Thermal Burns – StatPearls – NCBI Bookshelf

Continuing Education Activity

Thermal burns are skin injuries caused by excessive heat, typically from contact with hot surfaces, hot liquids, steam, or flame. Most burns are minor and patients can be treated as outpatients or at local hospitals. Approximately 6.5 percent of all burn victims are treated in specialized burn centers. The decision to transfer and treat at burn centers is based on the extent of body surface area burned, the depth of the burns and individual patient characteristics such as age, additional injuries or other medical problems. This activity will review burn evaluation and management and highlight the role of the interprofessional team in recognizing and treating thermal burns.

Objectives:

• Recall the causes of thermal burns.

• Describe the pathophysiology of thermal burns.

• Identify the treatment strategy for a patient with thermal burns.

• Outline the importance of enhancing care coordination among the interprofessional team to ensure proper evaluation and management of thermal burns.

Access free multiple choice questions on this topic.

Introduction

Thermal burns are skin injuries caused by excessive heat, typically from contact with hot surfaces, hot liquids, steam, or flame. Most burns are minor and can be treated as outpatients or at local hospitals. Approximately 6.5% of all burned patients receive treatment in specialized burn centers. The decision to transfer and treat at burn centers is based on the extent of body surface area burned, the depth of the burns, and individual patient characteristics such as age, other injuries, or other medical problems.[1][2][3][4]

Burns occurring in the home account for 25% of all serious burns.

Etiology

Thermal burns are the most common type of burn injuries, making up about 86% of the burned patients requiring burn center admission. Burns often result from hot liquids, steam, flame or flash, and electrical injury. Risk factors for thermal burns include:

• Young age – children often come into contact with hot liquids

• Male gender – males are also at high risk for burn injuries chiefly due to occupation-related injuries. Additionally, flame burns are also common during the summer, as many people use gasoline products for recreation or farming. Alcohol consumption is a common risk factor in adults who suffer burn injuries.

• Lack of smoke detectors in the home

When immersion scald burns are present, one should always suspect child abuse by the parent or caretaker.

Epidemiology

Approximately 450,000 patients received treatment for burns annually, and about 30,000 require admission to burn centers. About 86% of burns are thermal burns (43% from fire/flame, 34% from scalds, 9% from hot objects), 4% electrical burns, 3% chemical burns, and 7% are other types of burns. Annually, approximately 3400 patients die from burns or related complications such as smoke inhalation, carbon monoxide or cyanide poisoning, organ failure, or infection. Roughly 72% of these deaths occur from residential fires. Burns represent the fourth leading cause of trauma deaths and the second leading cause of accidental deaths in children ages one to four. The good news is that the overall survival rate for all types of burns is about 97%, and deaths from burns have declined by about 75% from the 1960s.

Pathophysiology

The skin is the largest organ of the body, making up about 16% of a person’s weight. The main skin functions are protection (infection, temperature changes, physical forces, chemicals, etc.), body temperature regulation, preventing fluid loss, and cosmetic/identity. Two primary layers comprise the skin, the thinner outer layer called the epidermis, and the deeper, thicker layer called the dermis. There are various other structures within the skin like hair follicles, sebaceous glands, sweat glands, capillaries, and nerve endings.

Thermal burns cause both local injuries and, if severe (> 20% of body surface area), a systemic response. The local injuries can be roughly separated into three zones of injury analogous to a circular target pattern. The innermost injury is the zone of coagulation or necrosis, representing the area of irreversible cell death. Surrounding this is the zone of ischemia or stasis, representing an area of decreased circulation and an area at increased risk of progression to necrosis due to hypoperfusion or infection. The outermost area is the zone of hyperemia, representing an area of reversible vasodilation and an area that usually returns to normal. In clinical practice, burns are dynamic injuries that may progress over hours to days, making it difficult to accurately determine the various zones during the early course of the injury.

Large burns (>20% body surface area) also cause a systemic response from the release of inflammatory and vasoactive mediators. Fluid loss locally at the burn site, fluid shifts systemically, plus decreased cardiac output and increased vascular resistance, can all lead to marked hypovolemia and hypoperfusion called “burn shock.”  This condition can be managed with aggressive fluid resuscitation, as discussed in the Burn, Resuscitation, and Management chapter.

History and Physical

Most burns are small and classify as minor burns with the primary symptom being pain. These burns will need only local burn wound care and pain control. If the patient has extensive and deep burns, then they may be classified as severe burns and could be approached like other trauma patients (See Burns, Resuscitation, and Management for discussion of severe burns). If the patient does not have severe burns, then the history and physical examination can proceed as usual. Key parts of the history to include are the type of burn (thermal, electrical, chemical, radiation), the possibility of associated inhalation injury (e.g., trapped in an enclosed space), and the possibility of other injuries (e.g., explosion or jumped to escape fire).[5][6][7][8]

During the physical exam, special attention should be placed on the airway and breathing, looking for oral burns, facial burns, soot in the nose or mouth, coughing, wheezing, or labored breathing. Also, look for signs of injury other than the burns. Finally, the burns are the focus of the skin exam. The key features to assess are the extent of the burns, expressed as a percent of total body surface area burned (% TBSA), and the depth of the burns, expressed as superficial (or first-degree), partial-thickness (or second-degree), or full-thickness (or third-degree).

If the burn injury only involves the epidermis, it is classified as a superficial or first-degree burn and does not cause any significant impairment of normal skin function. If the injury extends into the dermis, it classifies as partial-thickness or second-degree burn. Partial-thickness burns may disrupt skin functions such as protection from infection, thermal regulation, prevention of fluid loss, and sensation. If the injury extends through both layers, this is a full-thickness or third-degree burn, and normal skin functions are lost.

Superficial (or first-degree) burns are warm, painful, red, soft, usually do not blister, and will blanch when touched. A typical example is a sunburn. Partial-thickness (or second-degree) burns can vary but are very painful, red, blistered, moist, soft, and will blanch when touched. Examples include burns from hot surfaces, hot liquids, or flames. Full-thickness (or third-degree) burns have little or no pain, can be white, brown, or charred and feel firm and leathery when touched and will not blanch. Examples include burns from flames, hot oils, or superheated steam.

Evaluation

The American Burn Association’s criteria can help differentiate burns as minor, moderate, or severe based on the extent of skin injured, the depth of the burns, age of the patient (<10 or >50 y/o),  associated medical conditions, associated injuries such as smoke inhalation or other trauma, or burns involving particular areas of the body such as the hands, feet, face, ears, nose, or genitalia (See also Burns, Evaluation and Management for more details regarding determining depth and extent of burns).[9][10][11][12]

Burn size quantification is essential when making decisions about treatment and admission, and the rule of nines is often used.

For adults:

• 9% of the total body surface area to the head and neck

• 9% to each upper extremity

• 18% to the anterior and posterior trunk

• 18% to each lower extremity

• 1% to the perineum

The patient’s palm represents about 1% of the total body surface area. Also, burn injury can subdivide into partial and full-thickness injury.

Major Burn Injury

• More than 25% of total body surface area in adults or 20% in children

• Full-thickness burn involving more than 10% of TBSA

• There is burn to the face, perineum, or extremities

• There is significant cosmetic impairment

• These injuries are best managed in a burn center

Moderate Burn Injury

• Partial-thickness burn between 15 to 20% TBSA in adults, 10 to 15% in children   or a full-thickness burn involving 2 to 10% TBSA

• Minimal threat to face and perineum

• The risk of cosmetic impairment is not severe

• These patients need admission but do not always require a referral to a burn center.

Minor Burn Injury

• Burns that involves less than 15% of TBSA in adults and less than 10% in children

• No threat of functional or cosmetic loss

• Face and perineum not involved

• These burns receive outpatient management.

Treatment / Management

Burn treatment begins at the site of injury. EMS should assess for inhalation injury by looking for singed nasal hairs, burns on the nasal and mouth area, respiratory distress, and sooty sputum. Patients in respiratory distress should be intubated at the site. The patient should have an IV started and fluids, esp in adults. In children accessing small veins in a dark home can be difficult, and transport is recommended. Local cooling can be applied to relieve pain.

The first step is to immediately stop the burning process by removing burning and hot items from skin contact. Small areas of burn can be cooled with liquids like tap water or saline solution. If the patient has larger burns, be cautious of extensive cooling as this could lead to hypothermia. Superficial burns need little more than over-the-counter pain medicine, topical analgesics, or topical aloe vera. Partial-thickness and full-thickness burns are treated with cleansing, topical antibiotic ointments or occlusive dressings, pain medications, and tetanus booster if needed. Patients with severe burn will require fluid resuscitation, oxygen, cardiac monitoring, nasogastric tube, Foley catheter, IV pain medication, a tetanus booster, and transfer to a burn center. If patients are transferring to a burn center, simply cleaning and covering the burns without topical creams or ointments is all that is usually needed. It is best to contact the burn center for instructions.[13][14]

Inhalation injury must be ruled out in the ED. Inhalation injury can lead to upper airway edema within 12 to 24 hours, and the recommendation is for intubation if there is any doubt. Fiberoptic bronchoscopy is possible, as it does provide an accurate way to determine inhalation injury. Following control of the airway, one should perform a vertical incision of the eschar on the chest to prevent limitations of chest expansion. Sometimes additional lateral incisions may be required depending on the degree of eschar formation.

All circumferential full-thickness burn injuries need an escharotomy to prevent compartment syndrome.

