somebody call 911, shawty fire burnin on the dance floor” – Sean Kingston

A monumental and life changing lyric by the king, Sean KINGston himself. Well then, are you comfortable resuscitating shawty who is indeed burning on the dance floor? If you aren’t, keep on reading.

Between 2009 and 2014, over 3 million emergency department visits were for burn related injuries. While these patients may not get admitted at your facility (unless you’re a certified burns center), there is a very high chance that the initial resuscitation phase occurs in your emergency department. So, let’s get you prepared with the pharmacotherapy needed for initial burn resuscitation.

Burn Types & Classification

I’m sure a house fire is the first thing that comes to mind when you hear about burn-related injuries. But believe it or not, there are multiple types of burns that aren’t related to flames. These different types of burns include:

(Image)

• Thermal Burn: burns secondary to an external heat source (e. g., flames, scalding liquids, hot metals, steam)

• Radiation Burn: burns secondary to prolonged exposure to ultraviolet rays (e.g., sun, X-ray machine)

• Chemical Burn: burns secondary to strong acids, alkalis, detergents, or solvents (e.g., sulfuric acid, hydrochloric acid, lime)

• Electrical Burn: burns secondary to an electrical current (e.g., alternating current, direct current)

Burns are further classified by degree depending on the depth of skin surface penetration. Obviously, the deeper the burn, the worse the outcomes.

(Image)

• First-degree (superficial) burn: effects on the epidermis (outermost layer of the skin)

• Second-degree (partial thickness) burn: involves the epidermis and part of the dermis

• Third-degree (full thickness) burn: involves the epidermis and complete dermis

• Fourth-degree burn: involves both layers of the skin and underlying tissues, possibly including muscle and bone

Calculating the Total Body Surface Area (TBSA) Affected

As we will talk about later, estimating the total body surface (TBSA) affected is crucial in determining appropriate resuscitation measures. The easiest and fastest way to calculate a quick estimate of the TBSA involved is by using the Wallace Rule-of-Nines. The rule-of-nines assigns body surface area to each of the major body parts below:

(Image)

Let’s use an example. Patient AA was brought into your ED by ambulance following a house fire. On examination, it appears the entire abdomen, back, and both legs were severely burned. To get an estimated TBSA, add 9% (entire abdomen), + 18% (entire back) + 18% (left leg) + 18% (right leg) = 63% TBSA. Simple, right?

Pathophysiology of Burns (AKA Jackson’s Burn Model)

To understand the pharmacological treatments used in burns resuscitation, we must first understand the pathophysiology. As described by Douglas Jackson in 1947, when skin is exposed to excess heat, formation of three zones follows:

(Image)

• Zone of Coagulation: occurs at the point of maximum damage. Irreversible tissue loss is experienced in this zone.

• Zone of Stasis: surrounding tissue experiences decreased perfusion. Tissue in this zone is potentially salvageable as long hypoperfusion is quickly reversed.

• Zone of Hyperemia: outermost zone tissue perfusion is increased. Tissue here will generally recover unless there is severe sepsis or prolonged hypoperfusion.

At the endothelial level, damage to the skin triggers several inflammatory responses including the increased release of nitric oxide synthase. Increase in nitric oxide causes vasodilation and massive capillary leakage into the interstitial space. This mass capillary leakage results in hypovolemic shock. If not quickly reversed, patients will develop multi-organ failure and death.

Pharmacological Treatment of Thermal Burns

Since the majority of burn cases are caused by thermal burns, we will primarily focus on the initial resuscitation of thermal burns. As with any trauma, our initial focus is on stabilizing the airway, breathing, and circulation (ABC’s).

Starting with “Airway”, burn patients are at an increased risk of upper airway and inhalation injury – specifically, carbon monoxide and cyanide poisoning. Let’s discuss.

Carbon Monoxide Poisoning

Carbon monoxide is one of the most frequent immediate causes of death following inhalation injury. Let’s simplify this a little to make it easier to understand. I’ll start by painting a picture for you.

When carbon monoxide sees your hemoglobin molecules, occupied by oxygen or not. (Image)

Boom. House fire erupts. Where there’s fire, there’s smoke (thank you, 1st grade science). Well, smoke contains a byproduct called carbon monoxide. Carbon monoxide is a colorless, odorless gas with an affinity for hemoglobin more than 200 times greater than that of oxygen.

Take a moment for that figure. Carbon monoxide wants to bind to your hemoglobin at least 200 times more than oxygen. That’s insane. So what happens when it does bind to hemoglobin?

