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What can cause a thermal burn: Different Types of Burns | Stanford Health Care

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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

1.
Brink C, Isaacs Q, Scriba MF, Nathire MEH, Rode H, Martinez R. Infant burns: A single institution retrospective review. Burns. 2019 Nov;45(7):1518-1527. [PubMed: 30638666]
2.
Reid A, Ha JF. Inhalational injury and the larynx: A review. Burns. 2019 Sep;45(6):1266-1274. [PubMed: 30529118]
3.
Regan A, Hotwagner DT. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 9, 2021. Burn Fluid Management. [PubMed: 30480960]
4.
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]
5.
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]
6.
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]
7.
Huang HH, Lee YC, Chen CY. Effects of burns on gut motor and mucosa functions. Neuropeptides. 2018 Dec;72:47-57. [PubMed: 30269923]
8.
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]
9.
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]
10.
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]
11.
Struck HG. [Chemical and Thermal Eye Burns]. Klin Monbl Augenheilkd. 2016 Nov;233(11):1244-1253. [PubMed: 27454309]
12.
Ottomann C, Hartmann B, Antonic V. Burn Care on Cruise Ships-Epidemiology, international regulations, risk situation, disaster management and qualification of the ship’s doctor. Burns. 2016 Sep;42(6):1304-10. [PubMed: 27344547]
13.
Vivó C, Galeiras R, del Caz MD. Initial evaluation and management of the critical burn patient. Med Intensiva. 2016 Jan-Feb;40(1):49-59. [PubMed: 26724246]
14.
Píriz-Campos RM, Martín Espinosa NM, Postigo Mota S. [Therapeutic guide to critical burn patients]. Rev Enferm. 2014 Feb;37(2):39-42. [PubMed: 24738172]
15.
Jaspers MEH, van Haasterecht L, van Zuijlen PPM, Mokkink LB. A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns. 2019 Mar;45(2):261-281. [PubMed: 29941159]
16.
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]

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

1.
Brink C, Isaacs Q, Scriba MF, Nathire MEH, Rode H, Martinez R. Infant burns: A single institution retrospective review. Burns. 2019 Nov;45(7):1518-1527. [PubMed: 30638666]
2.
Reid A, Ha JF. Inhalational injury and the larynx: A review. Burns. 2019 Sep;45(6):1266-1274. [PubMed: 30529118]
3.
Regan A, Hotwagner DT. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 9, 2021. Burn Fluid Management. [PubMed: 30480960]
4.
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]
5.
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]
6.
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]
7.
Huang HH, Lee YC, Chen CY. Effects of burns on gut motor and mucosa functions. Neuropeptides. 2018 Dec;72:47-57. [PubMed: 30269923]
8.
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]
9.
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]
10.
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]
11.
Struck HG. [Chemical and Thermal Eye Burns]. Klin Monbl Augenheilkd. 2016 Nov;233(11):1244-1253. [PubMed: 27454309]
12.
Ottomann C, Hartmann B, Antonic V. Burn Care on Cruise Ships-Epidemiology, international regulations, risk situation, disaster management and qualification of the ship’s doctor. Burns. 2016 Sep;42(6):1304-10. [PubMed: 27344547]
13.
Vivó C, Galeiras R, del Caz MD. Initial evaluation and management of the critical burn patient. Med Intensiva. 2016 Jan-Feb;40(1):49-59. [PubMed: 26724246]
14.
Píriz-Campos RM, Martín Espinosa NM, Postigo Mota S. [Therapeutic guide to critical burn patients]. Rev Enferm. 2014 Feb;37(2):39-42. [PubMed: 24738172]
15.
Jaspers MEH, van Haasterecht L, van Zuijlen PPM, Mokkink LB. A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns. 2019 Mar;45(2):261-281. [PubMed: 29941159]
16.
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]

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

1.
Brink C, Isaacs Q, Scriba MF, Nathire MEH, Rode H, Martinez R. Infant burns: A single institution retrospective review. Burns. 2019 Nov;45(7):1518-1527. [PubMed: 30638666]
2.
Reid A, Ha JF. Inhalational injury and the larynx: A review. Burns. 2019 Sep;45(6):1266-1274. [PubMed: 30529118]
3.
Regan A, Hotwagner DT. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 9, 2021. Burn Fluid Management. [PubMed: 30480960]
4.
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]
5.
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]
6.
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]
7.
Huang HH, Lee YC, Chen CY. Effects of burns on gut motor and mucosa functions. Neuropeptides. 2018 Dec;72:47-57. [PubMed: 30269923]
8.
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]
9.
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]
10.
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]
11.
Struck HG. [Chemical and Thermal Eye Burns]. Klin Monbl Augenheilkd. 2016 Nov;233(11):1244-1253. [PubMed: 27454309]
12.
Ottomann C, Hartmann B, Antonic V. Burn Care on Cruise Ships-Epidemiology, international regulations, risk situation, disaster management and qualification of the ship’s doctor. Burns. 2016 Sep;42(6):1304-10. [PubMed: 27344547]
13.
Vivó C, Galeiras R, del Caz MD. Initial evaluation and management of the critical burn patient. Med Intensiva. 2016 Jan-Feb;40(1):49-59. [PubMed: 26724246]
14.
Píriz-Campos RM, Martín Espinosa NM, Postigo Mota S. [Therapeutic guide to critical burn patients]. Rev Enferm. 2014 Feb;37(2):39-42. [PubMed: 24738172]
15.
Jaspers MEH, van Haasterecht L, van Zuijlen PPM, Mokkink LB. A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns. 2019 Mar;45(2):261-281. [PubMed: 29941159]
16.
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]