Levels of carbon monoxide and cyanide need to be measured, and patients provided with oxygen. One should suspect cyanide toxicity in the presence of severe metabolic acidosis, normal arterial oxygen, and low carboxyhemoglobin.

All burns larger than 20% TBSA need fluid resuscitation based on the parkland formula. Crystalloids are preferable to colloids. One should be careful not to overhydrate and cause ARDs. Since there is a significant amount of protein loss during a burn, some centers do infuse 5% albumin. A foley should be inserted for the strict assessment of fluid balance.

Debate continues over the best way to treat blisters. Large blisters, tense blister, and blister crossing joints require debridement while small blisters and blisters involving the palms or soles are left intact.

One method of treating partial-thickness burns is to cover them with topical antibiotic ointments, like bacitracin or triple-antibiotic ointment, and then apply a simple absorbent dressing. The ointment can be spread on the dressing like peanut butter on bread, then placed on the burn. Dressings are changed once or twice a day and may take 1 to 2 weeks to heal. Silver sulfadiazine has historically been a commonly used topical antibiotic cream but is falling out of favor with growing evidence it can delay healing. The other method of burn wound management is to apply a specialized occlusive burn dressing to the burn and leave this in place for about one week.

After stabilization of the patient, surgical debridement and grafting are necessary.

Nutritional support is critical because the basal energy expenditure is high. Early enteral nutrition is the recommendation to prevent bacterial translocation from the gut. The patient’s caloric requirement can be estimated by using the Curreri formula (25kcal/kg+40kcal/% TBSA).

Skin discoloration is a common problem after a burn and a source of severe distress. Epidermal grafts are an option, but this is also time-consuming and expensive.

Because burns are dynamic injuries, they are difficult to assess on the initial exam accurately. Patients with burns should be reexamined in several days to reassess both the extent and depth of the burns.

Differential Diagnosis

• Chemical burn

• Electric burn

• Heat/fire burn 

Prognosis

The prognosis following a burn depends on many factors. While first degree burns have a good prognosis, both second and third-degree burns can have high morbidity and mortality. Extremes of age, other comorbidities, facility experience, and presence of inhalation injury play a significant role in the outcomes.

Enhancing Healthcare Team Outcomes

The management of a thermal burn is with an interprofessional team that consists of an emergency department physician, burn nurse, dietitian, ophthalmologist, dermatologist, and plastic surgeon.

The initial treatment is done in the emergency room to stop the process of burning and to resuscitate the patient. Depending on the depth and extent of the burn, admission may be required. Since these patients are prone to infections, an infectious disease consultant should be involved in the care of the patient. Those who suffer inhalation injury may need ventilation and management in the ICU.

The care for extensive second and third-degree burns is always a prolonged process, and some patients may require multiple plastic surgery procedures to cover the skin area burn. A wound care nurse should be involved early in the care. These patients need regular dressing changes for weeks or months. Additionally, nutrition is critical, and thus a dietitian should be consulted. Physical therapy should exercise the limbs to prevent contractures. The pharmacist should be involved in pain management.

Because cosmesis becomes altered, it is essential to seek a mental health consultation for the patient before discharge. The entire team should communicate with each member so that the goals of treatment are unified and meet the standard of care. With this approach, hopefully, the morbidity of burns can be reduced.

The outcomes depend on the type and extent of the burn. Those with first degree burns have an excellent prognosis, but those with second and third-degree burns, the prognosis is fair to guarded.[15][16] [Level 5]

Figure

Thermal Burn. Contributed by DermNetNZ

Figure

Thermal Burn
Third degree thermal burn to the foot. Total body surface area under 1%. Contributed by Mark A. Dreyer, DPM, FACFAS

References

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Reid A, Ha JF. Inhalational injury and the larynx: A review. Burns. 2019 Sep;45(6):1266-1274. [PubMed: 30529118]

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Regan A, Hotwagner DT. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 9, 2021. Burn Fluid Management. [PubMed: 30480960]

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Jones CD, Ho W, Gunn E, Widdowson D, Bahia H. E-cigarette burn injuries: Comprehensive review and management guidelines proposal. Burns. 2019 Jun;45(4):763-771. [PubMed: 30442380]

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Gentges J, Schieche C, Nusbaum J, Gupta N. Points & Pearls: Electrical injuries in the emergency department: an evidence-based review. Emerg Med Pract. 2018 Nov 01;20(Suppl 11):1-2. [PubMed: 30383348]

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Gentges J, Schieche C. Electrical injuries in the emergency department: an evidence-based review. Emerg Med Pract. 2018 Nov;20(11):1-20. [PubMed: 30358379]

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Huang HH, Lee YC, Chen CY. Effects of burns on gut motor and mucosa functions. Neuropeptides. 2018 Dec;72:47-57. [PubMed: 30269923]

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Dado DN, Huang B, Foster DV, Nielsen JS, Gurney JM, Morrow BD, Sharma K, Chung KK, Ainsworth CR. Management of calciphylaxis in a burn center: A case series and review of the literature. Burns. 2019 Feb;45(1):241-246. [PubMed: 30322738]

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Badulak JH, Schurr M, Sauaia A, Ivashchenko A, Peltz E. Defining the criteria for intubation of the patient with thermal burns. Burns. 2018 May;44(3):531-538. [PubMed: 29548862]

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Clark A, Neyra JA, Madni T, Imran J, Phelan H, Arnoldo B, Wolf SE. Acute kidney injury after burn. Burns. 2017 Aug;43(5):898-908. [PubMed: 28412129]

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Mauck MC, Smith J, Liu AY, Jones SW, Shupp JW, Villard MA, Williams F, Hwang J, Karlnoski R, Smith DJ, Cairns BA, Kessler RC, McLean SA. Chronic Pain and Itch are Common, Morbid Sequelae Among Individuals Who Receive Tissue Autograft After Major Thermal Burn Injury. Clin J Pain. 2017 Jul;33(7):627-634. [PubMed: 28145911]

Types of Burn Injuries | Thermal, Electrical & Chemical Burns

Many people think of burns as an external contact injury, such as when you touch something hot and blister your hand—a thermal burn. But burns can occur inside your body and result from several causes, including chemicals (inhaled or swallowed) and electricity. Of course, anyone who has experienced a sunburn knows that radiation from the sun’s rays can cause burns too.

Regardless of the type of burn, doctors treat any burn injury based on the degree of burn involved. First-degree and mild second-degree burns can be safely treated at home most of the time. Severe second- and third-degree burns require medical intervention, which can include hospitalization and skin grafts. To avoid complications from burns, learn what to do for thermal, chemical, electrical and radiation burns.

First Aid for Thermal Burns

Thermal burns occur when your skin comes in contact with heat or flame. Some common causes or sources of thermal burns include:

• Appliances, such as stoves, ovens and curling irons

• Cooking oil

• Fire or open flames due to residential fires, fireplaces, and gas cooktops

• Water including hot or boiling water and steam that cause scalding

Severe second- and third-degree thermal burns should be evaluated by a medical professional. But for milder burns you can take these first-aid steps:

• Apply cool compresses to the burn site or run cool water over it for several minutes.

• Cover the burn area with a sterile dressing, such as gauze. Do not apply cotton balls or any type of fluffy cotton, as the fibers may stick to the wound.

• If the burn area covers a large percentage of the total body surface or if it wraps around the entire body, call 911 for emergency medical assistance. Also call 911 if the burned person has trouble breathing or appears to have other injuries like broken bones.

• Seek medical treatment for burns of any severity to the face, hands, feet or genitals and for burns to infants or elderly people.

What to Do for Electrical Burns

Accidental exposure to electricity can cause electrocution, and it also can result in burns outside and inside the body. When electricity passes through the body, it burns tissue all along its pathway. After an electrical shock, you might notice a burn injury to your skin where the current entered and another mark where the current exited the body. In addition to these surface burn injuries, you may experience internal burns.

If you witness or suspect a person has sustained an electrical injury, take these first-aid steps:

• Shut off the electrical current. Never touch a person experiencing an electrical shock until you know for certain the current has stopped flowing through their body.

• Resuscitate, if necessary, and call 911.

• If the person is conscious but appears to have other injuries, such as broken bones, seek emergency medical assistance.

For mild electrical burns, you can perform first aid:

• Apply a cool compress to the burned area. Never apply ice packs, as this can delay the healing process. Look for at least two burn marks: one where the current entered the body and one where it exited.

• Apply a light gauze dressing, if possible.

• For burns around the mouth that occur in a child who chewed on an electrical cord, seek medical attention.

• Monitor the person’s health for several days after experiencing an electrical burn and go to the doctor if he or she experiences any change in mental status (such as confusion or seizure), abnormal heart rhythm, or trouble with muscle coordination.

First Aid for Internal and External Chemical Burns

Chemicals can cause burns both inside and outside the body. People who swallow or inhale caustic substances can experience mild or severe internal burns to their nasal passages, lungs, and throat. You should always call 911 for emergency medical assistance for any suspected internal chemical burns. Do not induce vomiting. Symptoms may include:

• Frothing or foaming around the mouth

• Inability to talk

• Visible burns to the lips and oral area

• Wheezing or difficulty breathing

Toddlers are particularly susceptible to eating or swallowing cleaning products and other noxious chemicals. Always keep these products out of the reach of children.
Mild chemical burns to the skin, on the other hand, may be safely treated with first aid at home. Follow these steps:

• Brush any dry chemical residue off the skin. Be sure to wear gloves or other protective gear to avoid contact with the chemical.