Excess serum carbon monoxide kicks oxygen off hemoglobin and saturates red blood cells with carbon monoxide instead of oxygen. With minimal to no oxygen bound to hemoglobin, your tissues experience hypoperfusion and eventual death.

Carbon monoxide poisoning should be suspected in ALL patients who present following inhalation injury or house fires until it is excluded by a normal blood carboxyhemoglobin level. I repeat. Carbon monoxide poisoning should be suspected in all patients who present following inhalation injury or a house fire. And yes, it can ONLY be diagnosed by collecting a blood carboxyhemoglobin level.

REMEMBER THIS. You CANNOT use pulse oximetry since pulse oximetry does NOT differentiate carboxyhemoglobin from oxyhemoglobin. So your pulse oximetry may say that someone’s oxygen saturation is 99% even though their true oxyhemoglobin level is under 50%.

• Sign & Symptoms: Highly dependent on the blood carboxyhemoglobin level.

  • The higher the level, the more severe the symptoms. In general, patients with mild to moderate carbon monoxide poisoning will present with headache, dizziness, weakness, upset stomach, vomiting, and confusion. Severe carbon monoxide poisoning may present in a comatose state.

• Treatment: Hyperbaric oxygen

  • Mechanism of Action: Inhaling pure oxygen (100% oxygen) helps speed up the replacement of carbon monoxide with oxygen in your blood.

  • Treatment Criteria: In general, patients should be treated with hyperbaric oxygen if they meet the following criteria:

    • Carboxyhemoglobin level >25% (>15% if pregnant)

    • Patient has layered mentation or is comatose

    • Severe metabolic acidosis is present

    • Evidence of end-organ ischemia

Cyanide Poisoning

The other common inhalation injury is cyanide poisoning. Let me paint another picture for you.

Boom (again). House fire erupts (again). Fire is hot. Hot melts household items. When these products (especially plastic) are burned, a byproduct called cyanide is released. Cyanide is a colorless gas with the odor of bitter almonds.

Long story short (because the nitty gritty details aren’t that important right now), excess cyanide causes cessation of aerobic metabolism due to the depletion of ATP in the mitochondria. Lack of aerobic metabolism means your tissues aren’t getting oxygen. Without oxygen, you die. That was as simple as I could explain it.

• Signs & Symptoms: Initial symptoms are generally nonspecific. Majority of patients will present with headache, anxiety, confusion, and abdominal pain. Severe cyanide toxicity can lead to seizures and coma.

• First-line Treatment: Hydroxocobalamin

  • Mechanism of Action: Hydroxocobalamin binds to cyanide in our blood stream, converts it to cyanocobalamin (that’s right, vitamin B12), which is then excreted in the urine. *Okay, but how cool is that? This antidote literally converts a harmful toxin in our body to a vitamin. It’s turning the joker into a superhero. Pretty neat if you ask me!*

  • Adult Dosing: 5 g (IV/IO) as a single infusion over 15 minutes; may repeat a second 5 g dose over 15 minutes to 2 hours (total dose: 10 g), depending on the severity of poisoning and clinical response.

• Second-line Treatment (only to be used of hydroxocobalamin is unavailable): Sodium Nitrite (3% solution) and Sodium Thiosulfate (25% solution)

  • Mechanism of Action: both of these agents work similarly to hydroxocobalamin. They bind to cyanide, free up cytochrome oxidase, and allow aerobic metabolism to continue.

  • Adult Dosing:

    • Sodium nitrite (3% solution): 10 mL IV (300 mg) at 2.5 to 5 mL per minute; may repeat once

    • Sodium thiosulfate (25% solution): 50 mL IV (12. 5 g) immediately following sodium nitrite administration; may repeat once

    • Clinical Disclaimer: Hydroxocobalamin should ALWAYS be used when available. Since sodium nitrite and sodium thiosulfate are falling out of favor, the majority of hospitals carry hydroxocobalamin. Only use 2nd-line treatment options when hydroxocobalamin is absolutely not available.

Initial Fluid Resuscitation

Now that we’ve stabilized the “Airway & Breathing”, let’s move onto the “Circulation” portion of our ABC’s.

As we discussed earlier, during the first 24-48 hours following a major burn, patients have an increase in nitric oxide release, resulting in severe vasodilation and massive capillary leakage into the interstitial space. If left untreated, patients develop severe hypovolemic shock leading to anoxia and death.

Your fluid supply for burn patients. (Image)

Fluids. Fluids again. More fluids. This is the biggest theme of initial burn resuscitation. Given the severity of hypovolemic shock, you need MASSIVE amounts of fluid to reverse the shock and allow for tissue perfusion. And I mean MASSIVE.

How much exactly?