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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Brink C, Isaacs Q, Scriba MF, Nathire MEH, Rode H, Martinez R. Infant burns: A single institution retrospective review. Burns. 2019 Nov;45(7):1518-1527. [PubMed: 30638666]
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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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Struck HG. [Chemical and Thermal Eye Burns]. Klin Monbl Augenheilkd. 2016 Nov;233(11):1244-1253. [PubMed: 27454309]
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Ottomann C, Hartmann B, Antonic V. Burn Care on Cruise Ships-Epidemiology, international regulations, risk situation, disaster management and qualification of the ship’s doctor. Burns. 2016 Sep;42(6):1304-10. [PubMed: 27344547]
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Vivó C, Galeiras R, del Caz MD. Initial evaluation and management of the critical burn patient. Med Intensiva. 2016 Jan-Feb;40(1):49-59. [PubMed: 26724246]
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Píriz-Campos RM, Martín Espinosa NM, Postigo Mota S. [Therapeutic guide to critical burn patients]. Rev Enferm. 2014 Feb;37(2):39-42. [PubMed: 24738172]
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Jaspers MEH, van Haasterecht L, van Zuijlen PPM, Mokkink LB. A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns. 2019 Mar;45(2):261-281. [PubMed: 29941159]
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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]

Thermal burns | DermNet NZ

Author: Vanessa Ngan, Staff Writer, 2006.


What is a thermal burn?

A thermal burn is a burn to the skin caused by any external heat source. This may be in the form of a naked flame from an open fireplace or house fire, a scald from steam, hot or molten liquid, or via direct contact with a hot object such as a hot oven rack or hot cooking pan.

Other types of burns include radiation burns, sunburn from the sun’s ultraviolet rays, chemical burns and electrical burns.

Thermal burns

How are thermal burns classified?

To understand the nature and classification of thermal burns it is necessary to have a brief understanding of how skin is made up. Basically, skin consists of an outer layer called the epidermis and an inner layer called the dermis. The epidermis consists of epithelial cells among which are the pigment-containing cells called melanocytes, which absorb some of the potentially dangerous UV rays in sunlight. The epidermis does not contain any blood vessels but is nourished via the blood vessels located in the dermis. Hence, the dermis is richly supplied with blood vessels, lymphatic vessels and nerves. It also contains hair follicles, sebaceous glands and sweat glands. Lying below the dermis is the hypodermis or subcutaneous fat tissue. This is not part of the skin but attaches the skin to underlying bone and muscle as well as supplying it with blood vessels and nerves.

Traditionally thermal injuries were classified as first, second or third degree burns. Nowadays many doctors describe burns according to their thickness (superficial, partial and full). The signs and symptoms experienced by a burn victim depend largely on the severity of the burn and the number of layers of skin that are affected.

Superficial or first degree burn signs and symptoms

  • Involves only the epidermis skin layer
  • May be painful, red and warm, area turns white when touched, no blisters, moist

Partial thickness or second degree burn signs and symptoms

  • Involves the epidermis and some portion of the dermis
  • Depending on the how much of the dermis is affected the burn is further broken down into superficial or deep
  • Superficial partial thickness burns are usually painful, red, moist, with blisters, hair still intact
  • Deep partial thickness burns may or may not be painful (nerve endings destroyed), may be moist or dry (sweat glands destroyed), hair is usually gone

Full thickness or third degree burn signs and symptoms

  • Most severe burn and involves all layers of skin – epidermis and dermis
  • Nerve endings, small blood vessels, hair follicles, sweat glands are all destroyed
  • Subcutaneous fat tissue, muscle and bone may also be involved in very severe burns
  • Burns are painless with no sensation to touch, skin is pearly white or charred, dry and may appear leathery

What is the management of a thermal burn?

The management of thermal burn involves several key steps.

  • Evaluation of the burn patient
  • Evaluation of the burn wound
  • Identifying and treating burn wound infections
  • Managing the burn wound

Evaluation of the burn patient

Evaluating the total wellbeing of the burn patient is of paramount importance, particularly in patients with large burns. The primary aim is to ensure airway support, gas exchange and circulatory stability is achieved and maintained. Secondarily, a detailed history should be obtained from the patient to determine how the burn injury occurred. This may give clues for further examination, e.g. suspected carbon monoxide poisoning in individuals injured in structural fires.

Evaluation of the burn wound

Evaluation of the burn wound itself should only occur once the patient has been stabilised. The extent and depth of the burn will help guide decisions regarding wound care, inpatient or outpatient care, and monitoring.

Extent of burn

  • Estimate the size of the burn.
  • Rule of Nines is used to determine the amount of surface area burned (it basically divides the surface area of the body into sections, each roughly 9%).

Depth of burn

  • Estimate the depth of the burn (what layers of skin are affected).
  • Depth equates to the classification of burns, as described above.
  • Estimating the depth of a burn is difficult and often burns are underestimated in depth on initial examination.

Identifying and treating burn wound infection

Prompt diagnosis of infection of the burn wound is important to prevent further complication. Two burn wound infections are:

  • Burn wound cellulitis – manifests as progressive reddening, swelling and pain in the uninjured skin around a wound, seen in the first few days after burning. Streptococcus pyogenes is the causative bacteria and infection usually responds to penicillin.
  • Invasive burn wound infection – rapid growth of bacteria in burn eschar that go on to invade the underlying healthy tissues. A change in colour, new drainage, and sometimes a foul or sickly sweet odour are indicative of infection. Pseudomonas and other gram-negative bacteria are the common causative. These infections can be life threatening and usually require combined treatment with surgery and antibiotics.