• Flush the area with cool water for several minutes to remove the chemicals. If the eye is burned, flush with plain water for at least five minutes and seek medical attention.

• Carefully take off any clothing, jewelry, watch or other items that were contaminated by the chemical. Then take a cool shower to rinse off any remaining residue.

• Apply a loose gauze bandage to the burned area.

All severe second-degree or third-degree chemical burns require immediate medical attention. You also should seek professional care for milder chemical burns that:

• Are larger than about three inches in width or diameter.

• Cover a major joint, like the elbow or knee.

• Occur on the face, hands, feet or genitals.

• Wrap all the way around the body.

Too much exposure to the sun’s ultraviolet radiation can result in a burn. Of course, the sun isn’t the only cause of radiation burns. These injuries also can occur due to occupational exposures and targeted radiation therapies for certain cancers. If you experience a radiation burn for those reasons, rely on your doctor’s advice for how to care for the injury.

But for the most common type of radiation burn—sunburn—try these strategies to reduce discomfort and promote healing:

• Apply cool compresses (not ice packs) to the burn area.

• For blistered skin, apply light gauze bandages if possible. If not possible, be sure to launder your sheets every day until the blisters have healed. Wearing clean t-shirts or lightweight knit pants can absorb any oozing from weeping sunburns until they heal.

• To relieve sunburn pain, take over-the-counter (OTC) pain relievers like acetaminophen (if you are not allergic to it). If the skin is not blistered, you also can apply OTC sunburn creams and ointments that contain benzocaine to numb the skin. Some people find relief applying aloe vera gel to a sunburn. If the sunburn becomes very itchy, you can try taking an OTC antihistamine product.

Most people do not require medical attention for sunburn. However, if an infant or very elderly person sustains a sunburn, see a doctor.
No matter what causes a burn injury, your response to it can mean the difference between healing well and developing complications. Use common sense and basic first-aid techniques to care for burns at home or seek medical attention when appropriate.

Thermal Burns – Burns Caused by Fire, Steam, and Hot Liquids

A burn is an injury to the skin and other tissues typically caused by heat, cold, chemicals, electricity, radiation, or friction. Most burns are minor, and the injured person doesn’t need to be hospitalized. However, some burns require emergency treatment, and around 6.5 percent of all burns have to be treated in a specialized burn center. Whether or not a patient requires specialized treatment depends on a range of factors. These include the depth of the burns, the surface area of the body that was burned, and the age and health of the patient.

About 86 percent of burns are thermal burns. These are injuries caused by excessive heat, and they are usually due to contact with steam, flames, hot liquids, or hot surfaces. Forty-three percent are from fire or flames, 34 percent from scalds, and nine percent from hot objects. Other types of burns include electrical burns, friction burns, and chemical burns.

Risk Factors for Thermal Burns

Anyone can suffer a thermal burn, but some people are more at risk than others. Children and males are especially at risk. Children are often in contact with hot liquids, while males tend to work in jobs that make burn injuries more likely. Thermal burns resulting from flames are more common during the summer when people use gasoline for outdoor activities. Alcohol consumption is also a risk factor in burn injuries among adults. In addition, not having smoke detectors in a building puts the occupants in danger of suffering burns.

How Thermal Burns Affect the Skin

To understand thermal burns, it’s important to know some basic facts about the skin. The skin is the largest organ of the human body, and it accounts for around 16 percent of an individual’s weight. It protects the body against infection, regulates temperature, and prevents fluid loss. The skin is made up of three layers, the epidermis, dermis, and hypodermis or subcutaneous tissue.

The epidermis is the thinner outer layer, while the dermis is a thicker, deeper layer, and the hypodermis is the innermost layer. The latter is made up of fat as well as connective tissues that surround larger blood vessels and nerves.The thickness of this layer varies throughout the body and also from one person to another.

Types of Burns

The severity of a burn injury depends on the number of skin layers that are affected. Burns were traditionally categorized by degree, but healthcare professionals now classify them based on whether they’re full, partial, or superficial. These more or less correspond with the three layers of the skin. However, many burn injuries involve all three types of burns.

A superficial burn is one that involves only the epidermis. This type of injury is red and painful, and the area turns white when it is touched. There are no blisters present, and the skin is moist.

Partial-thickness burns involve both the epidermis and some part of the dermis. This type of burn can be either superficial or deep, depending on how much of the dermis is affected. Superficial partial-thickness burns are also red and painful, and the burned area turns white when touched. The skin is mottled and moist, and both blisters and hairs are present.

With deep partial-thickness burns, sometimes the damage goes so deep that the nerve endings are destroyed. This means this type of burn isn’t always painful. If the sweat glands are also destroyed, the skin will be dry rather than moist. The hair is usually gone, and the area may not turn white when it is touched.

Full-thickness burns are the most severe since they affect all of the first two layers of the skin. This means hair follicles, nerve endings, small sweat glands, and small blood vessels are all destroyed. In the most serious cases, even bones and muscles are damaged. These burns are painless, and there’s no sensation to touch. The skin is dry, and it may be charred or pearly white. It may also appear leathery.

When to Seek Medical Attention for Thermal Burns

Minor burns can be treated at home, while more serious burns will require a doctor’s attention. Victims should seek emergency medical care for partial or full-thickness burns on the hands, feet, eyes, ears, or genitals. Any burn over a major joint should also be treated as an emergency. Other emergencies include:

• Full-thickness burn injuries that look dry or charred
• Partial-thickness burns that are larger than the injured person’s palm
• Any burn that results in uncontrollable pain

Some situations require that the victim be transported in an ambulance. These include:

• Large full or partial-thickness burns about the body
• Burns to the face that cause problems with breathing
• Significant exposure to smoke in a closed room
• Loss of consciousness

Treatment and Recovery

Burn wounds change in the days following injury as inflammation sets in, and healing begins. Older adults and those who are ill often take longer to heal even when their thermal burns are superficial. Meanwhile, burns on the feet and lower leg tend to get deeper and more painful in the subsequent days, especially if the patient doesn’t keep the leg elevated.

Small superficial burn injuries don’t usually become infected. However, sometimes burn that were initially classified as superficial don’t heal, or they appear to be getting deeper. This can be a sign of infection. If a wound doesn’t seem like it will 14 days after the injury, more specialized treatment may be necessary.

A team of healthcare professionals, including emergency physicians, burn nurses, dietitians, dermatologists, and plastic surgeons, may be required to treat severe burns. Extensive partial-thickness and full-thickness burns require prolonged treatment. In addition to weeks or months of dressing changes, some patients need several plastic surgery procedures.

Physical therapy and pain management also form part of the treatment process. The effects of a serious burn injury aren’t only physical, and patients may also need mental health treatment. Many experience anxiety, depression, post-traumatic stress disorder, and sleep disturbances.

Prognosis

The outcome of a burn injury depends on several factors. Superficial burns have a good prognosis, but partial and full-thickness burns can have high mortality and mobility. Really young or really old patients are also at greater risk of having poor outcomes. Inhalation injuries and other co-morbidities also affect the outcome.

Resources

Burns (for Parents) – Nemours (XML)

What Are Common Causes of Burns?

The first step in helping to protect kids from burns is to understand how common burns happen:

• Thermal burns: These burns raise the temperature of the skin and tissue underneath. Thermal burns happen from steam, hot bath water, tipped-over coffee cups, hot foods, cooking fluids, etc.
• Radiation burns: These happen from exposure to the sun’s ultraviolet rays (a sunburn because skin isn’t well-protected in the sun) or from radiation such as during an X-ray.
• Chemical burns: These happen from swallowing strong acids (like drain cleaner or button batteries) or spilling chemicals (like bleach) onto the skin or eyes.
• Electrical burns: These are from contact with electrical current and can happen from things like biting on electrical cords or sticking fingers or objects in electrical outlets, etc.

What Are the Types of Burns?

Knowing the type of burn a child has can help with first-aid measures. All burns should be treated quickly to lower the temperature of the burned area and reduce damage to the skin and tissue underneath (if the burn is severe).

First-Degree (Superficial) Burns

Superficial (shallow) burns are the mildest type of burns. They’re limited to the top layer of skin:

• Signs and symptoms: These burns cause redness, pain, and minor swelling. The skin is dry without blisters.
• Healing time: Healing time is about 3–6 days; the superficial skin layer over the burn may peel off in 1 or 2 days.

Second-Degree (Partial Thickness) Burns

These burns are more serious and involve the top layer of skin and part of the layer below it. 

• Signs and symptoms: The burned area is red and blistered, and can swell and be painful. The blisters sometimes break open and the area is wet looking with a bright pink to cherry red color.
• Healing time: Healing time varies depending on the severity of the burn. It can take up to 3 weeks or longer.

Full Thickness Burns

These burns (also called third-degree burns or fourth-degree burns) are the most serious type of burn. They involve all layers of the skin and the nerve endings there, and may go into underlying tissue.

• Signs and symptoms: The surface appears dry and can look waxy white, leathery, brown, or charred. There may be little or no pain or the area may feel numb at first because of nerve damage.
• Healing time: Healing time depends on the severity of the burn. Most need to be treated with skin grafts, in which healthy skin is taken from another part of the body and surgically placed over the burn wound to help the area heal.

What Should We Do for Burns?