Thankfully we have a couple of easy equations we can use to help us determine the appropriate volume to be infused. Let me introduce you to the Parkland and modified Brooke formula. These equations can be used to determine the volume of fluid requirements during the initial 24 hours of resuscitation for adults with burns >20% TBSA.

Let’s try an example. A 48 year-old male (weight: 95.8 kg) is brought into your ED following a meth lab explosion and house fire (yes, I had to be dramatic). After physical examination, it appears the patient has suffered severe burns to the head, neck, chest, abdomen, and both arms.

First things first, we need to calculate the TBSA affected. Once we have that, all we need to do is plug and chug.

1. Calculate the TBSA:

   1. 9% (head & neck) + 9% (chest) + 9% (abdomen) + 9% (left arm) + 9% (right arm) = 45% TBSA

2. Since TBSA affected is >20%, patient qualifies for fluid resuscitation using the Parkland or modified Brooke Equation.

3. Calculate the Total Volume Needed to Infuse:

   1. Total Volume to Infuse: 4 mL x 45% (TBSA affected) + 95.8 kg = 17,244 mL

      1. First 8 hours: infuse 1⁄2 of the total volume within the first 8 hours; ~8.5 L (~1062.6 mL/hr).

      2. Next 16 hours: Infuse 1⁄2 of the total within the next 16 hours; ~8.5 L (~531.3 mL/hr).

Not so bad right?

In terms of initial fluid selection, patients with moderate to severe burns should receive IV crystalloid solution, generally Lactated Ringers. Normal saline is typically avoided due to the risk of hyperchloremic acidosis that can occur with administration of large volumes of isotonic fluids.

Secondary Prevention

Awesome. So now we’ve stabilized the patients “Airway, Breathing, and Circulation” (ABC’s). The next and final step of initial burn resuscitation is secondary prevention.

First let’s talk tetanus. Make sure that burn patients are up to date on their tetanus immunization. If not, administer a tetanus shot for for any burn deeper than superficial-thickness (i.e., anyone with a 2nd degree burn or worse).

Next, what is our body’s first-line defense against harmful microbes? Yup, our skin! When you experience a deep burn, that defense mechanism is completely lost. So how do we prevent infection?

Topical antimicrobials. These should be applied in the emergency department, especially if there are delays in patient transfer. The most common topical antimicrobials used in burn patients include silver sulfadiazine, bacitracin, polymyxin B, and neomycin.

The tl;dr of Burns Resuscitation

That’s all folks. That right there is pretty much everything you need to know for the initial pharmacological management of burns. So now, are you more comfortable resuscitating shawty who is indeed burning on the dance floor? If you were too lazy to read this entire post, here is a tl;dr version (you’re welcome).

There are multiple types of burns, including thermal, radiation, chemical, and electrical. Burn are classified by degree depending on the depth of skin surface penetration, with classifications ranging from first-degree (superficial) to fourth-degree (possibly involving muscle and bone). Use the rule-of-nines to help estimate total body surface area (TBSA) affected.

Patients with major burns experience severe hypovolemic shock secondary to vasodilation and massive capillary leakage.

Clinical, Pharmacy School, Practice, ResidencyStephanie KujawskiFebruary 13, 2023pharmacotherapy for treating burn patients, how to manage burns in the ER, cyanide poisoning smoke inhalation injury, carbon monoxide poisoning smoke inhalation injury, types of burns and management, pharmacy emergency medicine burns

Algorithm of action in case of burns – News

Burns are one of the most common fire injuries. Therefore, it is important for all of us to know the techniques and methods of providing first aid to victims of burns.

The tragic consequences of burns would have been much less if help had been provided correctly from the first minutes. It is enough to apply a scheme of actions available to everyone directly at the scene of the incident in order not only to reduce pain, but also to significantly increase the likelihood of saving the victim.

As a rule, burns received in a fire are thermal, that is, obtained from direct exposure to fire, hot metal objects, flashed combustible liquid. By the way, thermal burns also include injuries received from boiling water or hot water.

It is important to be able to distinguish between degrees of burns. There are 4 degrees of burns:

I degree – skin redness, swelling. The mildest degree of burn.

II degree – the appearance of blisters filled with a clear liquid (blood plasma).

III degree – necrosis of all layers of the skin. Proteins of skin cells and blood coagulate and form a dense scab, under which there are damaged and dead tissues.

IV degree – charring of tissues. This is the most severe form of a burn, in which the skin, muscles, tendons, and bones are damaged.