Managing the burn wound

Any serious burns should be referred to a specialised burns unit, particularly those involving face, hands and genitalia. For less serious burns, management may be in the outpatient or inpatient setting.

Outpatient wound care strategies

  1. Teach wound cleansing techniques to patient and family 
  2. Select a suitable wound dressing (topical medication and/or wound membrane)
  3. Prescribe medication for pain control
  4. Teach awareness of complications or specific conditions that require prompt medical attention
  5. Plan short-term follow-up care
  6. Plan long-term follow-up care

Inpatient wound care strategies 

  1. Initial evaluation and resuscitation
  2. Initial wound excision and biologic closure
  3. Definitive wound closure
  4. Rehabilitation and reconstruction

The main treatment aims of burn wound management are:

  • Carefully monitor wound
  • Keep wounds clean
  • Prevent the wound drying out
  • Manage secondary infection.

Commonly used topical antibacterials include1% silver sulfadiazine cream, 0.5% silver nitrate solution and mafenide acetate 10% cream.

Burns: Types, Symptoms & Treatment

Overview

What is a burn?

A burn occurs when heat, chemicals, sunlight, electricity or radiation damages skin tissue. Most burns happen accidentally. There are different degrees of burns. Your healthcare provider determines the seriousness (degree) of a burn based on the depth of the burn and the amount of affected skin. Burns can be painful. Left untreated, a burn can lead to infection.

How common are burns?

Close to half a million people go to the emergency department every year with burn injuries. Children are at high risk for accidental burns. Every day, more than 300 children receive emergency treatment for burn injuries.

Who might get a burn?

Accidental burns can happen to anyone, although children, teenagers and older people are most at risk. These age groups are more prone to burn injuries from cooking, such as spilling a boiling pan of water onto skin. Children and teens are also more likely to mess around with lighters, matches and fireworks or get sunburns.

What are the types of burns?

Healthcare providers classify burns by degrees of severity. Your provider will evaluate the extent of skin damage. Burn degrees include:

  • First-degree burns are mild (like most sunburns). The top layer of skin (epidermis) turns red and is painful but doesn’t typically blister.
  • Second-degree burns affect skin’s top and lower layers (dermis). You may experience pain, redness, swelling and blistering.
  • Third-degree burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings, you probably won’t feel pain in the area of the burn itself, rather adjacent to it. Burned skin may be black, white or red with a leathery appearance.

Symptoms and Causes

What causes burns?

Many things can cause a burn. Thermal sources, including fire, hot liquids, steam and contact with hot surfaces, are the most common causes of burns. Other causes include exposure to:

  • Chemicals, such as cement, acids or drain cleaners.
  • Radiation.
  • Electricity.
  • Sun (ultraviolet or UV light).

What are the signs of burns?

Burn symptoms vary depending on the severity or degree of the burn. Symptoms are often worse during the first few hours or days after the burn. Burn symptoms include:

Diagnosis and Tests

How are burns diagnosed?

Your healthcare provider will examine the burn to determine the degree or severity. This process involves estimating the percentage of the body affected by the burn and its depth. Your provider may classify the burn as:

  • Minor: First- and second-degree burns that cover less than 10% of the body are considered minor and rarely require hospitalization.
  • Moderate: Second-degree burns that cover about 10% of the body are classified as moderate. Burns on the hands, feet, face or genitals can range from moderate to severe.
  • Severe: Third-degree burns that cover more than 1% of the body are considered severe.

Management and Treatment

How are burns managed or treated?

Burn treatment varies depending on the cause and severity. You need to keep all burns clean and apply proper bandages/dressing depending on the severity of the wounds. Treating the person’s pain is key: inadequate control can interfere with wound care.

Continue to check wounds for signs of infection and other long term issues, such as scarring and tightening of the skin over joints and muscles, which makes them difficult to move.

Treatments by burn type include:

  • First-degree burns: Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.
  • Second-degree burns: Treatment for second- and first-degree burns is similar. Your healthcare provider may prescribe a stronger antibiotic cream that contains silver, such as silver sulfadiazine, to kill bacteria. Elevating the burned area can reduce pain and swelling.
  • Third-degree burns: Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body. The area where the skin graft is taken from generally heals on its own. If the person does not have enough skin available for a graft at the time of injury, a temporary source of graft can come from a deceased donor or a human-made (artificial) source but these will eventually need to be replace by the person’s own skin. Treatment also includes extra fluids (usually given intravenously, with an IV) to keep blood pressure steady and prevent shock and dehydration.

What are the complications of burns?

Third-degree burns that are deep and affect a large portion of skin are very serious and can be life-threatening. Even first- and second-degree burns can become infected and cause discoloration and scarring. First-degree burns don’t cause scarring.

Potential complications of third-degree burns include:

Prevention

How can I prevent a burn?

Burns have many accidental causes. You can take these steps to reduce the risk of burns:

  • Wear sunscreen.
  • Set your home’s hot water heater below 120 degrees Fahrenheit.
  • Always test the water in a shower or bath before getting in or bathing a child.
  • Lock up chemicals, lighters and matches.
  • Use the stove’s back burners as much as possible when cooking, turn handles of pots and pans where they won’t be bumped and don’t leave the stove unattended.
  • Don’t hold a child when you’re near hot objects, such as the stove.
  • Set safeguards around a fireplace and never leave a child unattended.
  • Install and regularly test smoke detectors in your home.
  • Stock your home with fire extinguishers and know how to use them.
  • Cover electrical outlets.