Get medical help right away when:

• You think your child has any burn other than a superficial one.
• The burned area is large (2–3 inches wide), even if it seems like a minor burn. For any burn that appears to cover a large part of the body, call for medical help. Do not use wet compresses or ice because they can cause the child’s body temperature to drop. Instead, cover the area with a clean, soft cloth or towel.
• The burn comes from a fire, an electrical wire, a socket, or chemicals.
• The burn is on the face, scalp, hands, genitals, or on skin over a joint.
• The burn looks infected (with swelling, pus, increasing redness, or red streaking of the skin near the wound).

For superficial burns:

• Remove the child from the heat source and take clothing off the burned area right away.
• Run cool (not cold) water over the burned area (if water isn’t available, any cold, drinkable fluid can be used) or hold a clean, cold compress on the burn for 3–5 minutes (do not use ice, which can cause more damage to the injured skin).
• Do not apply butter, grease, powder, or any other “folk” remedies to the burn, as these can make the burn deeper and increase the risk of infection.
• Apply aloe gel or cream to the affected area. This may be done a few times during the day.
• Give your child acetaminophen or ibuprofen for pain. Follow the label directions for how much to give and how often.
• Keep the affected area clean. You can protect it with a sterile gauze pad or bandage for the next 24 hours. Do not put adhesive bandages on very young kids, though, as these can be a choking hazard if they get loose.

For partial thickness burns and full thickness burns:

Call for emergency medical care. Then, follow these steps until help arrives:

• Keep the child lying down with the burned area raised.
• Follow the instructions for first-degree burns.
• Remove all jewelry and clothing from around the burn (in case there’s any swelling after the injury), except for clothing that’s stuck to the skin. If you have trouble removing clothing, you may need to cut it off or wait until medical help arrives.
• Do not break any blisters.
• Apply cool water over the area for at least 3–5 minutes, then cover the area with a clean dry cloth or sheet until help arrives.

For electrical and chemical burns:

• Make sure the child is not in contact with the electrical source before touching him or her, or you also may get shocked.
• For chemical burns, flush the area with lots of running water for 5 minutes or more. If the burned area is large, use a tub, shower, buckets of water, or a garden hose.
• Do not remove any of the child’s clothing before you’ve begun flushing the burn with water. As you continue flushing the burn, you can then remove clothing from the burned area.
• If the burned area from a chemical is small, flush for another 10–20 minutes, apply a sterile gauze pad or bandage, and call your doctor.
• Chemical burns to the mouth or eyes need to be checked by a doctor right away after being thoroughly flushed with water.

Chemical burns and electrical burns might not always be visible, but can be serious because of possible damage to internal organs. Symptoms may vary, depending on the type and severity of the burn and what caused it.

If you think your child may have swallowed a chemical substance or an object that could be harmful (for instance, a button battery), first call poison control at (800) 222-1222. Then, call 911 for emergency medical help.

It helps to know what chemical product the child has swallowed or has been exposed to. You may need to take it with you to the hospital.

Keep the number for poison control, (800) 222-1222, in an easily accessible place, such as on the refrigerator.

Reviewed by: Kate M. Cronan, MD

Date reviewed: August 2019

Workplace Burn Prevention | Burn Safety Training

Every year for National Burn Awareness week, the American Burn Association brings attention to burn injuries that result in over 40,000 hospitalizations per year. While a very large majority of these burns actually occur in the home, workplace burns are a very preventable source of injury. Awareness, hazard prevention and protection can dramatically lessen the risk of burns in the workplace.

Types of Workplace Burns

Thermal Burns — Thermal burns are burns caused by the heat from liquids (called “scalding” burns), open flames, hot objects and explosions. The most important priority with thermal burns is controlling and stopping the burning process. Thermal burns can be prevented by wearing Personal Protective Equipment, using fire prevention tactics, and by having procedures and emergency action plans related to fire detection and protection.

Chemical Burns — Chemical burns are the result of skin or eyes coming into contact with strong acids, alkaloids or other corrosive or caustic materials that eat away or “burn” skin and deeper tissue. In the workplace, these accidents can occur after exposure to industrial cleaners (such as rust removers or drain cleaners), chemicals in laboratories or manufacturing workplaces. One of the best ways to prevent chemical burns is to make sure all workers are well-versed in Hazard Communication, which covers the symbols and labels that will communicate chemical risk. These labels will also include the important information on the steps workers can take to prevent burns if they come into contact with dangerous chemicals. Workers who will come into contact with chemicals should consider Hazard Communication training and should also take refresher courses as these standards can be updated often.

Electrical Burns — Current travels through body and meets resistance in tissue, resulting in heat burn injuries. To avoid burns from electrical sources, high-voltage areas and machinery should be clearly marked. Workers should also make sure to identify live wires, avoid contact with water while working with electricity, and wear the personal protective equipment necessary to avoid burns by electricity. Our Electrical standards course is a great overview of the types of electrical hazards workers may find on a worksite and the OSHA standards that help avoid accidents.

Sun Exposure Burns — While these could technically be considered a thermal burn, sun exposure burns are worthy of special consideration. Employees who work under the sun should be well versed in the sun safety practices that will keep them safe, and should take precaution to reduce hours under harsh direct sun, seek shade if possible, and wear sun-protective work clothing, hats and sunscreen to reduce the risk of burns from sun exposure.

Burn Severity

First Degree

First-degree burns cause minimal skin damage and are considered superficial since they affect the top layer of the skin. A mild sunburn is an example of this type of burn, where the burn site is red, painful, dry and without blister.

Second Degree

The damage from a second-degree burn extends beyond the top layer of the skin and can often cause the skin to blister or become extremely red and sore.

Third Degree

Third-degree burns destroy both the epidermis and the dermis, and they can also go as deep as to destroy tissue underneath. These burns can appear white or charred.

Fourth Degree

In a fourth-degree burn, all skin layers are affected, and there is also potential for damage to muscle, tendons and bone. Skin grafts do not work on these severe burns, so much so that fourth-degree burns may require amputation if injury occurs in a limb or extremity.

Employer’s Duty

Under the OSH law, employers have a responsibility to provide a safe workplace. This overarching responsibility is broken down, but at the end of the day, if a worker is not safe, the employer is likely at risk. When it comes to burns, here are a few ways employers can help to provide safe workplaces.

Initial Training

Making sure employees have the proper training is one of the most important steps an employer can take. Training should cover not only the hazards that the employee might face on their worksite, but also an overview of OSHA standards and how to identify hazards that may not have been covered. OSHA 10-hour training is a great way to get a baseline of safety standards training before an employee ever even starts receiving worksite-specific training. Then, employers should make sure that the employees are trained on their specific job functions, including in-depth safety training with any machinery, chemicals or other worksite hazards specific to their job.

Refresher Training

In addition to training before ever even starting a job, employers should regularly update training so that employees are kept up-to-date with standard changes and so that important concepts are kept at top-of-mind. Certificate training courses are a great way to re-train employees, and our online standards training topics can be taken 100% online for efficient and inexpensive refresher training.

Hazard Communication

Color codes, posters, labels or signs to warn employees of potential hazards are an employer requirement under the OSH Act, and these vital pieces of Hazard Communication are extremely important in burn prevention. Workers should be trained on how to recognize symbols and other hazard communication codes, and GHS communication standards should be used to identify material hazards in a consistent and easily recognizable way. When hazardous chemicals are found in the workplace, employers are also required to produce and provide a written Hazard Communication plan. These requirements, as well as an overview of GHS and the symbols now utilized in the United States, can be found in our Hazard Communication overview course.

Workplace Burn Prevention Game

Want a great workplace burn prevention game to share with your employees? Check out our Workplace Burn Prevention Game!

Burn Injury Lawyers & Fire Accident Attorneys

A fire that starts with a small spark can quickly grow to cause serious injuries, even fatalities, and they can be a more common hazard than you may expect.

Approximately

486K

burn injuries require medical attention each year in the United States

Causes of burn injuries

Burns injuries can be caused in many different ways and the cause of a burn is just one way a burn injury is classified: 

Thermal burns

Thermal burns are an extremely common type of burn injury and most people will experience thermal burns at some point in their lives. These types of burns are caused by coming in contact with a source of heat, either directly or indirectly. This can include an open flame, the sun, a hot stove, or a hot liquid. 

Electrical burns

Electrical burns are caused by coming into contact with an electrical current. They’re very commonly caused by electrical cords where the insulation has worn off, but they can also occur if a person is doing electrical repairs on a building’s electrical system and the power supply hadn’t been properly shut down first or if wiring is faulty. 

Chemical burns

Not all types of burn injuries are caused by heat or an open flame. Chemical burns occur when certain types of chemicals come in contact with skin or eyes and damage the tissues. Many chemical burns tend to occur in the workplace, but they can also be caused by substances commonly found in homes, including bleach, ammonia, battery acid, chlorine, and many types of cleaning products. 

Types of burn injuries

Burn injuries are also classified on their severity:

First-degree burns

First-degree burns are the least severe type of burn injury. These burns affect only the outer layer of skin, resulting in red skin and pain, but will heal fairly quickly without causing any long-term damage.

Second-degree burns

Second-degree burns affect the outer layer of skin and the layer of dermis beneath it. This type of burn results in blistering and are red, painful, and can have a shiny appearance. The long-term effects of a second-degree burn depend on the extent of the burn. If only part of the dermis is damaged, this is known as a superficial second-degree burn and might not result in permanent scarring. Partial-thickness burns go deeper and can cause scarring or discoloration of the skin. 