The first factor influencing the severity of the victim’s condition is the area of ​​the burn. You can determine the area of ​​the burn using the “rule of nines”: the skin surface of the palm is 1% of the body surface, the skin surface of the hand is 9%, the skin surface of the leg – 18%, the skin surface of the chest in front and behind – 9% each, the skin surface of the abdomen and lower back of the abdomen and lower back – 9% each. Burn of the perineum and genitals – 10% of the burn area. Burns in these areas are shock injuries. There are superficial and deep burns; limited (less than 10%) and extensive (more than 10%).

REMEMBER! With large burns, life-threatening dehydration occurs.

BURN SCHEDULE:

1. Stop exposure to high temperature on the victim, extinguish the flame on his clothes, remove the victim from the affected area.

2. Specify the nature of the burn (flame, hot water, chemicals, etc.), as well as area and depth. Wrap the victim in a clean sheet and immediately deliver to a medical facility.
3. Carry out transport immobilization, in which the burned areas of the body should be in the most stretched position.

4. With a small burn, the burnt area can be placed under a stream of cold water from a tap for 10-15 minutes, with extensive burns this should not be done.

5. It is better to cut the clothes in the places of the burn and apply an aseptic bandage around the burn, while cotton should not be applied.

6. When transporting the wounded to a medical institution, ensure that he is calm.

IT IS FORBIDDEN:
– to leave the victim alone;

– apply ointment, cream, vegetable oil to the burned area, sprinkle with powders;

– pierce bubbles;

– remove clothing from the burned area;

– in case of a burn of the oral cavity, give food and drink.

The Main Directorate of the Ministry of Emergency Situations of Russia for the Kabardino-Balkarian Republic reminds:

If you are in an emergency and you need the help of firefighters or rescuers – a single number to call all emergency services from the mobile phone “112” and “01” from the stationary.

First Aid for Thermal Burns – Safety Basics

Thermal skin burns: how to assess the degree of damage

Statistically, most burns occur in domestic conditions and are caused by exposure to flame, boiling water, hot steam or incandescent objects. And – alas! – children often get them. That is why every adult should be guided in determining the degree of burns, since the choice of the method of first aid, the method of further treatment of the burn and the assessment of the need for medical (including inpatient) care depend on this.

So, due to the fact that in case of thermal burns (unlike chemical burns and eye burns) it is quite easy to determine their degree, each person should be able to do this. To begin with, if possible, clarify with the victim or others what happened, in order to make sure that the victim has a thermal burn, then examine the affected surface and assess the area of ​​the burn and the degree.

There are 4 degrees of burns:

1. First degree: redness and swelling of the skin at the site of a thermal burn. There may be small blisters with transparent contents.

2. Second degree: redness and swelling of the skin at the site of a thermal burn, as well as tense or broken blisters and a thin eschar that begins to form.

3. Third degree. In the third degree of thermal damage, there is a deep burn to the muscles and bones with the formation of a scab. Bubbles in the third degree, as a rule, have already burst. In this case, there may be small blisters with transparent contents around the deep burn zone (second degree burn), redness (first degree burn).

4. Fourth degree. At the fourth degree of a burn, charring of the burnt part of the body occurs. It is possible to combine the fourth degree with the first, second and third.

That is, one victim may have burns of varying degrees. In this case, the severity of the victim’s condition is assessed by the deepest burns, depending on the area of ​​the affected surface.

Thermal burns of the skin: how to estimate the area of ​​damage

Knowing how to determine the area of ​​a thermal burn is extremely important – this allows you to choose the right treatment tactics and sometimes even save the life of the victim. One of the simplest ways to estimate the area of ​​a burn is the “rule of the palm”. The area of ​​the palm of a person is on average 1% of the area of ​​his body. So, using the palm of your hand, you can determine how many percent of the body is affected.

There is also a 9% rule for adults: arm, half leg, half back, chest, stomach, head 9% each, and perineum 1%. But in children, the head with the neck makes up about 21% of the body area.

Thermal skin burns: how to choose the right first aid strategy .

In case of superficial thermal burns of more than 10% of the body area of ​​adults (in children – more than 5%) and with deeper burns from 5% of the body of an adult (respectively, more than 2.5% of the body of a child), after first aid, mandatory medical assistance is required followed by hospitalization. Such burns lead to a violation of the general condition, threaten the life of the victim and may subsequently require surgical intervention.

In addition to these cases, victims with deep burns of the hands and feet and superficial extensive burns of the hands and feet, burns of the eyes, ears, face and perineum, as well as suspected burns of the respiratory tract due to inhalation of extremely hot air are subject to mandatory hospitalization .

Thermal skin burns: how to provide first aid

The algorithm for providing self-help and mutual assistance for any thermal skin burns is as follows: air), or throw off burning clothing. You can extinguish a flaming piece of clothing by throwing earth, sand or snow over it, dousing it with water, or lowering it into water.