Outlook / Prognosis

What is the prognosis (outlook) for people with burns?

With proper treatment, most first- and second-degree burns heal over two to three weeks. Depending on the burn severity, you may have some scarring, which may fade over time. People recovering from third-degree burns need physical and occupational therapy to maintain joint mobility and improve function. Some people develop post-traumatic stress disorder (PTSD) or depression after a burn event. Thanks to medical advancements, many people who have burns covering even up to 90% of their bodies survive .

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Burns on the hands, feet, face or genitalia.
  • Burns that don’t improve after two weeks.
  • Blistering.
  • Severe pain.
  • Fever, yellow or green discharge, or other signs of infection.
  • Signs of PTSD or depression.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • What degree is the burn?
  • What is the best treatment for this burn?
  • What steps can I take to lower the risk of infection?
  • What steps can I take to lower the risk of scarring?
  • What steps can I take to lower the future risk of accidental burns?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Burns happen accidentally. Children and older adults are at highest risk. All deep burns require treatment to prevent infection and scarring. Third-degree burns are the most serious type and can be life-threatening. However, first- and second-degree burns are more painful. If you or a loved one has a blistering burn, prompt medical attention can aid healing. Talk to your healthcare provider about ways to lower your family’s risk of accidental burns.

Burns and Wounds | Johns Hopkins Medicine

Burns are a type of painful wound caused by thermal, electrical, chemical, or electromagnetic energy. Smoking and open flame are the leading causes of burn injury for older adults. Scalding is the leading cause of burn injury for children. Both infants and the older adults are at the greatest risk for burn injury.

What are the different types of burns?

There are many types of burns caused by thermal, radiation, chemical, or electrical contact.

  • Thermal burns. These burns are due to heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring. Hot metals, scalding liquids, steam, and flames, when coming into contact with the skin, can cause thermal burns.

  • Radiation burns. These burns are due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as X-ray.

  • Chemical burns. These burns are due to strong acids, alkalies, detergents, or solvents coming into contact with the skin or eyes.

  • Electrical burns. These burns are from electrical current, either alternating current (AC) or direct current (DC).

The skin and its functions

The skin is the largest organ of the body and has many important functions. It is made up of several layers, with each layer having a specific functions:

Layer

Function

Epidermis

The epidermis is the thin, outer layer of the skin with many layers including:

  • Stratum corneum (horny layer)
    This layer is made up of cells containing the protein keratin. it keeps body fluid in while keeping external substances out. As the outermost layer, it continuously flakes off.

  • Keratinocytes (squamous cells)
    This layer is made up of living cells that are maturing and moving toward the surface to become the stratum corneum.

  • Basal layer
    This layer is where new skin cells divide to replace the old cells that are shed at the surface.

The epidermis also contains melanocytes, which are cells that produce melanin (skin pigment).

Dermis

The dermis is the middle layer of the skin. The dermis contains the following:

  • Blood vessels

  • Lymph vessels

  • Hair follicles

  • Sweat glands

  • Collagen bundles

  • Fibroblasts

  • Nerves

The dermis is held together by a protein called collagen, made by fibroblasts. This layer also contains nerve endings that conduct pain and touch signals.

 

Subcutis

 

The subcutis is the deepest layer of skin. The subcutis, consisting of a network of collagen and fat cells, helps conserve the body’s heat and protects the body from injury by acting as a “shock absorber.”

In addition to serving as a protective shield against heat, light, injury, and infection, the skin also:

What are the classifications of burns?

Burns are classified as first-, second-, or third-degree, depending on how deep and severely they penetrate the skin’s surface.

  • First-degree (superficial) burns
    First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually involves an increase or decrease in the skin color.

  • Second-degree (partial thickness) burns
    Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.

  • Third-degree (full thickness) burns
    Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. When bones, muscles, or tendons are also burned, this may be referred to as a fourth-degree burn. The burn site appears white or charred. There is no feeling in the area since the nerve endings are destroyed.

Burns that are more severe and extensive need specialized treatment. Because the age of a burn victim and the percentage of the body’s surface area that has been burned are the most important factors affecting the outlook of a burn injury, the American Burn Association recommends that burn patients who meet the following criteria should be treated at a specialized burn center:

  • Individuals with partial-thickness burns over 10% or more of the total body surface area (TBSA)

  • Any age with full-thickness burns

  • Burns of the face, hands, feet, or groin, or genital area, or burns that extend all the way around a portion of the body

  • Burns accompanied by an inhalation injury affecting the airway or the lungs

  • Burn patients with existing chronic conditions such as diabetes, high blood pressure, heart disease, kidney disease, or multiple sclerosis

  • Suspected child or elder abuse

  • Chemical burn

  • Electrical injury 

The effects of burns

A severe burn can be a seriously devastating injury — not only physically but emotionally. It can affect not only the burn victim, but the entire family. Persons with severe burns may be left with a loss of certain physical abilities, including loss of limb(s), disfigurement, loss of mobility, scarring, and recurrent infections because the burned skin has decreased ability to fight infection. In addition, severe burns can penetrate deep skin layers, causing muscle or tissue damage that may affect every system of the body.

Burns can also cause emotional problems such as depression, nightmares, or flashbacks from the traumatizing event. The loss of a friend or family member and possessions in the fire may add grief to the emotional impact of a burn.

The burn rehabilitation team

Because so many functions and systems of the body can be affected by severe burns, the need for rehabilitation becomes even more crucial.