Third-degree burns

Third-degree burns destroy the first two layers of skin, as well as other things in the affected area, such as nerve endings and hair follicles. Rather than having a red color, third-degree burns can be yellow, white, black, or brown in appearance. Third-degree burns also often have a leathery appearance. A skin graft will likely be needed to treat the burn. 

Fourth-degree burns

Fourth-degree burns are the most severe type of burn and can be life-threatening. These burns not only destroy all layers of the skin, they also destroy the underlying muscles, tendons, and bones. 

The area a burn injury covers is an important aspect of judging the severity of a burn. Burn sizes are measured by the percentage of total body surface area (TBSA). TBSA is only used in cases of moderate to severe burn injuries. Once an approximate TBSA is known, the burn can be classified as one of three types: 

Minor burns

In adults, a burn with a TBSA of less than 10% is considered a minor burn. For children and the elderly, a minor burn has a TBSA of less than 5%. In cases of third-degree burns, the TBSA only needs to be less than 2% to qualify as a minor burn. 

Moderate burns

Moderate burns have a TBSA of 10%-20% in adults and 5%-10% in children and the elderly. If the burn is a third-degree burn, the TBSA can be 2%-5% to count as a moderate burn. 

Major burns

Major burns have a TBSA greater than 20% in adults and greater than 10% for children and the elderly. In third-degree burns, the TBSA is greater than 5%. 

Effects of burn injuries

Burn injuries can potentially result in a wide range of problems, such as infections, scarring, skin discoloration, tissue damage, bone damage, loss of mobility, and disfigurement. If sweat glands were damaged by the burn, a person might easily overheat since they aren’t able to cool themselves through sweating. A person might also develop respiratory problems if smoke was inhaled around the time the burn occurred.

Burn injuries can be absolutely devastating, not just physically, but psychologically as well. One study by the Loyola University Medical Center found that 16% of burn patients experience PTSD as a result of their injury. It’s also extremely common for burn injury victims to have anxiety over their appearance and feel isolated from others. 

Treatments for burn injuries

Treatment options for burn injuries depend on the type of burn it is and how severe it is. Some common burn injury treatments include surgically removing dead tissue, skin grafting, intravenous fluids, pain medications, and topical ointments. If an infection develops, antibiotics may be needed. Specialty wound dressings and ultrasound water-based mist therapy can also be used to treat burns. 

In some cases, a burn injury victim might benefit from cosmetic reconstructive surgery, physical therapy, or occupational therapy. Seeing a counselor or psychologist may be able to help with the psychological effects of a burn. 

Who is most at risk for burn injuries?

Burn injuries can easily happen to anyone and most people experience a burn injury at some point in their lives. Statistically speaking, though, some people are more susceptible to severe burn injuries than others. 

According to the American Burn Association, children and the disabled are particularly vulnerable to burn injuries. 

In the United States

24%

of burn injuries occur in children under the age of 15

Children under 5 were

2.4x

more likely to require medical treatment for a burn injury between 2011 & 2015

As of 2015, unintentional fire and burn injuries were the 5th leading cause of injury death in the United States for children under 5 and the 3rd leading cause of injury death for children between 5 and 9. 

Older individuals can also be very susceptible to fatal burn injuries. Burn injuries are the 8th leading cause of death for people over 65. 

Damages in a burn injury claim

If you’re considering making a claim for damages caused by a burn injury, some types of damages you can collect include:

• Medical expenses, including future medical expenses
• Pain and suffering
• Lost income
• Out-of-pocket expenses

Contact a Los Angeles burn injury lawyer

The effects of a burn injury can be devastating, both physically and psychologically. When you’re dealing with a stressful situation like this, the last thing you need is someone trying to pressure you into accepting a smaller settlement than you deserve. When you work with The Wallace Firm, you’ll have a team of burn injury lawyers on your side to fight for you to get the compensation you need. We’ve successfully helped many burn injury victims just like you in the Los Angeles area. Contact us today for help with your claim. 

RACGP – Thermal burns

Background

Appropriate care of minor burns is key if complications, leading
to the need for surgical intervention and increased likelihood of
poor outcomes, are to be avoided.

Objective

This article provides guidance to support the appropriate
management of thermal burns in the general practice setting.

Discussion

Correct initial assessment of the patient with a thermal burn
will determine whether they can be managed at home or
require burns unit care, hospital admission for analgesia or
specialist outpatient review. Factors that may impact on
healing include the size, depth and location of the wound;
the presence of oedema and blisters; as well as the patient’s
social circumstances, age and health status. First aid with
cool running water should be applied to the burn for at least 20
minutes. Cooling and the application of an occlusive dressing
will minimise the pain associated with partial thickness burns.
Oral analgesics or short term hospital admission for adequate
pain control may be necessary. Definitive management of
minor burns involves dressings, rest, elevation and oedema
control, and regular review as the burn wound evolves and
heals. Referral should be considered for any burn wound that
appears unlikely to heal within 14 days postinjury.

A minor burn is commonly defined as a superficial burn to less than 10% of total body surface area (TBSA) in adults and less than 5% TBSA in children. However, this definition is imprecise and not sufficient to determine which burns can be managed at home and which need hospital admission or outpatient specialist review. The impact of any burn wound will vary according to the social circumstances, age and health status of the patient as well as location of the wound. In general, burns that are appropriate for management in the general practice setting are small superficial burns that can be expected to heal spontaneously. In practice, many superficial burns that are smaller than 10% TBSA will be difficult to manage in general practice due to dressing and pain management requirements. Depending on local resources, such patients may be best initially managed in an outpatient clinic or admitted to hospital.

Appropriate initial care for minor burn wounds can prevent delayed healing, infection and poor scarring. This involves:

• first aid
• analgesia
• assessment of the size and depth of the burn wound
• assessment and management of factors that may impact on healing (eg. rest and elevation)
• dressings
• blister management and debridement (as necessary)
• review.

When a patient presents with a burn, it is important to be aware of the possibility of nonaccidental injury, especially in children and the elderly. This article deals with thermal burns only. Chemical and electrical burns are beyond the scope of this article. More detailed burns management guidelines, developed by the Victorian statewide burns services at the Alfred Hospital and Royal Children’s Hospital Melbourne, are available online (see Resources).

First aid

The application of cool to cold (around 15°C) running water to the burn for at least 20 minutes is considered to be the gold standard for burns first aid. This should be applied as soon as possible after injury, and is considered to be beneficial for at least 1 hour, and possibly longer, postburn. However, research evidence is not conclusive regarding optimal duration and delays after which first aid may no longer be helpful. Early appropriate first aid to partial thickness burn wounds has been shown in an experimental animal model to be associated with earlier healing and less scarring.² In addition to improved healing outcomes, cold water also has an excellent analgesic effect, and modulation of pain related inflammatory mediators may be one mechanism by which first aid influences healing. Ice should not be used.

It is important to avoid the development of hypothermia during burn wound cooling, especially in children: cool the burn and warm the patient. Hydrogel products, such as Burnshield™ or Burnaid™ are best considered as temporary dressings for acute burns applied after first aid treatment; however they may also be useful to cool the burn wound if clean cold running water is not available. These products have a cooling effect on the wound provided they are left exposed to the air so that evaporative heat loss occurs.

Analgesia

Partial thickness burns are painful. Cooling these burns and applying an occlusive dressing can help minimise pain and oral analgesics should be prescribed if necessary.³ Some patients may require short term admission for adequate pain control if oral analgesia is insufficient. Elevation of the injured part to prevent oedema will also minimise the development of pain associated with swelling and stiffness.

Assessment of the size and depth of the burn wound

The most useful method for assessing the size of small burns is using the palmar surface of a patient’s hand (including fingers), which approximates 1% of TBSA. Larger burns are more accurately assessed using the ‘rule of nines’ chart for adults and the Lund and Browder chart (or one of its modifications) for children (see Resources).

The depth of a burn determines its capacity to heal by regeneration of epithelium from undamaged adnexal structures, such as hair follicles, in the dermis. Assessing the depth – and therefore the healing potential – of burn wounds is generally straightforward for both superficial and deep burns (Table 1). The clinical features are usually obvious, and primarily related to the depth of damage to the dermis. Living superficial dermis exposed after the removal of blisters is moist, pink and has a brisk capillary return. Due to the exposure of sensory nerve endings in the superficial dermis these wounds are often extremely painful and tender. Burns involving the reticular dermis and deeper, are progressively less well perfused and less sensitive as the injury deepens to a dry, insensate, unperfused full thickness burn wound.

Some burns at presentation are not obviously deep or superficial: these burns are referred to as ‘mid-dermal’ and generally have sluggish capillary return with some preserved sensation. It is not possible to predict the healing of such burns acutely, especially if they are small: they should be managed in an expectant fashion, as their capacity to heal may not become evident for some days after injury. With the passage of time (usually several days), these burns either progress to develop definite features of a deep burn, or else gradually recover a capillary circulation and progress to healing. The healing potential of scald burns in children and the elderly especially, may also be difficult to assess on presentation.

Factors that may impact on healing

Burn wounds evolve in the first few days after injury, as the process of inflammation becomes established and healing progresses. Sometimes healing does not proceed as expected. The elderly and unwell frequently have very limited capacity to heal even quite superficial burns. Burns involving the feet and lower leg often become more painful, swollen and deeper in the days after injury, especially if the patient does not rest with the limb elevated. This highlights the importance of active management of oedema in the acute phase of care; an aspect of management that is frequently overlooked. Oedema interferes with mobilisation, predisposes to stiff joints (especially in the hand) and delays healing. Where possible, the injured part should be kept elevated and supportive elastic tubular bandages should be applied over dressings, if needed, to control swelling. It is uncommon for small superficial burns to become infected.