– Reassure the victim and others.

– Carefully remove any smoldering clothing that has not stuck to the wound. It is forbidden to tear off the adhering remnants of clothing from the wound. It is also impossible to touch the burnt surface with your hands.

– In case of sunburn, simply move the victim into the shade.

– If you do not know what happened, briefly and quickly clarify the circumstances (“the child poured a cup of hot broth on himself”, “the clothes caught fire from the flames of a fire”).

– Keep the affected body surface under running cold water for 10-20 minutes (possibly in a container with clean cool water). This is necessary in order to prevent further deepening and expansion of the wound due to heating of the burnt area. It will also improve blood circulation in the wound. But in no case should ice be used to cool the burn area, since, in addition to the existing burn, the victim will have an additional injury – frostbite. In extreme cases (in the absence of running water), it is possible to cool the wound with urine, but in real life there is almost never a reason to use this method.

– Apply Solcoseryl® gel to the burnt surface, then apply a dry sterile dressing on top. In no case do not use cotton wool: you can only use a bandage, gauze – fabric materials. If there are no emergency burns nearby and sterile bandages are not available, you just need to apply a clean, dry bandage. It is forbidden to apply ointments, creams, vegetable oil, a beaten egg, sour cream, kefir, alcohol solutions and other means to the burned skin, as well as apply aloe leaves, Kalanchoe juice, golden mustache and others to the wound. For mild first-degree burns without extensive damage to the skin and blisters, you can not apply a bandage, but only apply the gel.

– In case of extensive burns of the arms and legs, fix the limb with a splint or improvised means and give the limb an elevated position.

– In case of extensive burns and if signs of burn shock occur (pallor, weakness, restlessness, cold sweat, tachycardia, drop in blood pressure, impaired cardiac activity and respiration), give the victim plenty of fluids to drink – clean water, tea, compote. The liquid reduces intoxication, which occurs due to the absorption of decay products of burned skin, subcutaneous tissue, and muscles into the blood.

– In severe pain, to prevent pain shock, the victim is given any painkiller (analgin, paracetamol, etc.).

– Start cardiopulmonary resuscitation (artificial respiration and chest compressions) in the absence of respiratory and (or) cardiac activity in the victim.

– In case of indications for hospitalization, call an ambulance or take the victim to a medical facility. It is still better to use the services of the “Ambulance”, since usually we do not know in which department of which hospital the treatment of burns is performed. If possible, this should be a specialized clinic or specialized department.

When can thermal skin burns be treated at home .

Not all burns require further treatment in a hospital or even a clinic. At home, you can independently treat superficial small burns without infection (without red swollen edges of the wound, without purulent discharge from the wound, fever, chills, increased pain in the wound, the appearance of twitching pain in the wound, etc. ).

Adults can start treating burns up to 1% of the body (the size of the person’s palm) at home, unless they are extensive burns to the hand, foot, face, genitals. This is important to know, as scarring can form during healing, which will impair the function of these parts of the body. Only non-infected burns to the hand, foot, or face (about the size of a coin) can be treated at home.

It should be remembered that in the case of a long-term non-healing burn, especially of the lower extremities with concomitant neurovascular pathology of the legs, deepening of the wound, the appearance of purulent discharge, an unpleasant odor from the wound, with increased pain and a violation of the general condition, it is necessary to contact the polyclinic surgeon .

Any burns in newborns require medical attention and usually hospital treatment.

If earth got into the wound during a burn, or the burn was received in nature, you should go to any emergency room or polyclinic surgeon on the same day to get vaccinated against tetanus, a dangerous infectious disease. It is good if the doctor also treats this burn surface. In the future, it will be possible to continue treatment at home.

What you need to prepare for the treatment of burns at home

– Sterile bandage – 1-2 packs per day (size and volume – depending on the area of ​​the burn).

– Hand sanitizer (antiseptic).

– Sterile medical gloves – 1 pair of gloves per dressing.

– Hydrogen peroxide (3% solution) – 1-2 vials per dressing.

– Alcohol solutions of iodine or brilliant green (the so-called “brilliant green”) – 1 bottle.

– Cotton swabs – 1 pack.

– Gauze swabs (for wound dressing) – you can make your own from a sterile bandage, wearing sterile gloves. Store them in a package from a sterile bandage. It is best to prepare new gauze pads before each dressing.

– Scissors.

– Plaster (sometimes necessary to secure the dressing to intact skin).

How to treat thermal skin burns at home

Attention! It is impossible to open burn blisters on your own and use cotton wool and plaster when treating the wound surface.