Many hospitals have a specialized burn unit or center and some facilities are designated solely for the rehabilitation of burn patients. Burn patients need the highly specialized services of medical professionals who work together on a multidisciplinary team, including the following:

  • Physiatrists

  • Plastic surgeons

  • Internists

  • Orthopedic surgeons

  • Infectious disease specialists

  • Rehabilitation nurses who specialize in burn care

  • Psychologists/psychiatrists

  • Physical therapists

  • Occupational therapists

  • Respiratory therapists

  • Dietitians

  • Social workers

  • Case managers

  • Recreation therapists

  • Vocational counselors

The burn rehabilitation program

Burn rehabilitation starts during the acute treatment phase and may last days to months to years, depending on the extent of the burn. Rehabilitation is designed to meet each patient’s specific needs; therefore, each program is different. The goals of a burn rehabilitation program include helping the patient return to the highest level of function and independence possible, while improving the overall quality of life — physically, emotionally, and socially.

To help reach these goals, burn rehabilitation programs may include the following:

  • Complex wound care

  • Pain management

  • Physical therapy for positioning, splinting, and exercise

  • Occupational therapy for assistance with activities of daily living (ADLs)

  • Cosmetic reconstruction

  • Skin grafting

  • Counseling to deal with common emotional responses during convalescence, such as depression, grieving, anxiety, guilt, and insomnia

  • Patient and family education and counseling

  • Nutritional counseling

Advances in the understanding and treatment of burns, state-of-the-art burn units and facilities, comprehensive burn rehabilitation services, and integrated medical care have all contributed to the increase in the survival rate and recovery of burn patients.


Continue Reading

90,000 Burns

Burn – is one of the most common home injuries that affects not only children, but also careless adults. However, if adults need to be very careless to get a severe burn, babies can seriously burn themselves by accidentally knocking over a cup of hot tea or even by opening a hot water tap.

A burn is a temperature, or, more correctly, thermal damage to body tissues. Such injuries are very dangerous for the body, since they lead not only to a violation of the integrity of tissues, but also to the destruction of complex proteins that underlie cells under the influence of high temperatures.

What are burns?

First degree burns affect only the outer layer of the skin, leaving it dry, reddened and painful. Sunburn is a typical first-degree burn.

In a second degree burn, exposure to heat extends to the deeper layers of the skin, causing fluid-filled blisters.

In case of third-degree burns, the skin is affected throughout its entire thickness. The skin looks like it is covered with a brown scab.Sensitivity at the site of the burn can be impaired, since the nerve endings are affected by temperature.

There is also a fourth degree of burn, in which heat exposure can destroy muscles and bones. Fortunately, in a domestic environment, such burns are very rare.

Causes of burns

Thermal burns resulting from exposure to high temperatures:

– Open fire strikes a large surface, causing predominantly second degree burns.

– Hot liquid can cause small but deep burns.

– Steam burns usually occur over a large area, but are not deep.

– Contact with hot objects causes a well-defined and deep burn – up to the fourth degree.

– Chemical burns occur as a result of contact with hazardous substances: acids and alkalis. Especially dangerous are burns caused by the ingress of these substances into the respiratory tract and digestive tract.

– Electrical burns occur at the points of entry and exit of an electric charge into the body. They take up a small area but can be very deep. In addition, if the wiring is short-circuited, a volt arc burn may occur. It resembles an open flame burn.

Attention!

If you develop second-degree burns that cover an area larger than your arm, leg or chest, seek medical attention as soon as possible. Do not delay contacting a doctor if a child has received a second-degree burn larger than the palm of the hand.

Third and fourth degree burns of any size – a reason for an immediate call for an ambulance! As well as second-degree burns to the face, neck or genitals.

First aid for minor household burns

  • Cool the burned area with cool running water for a few minutes.
  • Do not use high water pressure.
  • Do not use ice, snow, frozen food to cool the burn. Low temperatures can quickly cause frostbite, since the skin at the site of the burn is already damaged and does not fulfill its protective function.
  • First degree burns or minor second degree burns can be treated with Certified Burn Ointments or Sprays . Remember: such ointments must be made strictly water-based.
  • Never lubricate burns with oil, lard or any other grease , including fatty creams. The oil film traps the heat inside the skin and deepens the burn.
  • Do not open blisters left over from a burn yourself – you risk getting an infection.Burns are prone to inflammation and suppuration more often than other injuries.
  • If a burn causes severe pain, chills, or fever, see a doctor immediately.

How to prevent burns

  • Do not let a small child turn on the taps in the bathroom and kitchen on their own until they know how to mix hot and cold water. Even water with a temperature of 60 degrees can cause a serious burn in just half a minute of contact with it.
  • Do not carry hot liquids or food over the area where the child is playing.

Do not open the oven with a small child in the kitchen.

  • During a picnic, do not allow your baby to approach the barbecue. Play with your child away from the barbecue area.
  • When cooking on the stove, turn on the distant burners and turn the pots with the handles inward. This will help you to protect yourself from accidentally overturning the hot pot or pan.
  • Don’t delay fixing faulty electrical outlets and plugs.

Do not use appliances with faulty wiring.

  • Avoid using open coil heaters.
  • Do not teach your child to use lighters or matches until you are sure they understand the potential dangers. Store such items where the child cannot reach.
  • Never bring corrosive liquids of any kind into a home with small children.Clean household chemicals on cabinets, or better – under lock and key.
  • Prevent children from setting off fireworks, including playing with sparklers, firecrackers, or small firecrackers.

Most important

Burns occur under the influence of various hot objects, liquids, steam and even corrosive chemicals.

If the burns are deep and large in size, call an ambulance immediately.