However, if a wound that was initially assessed as superficial appears to be deepening or fails to heal, it is important to consider the possibility that this may be due to the development of infection. Prolonged healing times are associated with poor scarring. Referral should be considered for any burn wound that appears unlikely to heal at 14 days postinjury.⁴

Dressings

There is little evidence to establish the superiority of any particular burns dressing;⁵ however several basic principles should inform the choice of dressing.

Moist wound healing is preferred over the exposure treatment of burn wounds, as this is associated with improved healing and less pain. A burn wound produces exudate, which may be copious in the first 24–48 hours after injury. After this period there is less exudate and dressings should be switched from the primarily absorptive (eg. paraffin gauze/gauze or Melolin™) to a nonadherent occlusive type (such as polyurethane films, eg. Tegaderm™, Opsite™) or hydrocolloids (eg. Duoderm™, Comfeel Plus™).

Burns should be reviewed within 48 hours after injury in order to reassess depth of wound in cases where this may have been unclear at presentation, and also to change the initial dressing, which at this point will generally be soaked. Although there is great attention paid to choice of dressing, in practice the most important factor in burn wound management is to ensure early review after injury. As healing progresses, dressings should be changed less frequently in order to avoid disturbing regenerating epithelium.

Dressings containing silver, which is a potent and effective topical antimicrobial, are increasingly available. However, their value in the treatment of small partial thickness burns is not established. This is also the case for other topical antimicrobials and systemic antibiotics. Silver sulfadiazine cream in comparison to other dressings has been associated with delayed healing when used in the management of partial thickness wounds.⁵

For contaminated wounds, such as those that have been immersed in water from dams or rivers, it is reasonable to use some type of topical antimicrobial for a few days after thorough wound cleaning. Also, consider the need for tetanus prophylaxis and oral antibiotics. There are many suitable alternatives for burn wound dressings choices. General practitioners can access www.vicburns.org.au for further guidance.

Blister management and debridement

Blistering is the hallmark of the superficial partial thickness burn and may also be present at initial presentation in deeper burns, but these are often large and rupture early. There is little consensus regarding the management of the burn wound blister⁶ with theoretical arguments centring on the content of blister fluid and whether constituent cytokines and growth factors are more likely to favour or retard wound healing. However, practical considerations tend to dictate management. Intact blisters provide a moist wound healing environment and debriding them at initial presentation is frequently painful. In general, the larger the blister, the deeper the burn, and the more likely it is to rupture. Small blisters <6 mm are unlikely to rupture early and can usually be dressed pending review. Larger blisters should be debrided initially or at first review in order to allow for adequate wound assessment. Also, sterile aspiration of large blisters can sometimes be useful to decrease discomfort associated with pressure build-up in blisters and delay rupture. Ruptured blisters should be debrided in order to remove all loose skin and necrotic and possibly contaminated material from the wound.

Opinions differ as to the value of using the blister roof (dead epidermis) as a dressing on rupture of the blister: it should not be left in situ if the wound is contaminated. If a decision is made to leave the blister roof alone, it is important to monitor the wound to ensure infection does not supervene under the epidermis – a risk if contaminated fluid is allowed to accumulate. The wound bed, and thus the depth of the burn, cannot be accurately assessed without blister debridement, so at some point debridement is usually indicated.

Postacute care

Superficial burns that heal within 2 weeks are unlikely to develop hypertrophic scarring. However, these burns can result in hyperpigmentation which may not resolve, especially in dark-skinned people.

Patients should be advised to avoid sun exposure while the posthealing inflammatory phase persists, and to apply a low irritant sunscreen liberally at the site of healed burns. They should be warned that newly healed skin is fragile and will tend to develop blisters with minor trauma. The development of small superficial cystic lesions that look like pimples is common and these will generally resolve. A moisturiser can be helpful, especially in the early phase after healing when dryness can be a problem. In general, if burns have healed without complication in a timely fashion, ongoing scar management manoeuvres are not required. Patients with hand burns who develop persisting stiffness – which is often the result of oedema not managed in the healing phase – may require referral to a hand therapist.

Referral to a specialist burns unit

Patients with severe or extensive and complex burns require urgent referral to a specialist burns unit (Table 2).⁷ In addition, patients with small deep burns usually require surgical referral, as most of these types of injuries require surgical excision and reconstruction. Burns services in each state can provide referral and management advice (see Resources).

Key points

• First aid: cool the burn, warm the patient.
• Burn wound assessment is aimed at predicting time to healing.
• Burn wounds evolve and require regular review. Reassess at 24–48 hours postinjury, and then as indicated as healing progresses.
• Good basic acute burn care involves the provision of analgesia, appropriate dressing choices and oedema control.
• Burns that do not heal within 14–21 days have increased risk of poor scarring.
• All deep partial thickness and full thickness burns should be referred early for surgical opinion and will generally require excision and grafting.

Resources

Statewide burns services

Queensland
Adults: www.health.qld.gov.au/rbwh/services/burns.asp
Royal Children’s Hospital 07 3636 3777

New South Wales
www.aci.health.nsw.gov.au/networks/burn-injury/contact

Victoria
Adults: www.alfred.org.au/burns_unit
Children: www.rch.org.au/burns/contact

Tasmania
Royal Hobart Hospital 03 6222 8308
www.dhhs.tas.gov.au/hospital/royal-hobart-hospital/contact

South Australia
Adults: www.rah.sa.gov.au/burns/contact.php
Children: www.wch.sa.gov.au/services/az/divisions/psurg/burns/index.html

Western Australia
www.rph.wa.gov.au/Burns_Department/index.htm

Northern Territory
Royal Darwin Hospital, Burns Unit 08 8922 8888

New Zealand
www.nationalburnservice.co.nz.

Conflict of interest: none declared.

90,000 Treatment of various types of burns – treatment of burns

Burns – an attack that does not bypass, perhaps, a single person. Even as children and learning about the world, we are faced with boiling water spilled on ourselves, or with a hot iron. Growing up, we already know about the danger posed by hot objects, but this does not help us avoid meeting with old acquaintances.

Burns are classified according to their severity and origin.

Origin:

– thermal – contact with a scalding surface, fire, boiling water;

– chemical – burns with poisonous plants (for example, Hogweed, Ivy, Yasenets, Pasternak), solutions of salts, acids, alkalis;

– electrical; – electrical injuries;

– solar .

What to do? The very first thing that comes to mind is, of course, to the doctor. Only a doctor will be able to correctly prescribe treatment, which in turn will speed up and secure recovery, and also reduce the likelihood of scars and scars after treatment.

But you need to know something yourself.

Grade 1 is characterized by reddening of the skin, while grade 2 blisters appear as the deeper layers of the skin are damaged. Even more severe burns of the 3rd and 4th degree are treated only in a medical institution.Let us examine the myths and truths about the treatment of 1st and 2nd degree burns.

Myth 1.

“You cannot rinse with cold water, so all the skin will peel off!” Some treatments for burns never go out of date! The first thing to do is to cool the burnt area quickly. The simplest thing is to rinse the burn with cold water. This will quickly lower the temperature and clean the damaged area.

Myth 2.

“I will anoint with sea buckthorn oil and everything will heal!” No, oil cannot be applied to the burn, and nothing that can form a film over the wound surface.This contributes to the further maintenance of high temperature at the site of damage.

Myth 3.

“To keep the blisters out of the way, they need to be punctured.” No. If we are talking about home treatment, by no means! You can infect the tissues and make your situation worse. If the blisters really get in the way, or there is a risk of accidentally damaging them, see your doctor. In a hospital setting, your injuries will be treated and an aseptic dressing will be applied.

Myth 4.

“Medicines can be easily replaced with sour cream.” No, sour cream does not heal. It relieves symptoms only for a short time, which is due to one simple quality, as a rule, it is cold. To treat a burn, you need to use funds that help restore the skin.

How to treat the effects of burns?

• For the local treatment of burns, drugs that promote tissue regeneration are used, such as Panthenol Consumed, Bepanten have several actions.They cool the tissues and stimulate their regeneration.
• Betadine, Argosulfan – antiseptic treatment of wet burns.
• Hydrogel and hydrocolloid wipes with a multicomponent composition accelerate healing, anesthetize and disinfect.

Now let’s summarize: we ourselves only treat burns of the 1st and 2nd degree of severity, everything that is more difficult – we consult with a doctor. Piercing burns is a surgical operation, only a doctor can safely perform this!

What we do ourselves: rinse with water, cool, treat with preparations for local treatment.

And of course, we take care of ourselves! Handle hot liquids, surfaces and fires. Protect yourself from direct sunlight. Don’t forget sunscreen when going to the beach.

Be healthy!

Dressings for local treatment of burns

The high level of modern medicine and innovative medical technologies can save lives for people with burns over 50% of the entire body surface, including those with deep thermal injuries.And local treatment after burns is of great importance, the success of which largely depends on the properties of the dressings used.


Classification of burns

The provision of medical care for burns should be differentiated, depending on the depth and degree of the burn. All types of burns are classified as follows:

I degree – a slight burn of the upper layer of the epidermis, which is manifested by edema of the affected area of ​​the skin and its redness.Help with a 1st degree burn is provided at home, inpatient treatment is required only if more than 50% of the skin has been affected.