Never grease the burn area or apply ice to the affected skin.

Author: ch. nurse Striga T.V.

From the sun and beyond. What to do if a child has a burn

Summer is not only a time of relaxation, gatherings by the fire and fun on the city beach, but also a season of thermal burns. Parents know how difficult it is to keep track of their children at a picnic, when a child may discreetly walk up to the fire and get burned. And how difficult it is to protect delicate baby skin from sunburn! So that the accident does not have serious consequences, it is important for parents to be able to determine the degree of burn that the child has received, and to know the rules of first aid for burns.

The head of the burn department of the Central City Clinical Hospital of Ulyanovsk, chief freelance combustiologist of the Ministry of Health of the Ulyanovsk Region, Honored Health Worker Olga Nikolaevna Demidova answered our questions.

– How to determine the degree of a burn?

– If the skin turns red during a burn, it means that the child has a first-degree burn. With such burns, the child may feel pain, there is a burning sensation, constriction.Most often, first-degree burns heal within two to three days. The second degree is characterized by the appearance of blisters on the skin filled with a clear, light liquid. The blisters may increase in size, and new blisters may gradually appear. The restoration of the skin layer in second-degree burns usually stretches for several days, and the burn marks remain for life – after healing, the skin at the site of damage has a lighter tone. A thermal burn on contact with a dry hot object appears as a thick crust covering the burned area – this is also a second degree burn.Deep damage to the skin, tendons, muscle, and sometimes even bone tissue occurs with a third-degree burn. Large blisters appear on the skin, filled with jelly-like contents mixed with blood. Deep burns cause death of skin cells, muscles, neurons at the site of injury – the damaged area looks like a charred wound. With third-degree burns, burn shock may develop, and a serious condition does not always occur immediately after the burn – the shock can begin several hours later. Burn shock is manifested by chills, vomiting may begin, convulsions and loss of consciousness are possible.

– When should you call an ambulance?

– First-degree burns can be treated at home, for this it is important to have anti-burn products in your home medicine cabinet. A second degree burn is more dangerous and requires immediate medical attention. In case of third and fourth degree burns, an ambulance must be called. Trying to self-treat deep burns can have dire consequences. For example, after a burn shock, in the absence of the necessary therapy, burn toxemia may develop – toxic substances from the burned area enter the bloodstream and spread to all tissues and organs of the victim.In young children, burn disease can cause acute renal failure, pneumonia, sepsis, pulmonary and cerebral edema.

– What cannot be done?

– In case of second-degree burns with blistering on the skin, do not open them yourself under any circumstances – trust your doctor. If clothes are stuck to the burn site, do not try to separate them from the burned skin – you can damage the wound and slow down the healing process. Use scissors to cut the tissue around the affected area.Do not use sunflower oil, olive oil, soda solution and other folk remedies to clean the wound – they are not sterile and can cause wound infection. Burns are treated only with special pharmaceutical compositions. Treatment of burned areas with iodine and other alcohol solutions not only does not help, but can also worsen the child’s condition. When applying a bandage to the burn site, you must be sure that it is sterile – non-sterile cotton wool, bandages for processing and dressing wounds cannot be used.

– What to do if a child is burned?

– Determine the severity of the burn. For a first-degree burn, treat the affected area with a spray, gel, ointment, or burn cream from your home medicine cabinet. Then apply a dry bandage from a sterile bandage. It is good to keep the scald remedies in the refrigerator. In case of a second-degree burn, free the place of the burn from clothing, cover the affected area with a sterile bandage soaked in clean cold water, and take the child to the local clinic or trauma center.For third and fourth degree burns, call an ambulance immediately.

– How to treat sunburn?

– Redness at the site of the burn may not appear immediately, therefore, during exposure to the sun, you need to monitor the condition of the child. Lethargy, irritability, burning and itching complaints can be signs of sunburn. In this case, you need to take the child into the shade or room and act depending on the degree of the burn. For first-degree burns, treat the skin surface with an anti-burn agent; for second-degree burns, consult a doctor.When in the sun, be sure to have a bottle of clean water with you. During the treatment of burns, the child needs a plentiful drink – water, compotes, fruit drinks from natural berries.

Burns are a significant health hazard – and this danger is all the more serious, the younger the child is. Treatment of burns is carried out in strict accordance with the doctor’s prescriptions. A home medicine cabinet should always have a burn treatment and a sterile dressing.

Do not smear with butter and curdled milk.Doctor on what not to do with burns | HEALTH: Events | HEALTH

Most often people get burns in everyday life: at home, in the country, at a construction site. The main reason is negligence and disregard of safety rules. It is not in vain that they say: fire is warm to a clever, a burn to a stupid one. But if this trouble happened – what to do? Someone advises pouring cold water on the burn, while others tell you to spread it with vegetable oil. How is it correct? expert – traumatologist-orthopedist Gor Gyurjyan tells about first aid for burns “AiF-Yug”.

First things first

“Let’s define the term first,” says the doctor. – It is customary to call a burn damage to the body under the influence of high temperatures. Burns are different: thermal, chemical, electrical and radiation. Accordingly, the first aid algorithm is not the same. ”

The general principle is one: to immediately eliminate the impact of the damaging factor.

  • In case of fire burns – extinguish burning clothing.
  • In case of burns with boiling water and steam, if the wound comes into contact with clothing, remove the clothing carefully and quickly, and cut if necessary.
  • If the burn is electrical, disconnect the power source.

Further nuances arise.

In case of thermal and chemical burns immerse the affected area of ​​the body in cold water for a few minutes or put it under a cold stream. (Alternatively, flush with isotonic sodium chloride solution). In addition to cooling, this will help flush out dead tissue from the wound. It is especially important that the stream of water does not hit directly on the wound, but simply flows down the burned surface.

The skin burned with acid is washed with a solution of baking soda, and in case of a burn with alkali – with a weak solution of citric acid. After rinsing and cooling, a damp bandage can be applied to the affected skin.

Electrical burn is not always visible. If it was possible to find the places of electric shock (inlet and outlet openings), cover them with a sterile bandage or gauze and take the victim to the hospital (call an ambulance). High voltage burns are very often accompanied by internal injuries, medical advice is necessary.

In case of radiation burns (or solar in common parlance), after cooling and washing with antiseptics, treatment with special tanning agents is needed. Depending on the severity of the burn, you can apply creams with extracts of aloe, chamomile, sea buckthorn, vitamin E.

If the area of ​​the burn is from the palm, call an ambulance.

What to do next

What must be in a first aid kit?

Must be

  • Dressing material (napkins, bandages).
  • Antiseptics. Water-based solutions of iodopyrone or chlorhexidine.
  • Pain medications. Powdered ones are preferable because they work faster. (Give the victim pain reliever and give him water frequently.) In serious cases, the use of Panthenol is effective.

What not to do?

The most common mistake is greasing burns with vegetable oil, dairy products, animal fat or egg yolk.This not only does not have a positive effect, but can also cause harm.

  • When vegetable or animal fat is applied, a fatty film is formed, which prevents the cooling of the affected tissues, the severity of the damage is aggravated.
  • For the same reason, a bad option is ointments or fat-based creams.
  • Another typical mistake is the application of decoctions and tinctures of medicinal herbs to the burn surface. There are no convincing data on the benefits and effectiveness of their use.
  • In addition, a burn is often treated with hydrogen peroxide or ethyl alcohol, vodka or other alcohol-containing liquids. This, of course, cannot be done, just like sprinkling the burned area with soda, flour, starch, powders and other substances.
  • It must be remembered that in no case should burn bladders be pierced!

How to determine the degree of a burn?

This is important to understand. The more severe the degree of the burn and the larger its surface, the sooner you need to seek professional help.

  • The area of ​​the lesion is important. A burn the size of a palm or larger is always serious. If the doctor recommends inpatient treatment, you need to agree. The doctor will not advise bad. In cases where the lesion is severe and threatens life or the development of complications such as burn shock, hospitalization is necessary. The hospital has medicines and equipment to provide the necessary assistance. The patient is constantly supervised by trained nursing staff.
    The first degree is the easiest.This superficial lesion of the epithelium usually goes away on its own in three to four days. Redness, swelling, and pain are observed. The skin at the site of the lesion is bright pink and slightly protrudes above the healthy skin area.

  • In the second degree, small and relaxed blisters appear on the skin, filled with a light yellow transparent liquid. If the blisters break open, reddish erosion occurs in their place. Healing occurs on its own on the 10-12th day. Usually no scarring.
  • In the third degree, the deep layers of the skin are affected with partial capture of subcutaneous fat. Tissue necrosis is noted. A sharp decrease or complete absence of pain. On the affected surface of the skin, bubbles form, the sizes of which vary from two centimeters or more, with a dense wall, filled with a thick jelly-like or hemorrhagic (bloody) fluid. Such wounds do not heal on their own. Treatment can last up to three months.
  • In case of fourth-degree burns, not only all layers of the skin are affected, but also muscles, fascia (vessels, nerves) and tendons, right down to the bones.A dark brown or black burn crust forms on the affected surface, through which the venous network is visible. There is no pain at this stage. Severe intoxication is noted, there is also a high risk of developing purulent complications.

How to avoid complications?

Usually they are the result of improper self-medication and untimely access to a doctor. Gor Gyurjyan recalls the following case: “A woman came to our clinic with a thermal burn of her feet.We were treated on an outpatient basis. The treatment was protracted, but with positive dynamics. After a while, the woman stopped going to the procedures. It turned out that the patient decided to “make adjustments” to the treatment and, on the advice of her friends, smeared the wound with bear fat. As a result, the wound was covered with a hard “bullet-proof” crust and had to resort to surgical intervention. ”

The most common mistake is greasing burns with vegetable oil, dairy products, animal fat or egg yolk.

See also:

90,000 First aid for burns: rules

Burns (combustio) is damage to body tissues resulting from the local action of high temperatures, as well as chemicals, electric current or ionizing radiation.

In this case, a burn shock is a particular danger, therefore pre-medical measures are aimed, among other things, at its prevention.We will tell you how to properly provide first aid for burns by high temperatures, chemicals and other types of exposure.

Types of burns and their features

There are several types of classification of burns. According to the situation in which they arose, they distinguish military, household, industrial and other burns. By the mechanism of appearance – thermal, electrical, chemical, radiation, and so on. Let’s get acquainted with them in more detail.

Thermal burn

Most common.It occurs when a part of the body comes into contact with an open fire, hot surfaces, steam, boiling water, etc. With thermal burns, the skin or mucous membranes can be damaged, in severe cases, muscle tissue is affected. The severity of the injury depends on the duration of the victim’s contact with the fire, the thermal conductivity of the hot substance, and other factors.

There are 4 degrees of thermal burn

Degree Description
I Minor lesion, presence of redness of the skin.
II Liquid filled blisters form on the skin. Swelling and redness in the affected area.
III-A The skin is seriously affected, to a great depth. The hair follicles are not damaged, the sebaceous and sweat glands are functioning.
III-B Destruction of all layers of the skin.
IV The skin and underlying tissues are completely affected. Necrosis develops.