II degree – the entire epidermis is affected, the burn is manifested by the exfoliation of the epidermis and the formation of blisters (for example, a burn with boiling water). If a significant part of the body surface is affected by burns, a burn disease may develop, this condition requires compulsory inpatient treatment.

IIIa degree – these are skin burns, in which not only the epidermis is affected, but also the dermal layer of the skin, or the skin itself, but viable cells remain in the affected areas, from which epithelialization of the wound is possible in the future.

IIIb degree – characterized by complete damage to the dermal layer of the skin, subcutaneous tissue may also be affected. Treatment of this type of burns is only stationary, with a large area of ​​burns, burn shock develops.

IV degree – deep severe burns, in which, in addition to the skin, subcutaneous structures are affected – subcutaneous tissue, muscles, bones.

First aid for burns

First aid for burns large and / or deep – take the victim to a hospital as soon as possible to provide qualified medical care.Before transporting the victim, first aid for burns will consist of cooling the burned site and pain relief. For cooling, you can use cold running water, snow or ice. For pain relief, the victim can take two tablets of analgin orally.

Treatment after mild burns at home

Treatment after burns I-II degrees with a small area of ​​affected areas is possible at home. First aid for burns in this case will consist in treating the wound, after which a special burn bandage is applied.The wound is carefully cleaned of dirt and scraps of the epidermis so as not to injure, after which it is treated with antiseptic solutions – for example, an aqueous solution of chlorhexidine bigluconate. Opened blisters should be removed, and liquid should be removed from large blisters that did not penetrate by puncture; the upper epidermis should not be cut off. It is not necessary to open small bubbles.

Next, you should use an antibiotic ointment for burns – this will avoid suppuration and soften the edges of the wound.After that, a burn bandage is applied to the wound, which will protect the wound surface from external influences and secondary infection.

Optimal dressings for burns

Until recently, each dressing for a patient with burns turned into a very painful and extremely unpleasant procedure, since ordinary sterile gauze bandages and napkins adhered to the wound surface and each time the dressing was removed, the wound was injured. In addition, such bandages have insufficient sorption capacity, as a result of which the wounds remain wet for a long time and very slowly pass from the exudation phase to the granulation phase.

But now you can make the dressings painless and speed up wound healing with the new comfortable dressings from PAUL HARTMANN. At home, it will be optimal to use the following dressings for burns: Atrauman Ag, Branolind N, Grassolind neutral. They not only close the wound, but also act as a burn remedy to promote early wound healing. The burn dressing from PAUL HARTMANN does not stick to the wound surface, it can be easily removed and easily applied.The use of dressings Atrauman Ag, Branolind N, Grassolind neutral is quite enough for wound healing.

Treatment for third degree burns

As for third degree burns, here the treatment should be adjusted depending on the phase of the wound process. As a rule, such treatment is carried out in a hospital setting. They also use special dressings for burns by PAUL HARTMANN: TenderWet 24 (does not have adhesion, reliably closes the wound, softens its edges, can be easily removed), HydroTac (stimulates regeneration, has good absorbency), Syspur-derm (burn dressing that prepares the wound to skin plastic), Hydrotul (dressing used after plastic surgery).

Types of burns and first aid

Types of burns and first aid

Article from a specialist

Burns are of different types, and their treatment depends on how severely and how the skin is damaged. How to treat a burn of one type or another, and in which cases it is more advisable to consult a doctor, read our article.

An open fire in a metropolis is rare, but despite this, one of the most common childhood injuries at home is a household burn.The cause of the burn is most often boiling water, hot dishes, steam, iron or other heating appliances, and its consequence is the confusion of parents or the use of “grandmother’s” methods of treatment.

To avoid undesirable consequences from a burn, each parent needs to learn the correct first aid algorithms, depending on the type and degree of burn that the child has suffered.

First aid for thermal burns of the first and second degree

1. Determine the severity of the burn. The most common burns in everyday life are burns of the first and second degrees. With a first-degree burn, redness of the skin is observed, and second-degree burns are characterized by the appearance of redness and blisters. First-degree burns heal without scarring.
2. Treat the burn with cool running water. Not ice, not ice water, or even warm. The water temperature should be around 15-18 degrees. When we treat a burn with cool water, we slow down the process of tissue damage near the burned area.Treat the skin with water for at least 15-20 minutes. Remember that running water is more effective than submersion in water.
3. Apply a sterile tissue to the burn site. Carefully blot the remaining moisture afterwards with a sterile napkin, taking care not to injure the skin additionally. If your child burns their fingers, wrap each finger with a sterile wipe soaked in cool water and wrung out to prevent the damaged skin from sticking between the fingers.
4. Treat skin with an anti-burn agent. A caring parent should always have a remedy for burns in the first aid kit. Burns of the first and second degree must be treated very carefully, with a special cream that can reduce pain, accelerate the healing of damaged skin and provide antibacterial protection. These characteristics are fully consistent with the cream “Bepanten Plus”. It should be applied to the skin several times a day until the burn heals.
5. Observe the child’s well-being for 24 hours. If the child has even a slight increase in temperature for more than 12 hours, he is nauseous, the pain at the site of the burn does not subside or becomes stronger (usually it becomes easier the next day), there is no sensitivity at the site of the burn, and the area of ​​redness does not decrease – this means that one cannot do without a doctor.

First aid for chemical burns

One of the most harmful “grandmother’s” advice for a chemical burn, which is firmly in the minds of many parents, is to neutralize the alkali with acid or vice versa. Do not try to follow it. The correct algorithm of actions for a chemical burn differs from the algorithm for a thermal burn:

1. Shake, brush off substance from skin. Do not deflate it, but rather shake it off or brush it off with a cloth.
2. Carefully remove clothing. If the substance gets on the clothes, and there is no way to take it off without spilling it, cut the fabric and carefully remove the clothes from the child.
3. Rinse with warm water. If a thermal burn is treated with cool water, then a chemical burn must be treated with warm running water. In this case, water acts not so much as a washer, but as a solvent.
4. Save the packaging. The substance must be kept in its original packaging and shown to the doctor.

Hot bugs

There is a whole list of what not to do with burns. Do not under any circumstances pierce the bubble with liquid, do not cover the burn with a tape or try to separate the adhering tissue from the skin, but rather simply cut the tissue.

In addition, you can not handle the burn with ice, and also use cotton wool when processing.

Do not lubricate the burn:

• Dairy and fermented milk products: kefir, sour cream, yogurt
• Oil
• Urine
• Alcohol or vodka
• With iodine, peroxide or brilliant green.

But the biggest mistake in providing first aid for burns is the parent’s panic, which is transmitted to an already frightened child. This article will help parents act in cold blood to help their child cope with the incident without fuss.

Prepared based on:

¹ Thermal burns. Grodno State Medical University. Lecture material for LF.20s.
² Maksimovich S.V. First aid. A guide for parents. – Moscow: AST Publishing House, 2017 .– 192 p.
³ Fragment of a book on thermal burns E.O. Komarovsky’s “Handbook of sane parents. Part 2. First aid ”

L.RU.MKT.CC.11.2017.2047

90,000 Burns – a lesson. Red Cross, First aid.

Types: thermal, chemical, electrical, solar.

Thermal burns can be roughly divided into superficial, moderately deep and deep.

Signs:
Superficial burn: pain, burning, redness, swelling.
Moderately deep burn: severe pain, burning, redness and blisters with clear liquid.
Deep Burn: May appear black or white and dry (looks like parchment). If the deepest layer of the skin has suffered, then at the site of the burn itself, no pain is felt, since the nerve endings are affected.However, the pain is caused by the damaged skin around the burn, which is burned much less.

What to do

For all types of thermal burns, the assistance will be the same.

1. Quickly cool the burned area with cold (not ice cold) or cool water.
2. Cooling the burn site until the pain is relieved.
3. Remove clothing and jewelry if not adhered to your skin.
4. Apply a wet bandage.
5. If there are blisters, do not pierce them.
6. If the integrity of the skin is violated, cool the burned area, after covering it with a damp cloth.
7. Advise the victim to see a doctor.

After first aid, seek professional help if:

• Burns injured children under 5 years of age or adults over 60 years old
• Burns injured face, ears, hands, feet, joints or genitals
• Burns affected the respiratory tract (for example, inhalation of smoke or hot gases)
• The burn completely covers the neck, torso or limbs
• The victim has a deep burn
• The burn is caused by electricity, chemicals, ionizing radiation, high pressure steam
• Burns affected more than 5% of the skin of children under 16 and more than 10% of the skin of adults over 16

To assess the size of the burn, use the victim’s palm: his palm together with fingers makes up about 1% of all skin of his body.

Pay attention!

Attention!
If necessary, have someone call an ambulance. If you are alone, do it yourself. Continue cooling the burn site until qualified assistance is provided.

First aid for other types of burns.

Chemical burns

If the burn is caused by a dry chemical, first shake off the dry substance, mindful of your own safety, and then provide first aid as for a thermal burn.

Wash off liquid chemical substance with plenty of running water. If the chemical gets into the eye, flush the eye with copious amounts of running water. In this case, the damaged eye must be lower than the healthy one in order to avoid damage to the second eye.

Electrical burns

First aid:

• Ask someone to call an ambulance or do it yourself
• Place a dry cloth on the burn site
• Observe the victim’s condition

Pay attention!

Attention! In case of electric shock, the victim should seek qualified medical attention.

Thermal burn. Types of burns. First aid for burns.!

1. Skin composition and classification of burns

The skin plays a very important role in the control of fluid balance and body temperature. If a large enough area of ​​skin is damaged, this control is lost. In addition, the skin acts as a protective barrier against bacteria and viruses from the environment.

The anatomy of the skin is quite complex. Leather consists of three layers:

• Epidermis – outer layer of the skin;
• Dermis – It consists of collagen and other elastic fibers. The dermis contains nerves, blood vessels, sweat glands, and hair follicles;
• Hypodermis , or subcutaneous tissue – the area of ​​the location of large blood vessels and nerves. This layer of tissue plays the most important role in temperature regulation.

The damage that a skin burn can cause depends on its location, depth and how much surface area of ​​the body is burned.

Classification of burns

Types of skin burns are defined by depending on their depth.

• First degree burn is a superficial burn that causes local inflammation of the skin. Sunburns are often referred to as first-degree burns.The inflammation associated with this type of burn is characterized by pain, redness, and small swelling.
• Second-degree burns are deeper, and in addition to pain, redness and inflammation, skin blisters appear.
• Third degree burn – deepest. It affects all layers of the skin and, in fact, simply destroys the affected area of ​​the skin. Because third-degree burns damage nerves and blood vessels, the burn may feel relatively painless.

The skin burn is not static and can change even after the exposure to the factor that caused the burn has ceased. In a few hours, a first-degree burn can go to deeper structures and become a second-degree burn. For example, sunburn blisters may not appear immediately, but on the second day. Likewise, a second-degree burn can develop into a third-degree burn.

Regardless of the type of burn, inflammation and accumulation of fluid in and around the wound can begin.In addition, since the skin is the first stage of the body’s defense system, a burn increases the risk of infection.

Only the epidermis has the ability to heal itself. Deeper skin burns can cause scarring or prevent the skin from returning to normal function.

As we have already said, in addition to the depth of the burn, the total area of ​​the lesion is also important. Burns are measured as a percentage of the total body area of ​​the victim. Often for these purposes, adults use the Rule of Nines. The principle of calculation is based on the fact that the surface area of ​​the body consists of several parts, each of which corresponds to approximately 9% of the total 100% – head, chest, abdomen, each arm, etc.

Measurement of the area of ​​the burned surface of the body is carried out only for burns of the second and third degree. Since the integrity of the skin is not compromised during first-degree burns, it remains able to control fluid balance and maintain body temperature.

If more than 15-20% of the body is affected, there is a risk of severe fluid loss.The balance needs to be replenished artificially. With an increase in the percentage of burns, the risk of death also increases. A burn of less than 20% of the body usually responds well to treatment. But if the area of ​​the burn is more than 50%, it is already very serious and life-threatening.

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2.What does the location of the burn affect?

If the burn affects the face, nose, mouth, or neck, there is a risk that the burn could cause inflammation and swelling causing breathing problems by blocking the airway. Chest burns can prevent sufficient chest wall movement necessary for normal breathing. Burns to the hands and feet can impair blood flow to the extremities. And burns at the bends – elbows, knees, face, groin, etc., need special treatment, as as the burn wears off, scars can appear that will impede the full range of motion in these areas.

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3.First aid for burns

In case of severe second and third degree burns, it is important to remove the victim from the zone of damaging impact, without exposing yourself to unreasonable risks.Be sure to call an ambulance. Before her arrival, you can wrap the victim in some kind of clean cloth. But cold water is not needed. In severe skin burns, it can lower body temperature and cause hypothermia.

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4.First aid for burns of the first degree

Gently clean the burn area with warm water. Do not use oil. Remove rings, bracelets and other jewelry – swelling may begin and it will be difficult to remove them later. It is helpful to treat a skin burn with a local antibiotic ointment. There are such in any pharmacy. If you suspect that the burn is serious, you should definitely see a doctor.

90,000 How to deal with a prehospital burn? Various types of burns

Burns are very common and many require treatment.Initial evaluations and prehospital burn management can definitely influence patient outcomes and EMS providers should therefore be aware of current therapies.

Prehospital burn treatment: different types of burns

Although there are no burns, they still damage human skin and some of the underlying tissue. However, there is a very important mechanistic difference between the different types of burns that will influence treatment decisions.

Thermal burns are most common and are the result of intense heat, scalding water, or open flames. The thickness of the injury will vary depending on the duration and intensity of the exposure.

Chemical burns are the result of accidental or deliberate exposure to thousands of different chemical compounds. Chemicals that can burn the skin are classified into acids (pH <7), alkalis or bases (pH> 7), and organic.In this case, the injury is proportional to the concentration of the chemical, its volume on the victim, and the duration of exposure. It is very important to dust off your skin and rinse the contaminated area with clean water.

Electrical burns are those caused by electrical current, both alternating and direct (alternating and direct current), passing through the body and making it difficult to know which tissue is affected. This type of burn can lead to internal trauma and will leave few marks on the surface of the skin.The nature of the injury will worsen with prolonged exposure to the

electrical source

GCS in the treatment of prehospital burns

During initial and follow-up examinations, providers should document circulatory status and Glasgow Coma Score (GCS) to gather information about the course of burn injury and patient response to resuscitation.

It is also important to document the circumstances associated with burn injury, such as thermal burns caused by structural fires, which can be compounded by inhalation injuries.If the victim catches fire, suppliers should pay attention to the type of clothing, some fibers, such as cotton burns, while others melt and complicate skin burns. In the case of chemical burns, it is instead important to document the chemical and, if possible, its concentration and volume. Cooling of thermal burns and decontamination of chemical burns should be part of primary prehospital care.

After initial treatment and evaluation, providers should determine the severity and extent of the burn.The degree is expressed as the total burn surface area (TBSA), a number that represents the percentage of the total burn area. The Rule of Nines is typically taught to EMS providers to estimate the size of the burn.

Features are available to help the vendor distinguish between partial (first and second degree) and full (third and fourth) degree burns.

A first degree burn is limited to the epidermis (outer layer of the skin) and is red and hypersensitive to pain.A second degree burn includes both the epidermis and some part of the dermis. This type of burn tends to blister and will appear pink, moist, and pale when touched.

A third degree burn will destroy the epidermis and the entire skin layer. It will appear whitish or charred and will not fade when touched. A fourth-degree burn also damages underlying muscles, connective tissue and possibly bone, and often results in amputation.

Severe shock is to be expected if burns exceed one third of the TBSA, and an important element of prehospital burn therapy is vascular restoration to restore tissue perfusion and limit further damage to the areas surrounding the burn.

Serious burns must be taken to an accredited burn center and burn victims with significant trauma, first transported to a trauma center, which must be stabilized if traumatic injuries pose a greater threat to life than burns.

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SOURCE

Nose burn

Nose burn – is one of the most common types of facial burns.

Types of burns:

• Thermal – occurs, as you might guess, after contact with hot steam or liquid and an open planet.
  Sunburns are also here. These burns are usually associated with damage to the upper respiratory tract, mouth and skin.
• Chemical – which is also logical – occurs if concentrated alkali or acid gets on the skin. Contact with household chemicals, inhalation of ammonia, poisoning with industrial chemicals – all this can cause a burn to the nose.

Classification of burns occurs according to the degree of damage to the tissues of the nose itself and according to the degree of damage to the mucous membrane.

• In the first case, the classification will be as follows:

1st degree: the skin turns red, and the subcutaneous tissue of the nose swells a little

2nd degree: liquid-filled blisters form on the skin, and when they burst, bright red young skin is exposed …

Grade 3: tissue necrosis (i.e. death) of the skin begins.Dark scabs form.

4 degree: not only skin cells die, but also tissues that are under it: fatty tissue, cartilage, bones.

• In the second case, the picture will be as follows:

Grade 1: the surface layer of the nasal mucosa is affected

Grade 2: the burn penetrates deep into the tissues, after healing, scars will remain on them.

Grade 3: the mucous membrane is completely and completely damaged, and necrosis spreads further, to the tissues that are under it.

Symptoms of a nasal burn:

• If the outer surface of the nose is affected

1. acute burning pain;
2. redness, blisters with cloudy liquid;
3. for chemical burns, changes in the shape of the nose, black and brown spots.

• If the nasal mucosa is affected

1. burning and dryness in the nose;
2. nasal congestion, pain;
3. loss of smell;
4. in the case of a chemical burn, a specific odoriferous substance is added that has got into the nose;
5. increase in body temperature to 38, increase in blood pressure;
6. nausea, weakness.

Emergency care for a burn of the nose:

• Immediate and prolonged (10-15 minutes) rinsing the affected area with cold water, or applying ice wrapped in a clean handkerchief.
• Application to chilled skin with an anti-burn ointment such as Panthenol. It is important that it is chilled. All these preparations “preserve” the tissue in the form in which they were applied.
• It is forbidden to apply oil and alcohol preparations to burns.They will aggravate the condition.
• In case of severe burns, call an ambulance for inpatient treatment. Before arrival, you can anesthetize the affected area with ointment with lidocaine or novocaine.

Specific antidotes, plasma substitutes, antibacterial drugs, and anti-inflammatory drugs will already be selected at the hospital. For grade 4 burns, surgical intervention may be required, up to tissue transplantation and the use of implants.

Take care of your health!

Make an appointment with an otolaryngologist

Otolaryngologist – Aliyev Ramal Mardanovich

You can make an appointment by calling (391) 218-35-13 or through your personal account

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