( Infographics and poster first aid for burns on the stands, available by clicking the download button )

Burns of severity up to grade III-A, inclusive, can be treated at home using conservative methods. More serious damage is restored only with the help of surgery.

Another type of thermal burn is frostbite. Occurs when exposed to low temperatures, for example, when in contact with gases. It is characterized by severe redness of the skin, the appearance of bubbles and spots.With deep frostbite (upon contact with liquid nitrogen), the skin may turn black, symptoms of severe intoxication appear.

Chemical burns

Occurs when certain substances are exposed to the skin or mucous membranes. The greatest danger in this case is represented by:

  • Acids;
  • alkalis;
  • phosphorus, etc.

Many household products can also cause burns.

Chemical burns caused by acids are characterized by the formation of a dry and dense scab.When exposed to sulfuric acid, the crust becomes black, if the burn is obtained with nitric acid, the scab is yellowish. Edema and redness of the skin are moderate.

In case of burns with alkalis, the scab has a soft white color, with a deep burn it is light green in color. Swelling and redness of the skin is significant. There are signs of intoxication of the body – nausea, vomiting, fever.

Other burns

Radiation burns – occur when exposed to radiation or sunlight. Almost always accompanied by nausea, vomiting, depression.Radiation burns cause redness of the skin, edema forms in the area of ​​the hair follicles, as well as near the sebaceous and sweat glands, and blood circulation in the capillaries is disturbed.

Electrical burns – formed when an electric current passes through the victim’s body. This injury can occur through contact with the electrical network or being struck by lightning. In most cases, the damage characteristic of a burn is visible only at the point of entry and exit of the current, however, similar changes occur in tissues along the path of electricity.

Also burns can be combined – caused by a combination of several factors.

First aid for thermal burns

The procedure for first aid in case of thermal burn will depend on its severity. The depth of the skin lesion can be judged by the behavior of the victim. So, with burns of degrees III-A and IV, a person does not respond to touching the wound with a swab dipped in alcohol. Also, in this case, the hair in the affected area can be pulled out without difficulty.

It is also important to estimate the area of ​​the lesion. In medicine, it is accepted that the area of ​​each of the zones listed below is 9% of the body area:

  • Head and neck;
  • 90,051 hands;

  • chest;
  • belly;
  • 90,051 back;

  • drumstick;
  • 90,051 thigh;

    90,051 genitals.

Having quickly assessed the condition of the victim, you can begin to provide first aid.

Algorithm and procedure for providing first aid for burns of I and II degrees:

  1. Remove the factor causing the burn.If the clothes are on fire, douse the victim with water or wrap it in a thick cloth.
  2. Treat the burn with a mild potassium permanganate solution.
  3. Place a bandage or clean cloth over the injury.
  4. In case of a large area of ​​the burn, treat it with Panthenol or Alazol ointment.
  5. Pain medication may be given in case of pain.

In case of signs of infection – development of edema, purulent discharge, fever, consult a doctor.Under normal conditions, the skin will recover on its own.

Actions for 3rd degree burn:

  1. Assess the condition of the victim – pulse, breathing, response to external stimuli.
  2. Call an ambulance.
  3. Place a clean cloth soaked in cold water on the burned area.
  4. In case of a burn to your fingers, try to remove the rings (if any) from them, isolate the affected finger from the healthy one.
  5. Give pain relievers and plenty of fluids to prevent burn shock.

Do not stop monitoring the victim until the ambulance arrives. Pay particular attention to your behavior, pulse, and breathing.

Actions for IV degree burns:

  1. Remove source of burn.
  2. Call the ambulance team.
  3. Assess the condition of the victim.
  4. Remove clothing from it, except for areas that have adhered to the skin.
  5. Wrap the victim with a blanket, jacket, or similar to prevent heat loss, which is dangerous with a grade IV burn.
  6. Take measures to prevent burn shock – give any strong pain reliever or a combination of one diphenhydramine tablet with two analgin tablets.
  7. Give a drink, hot tea or mineral water.

Remember that the wound is sterile by default when the burn occurs. Do not put plants, potatoes, sour cream, egg yolk or other traditional medicine on it. This will help avoid infection.

If the head, respiratory organs, genitals are affected, an ambulance must be called, regardless of the degree of the burn.

First aid for frostbite

The principles of providing first aid for exposure to low temperatures depend on what caused the injury. So, in case of a burn with liquid nitrogen, you need to do the following:

  1. In case of deep burns, call an ambulance.
  2. The unconscious person must be taken to fresh air.
  3. Wash the burned area with water, the temperature of which does not exceed 45 0 C, until the skin turns red.
  4. Apply a sterile dressing.
  5. Do not stop monitoring physiological parameters.

In case of burns with low temperatures, it is forbidden to rub the affected area, give alcohol, allow a sharp temperature drop (quickly heat the damaged skin area).

First aid for chemical burns

First aid methods for chemical burns from the substance with which the victim was in contact.

Consider the basic rules:

  1. If the victim does not breathe, does not respond to pain relievers, the substance gets on the genitals or the affected area is more than 7.5 cm 2 , an ambulance should be called immediately.
  2. In case of burns with acid or liquid alkali, rinse the skin with plenty of water for 10-15 minutes.
  3. Neutralizers do not need to be used: the reaction that occurs will aggravate the burn.
  4. In case of damage with phosphorus powder, it is first removed with tweezers, then rinsed with abundant water. The same applies to any powdered alkalis.
  5. Quicklime must not be rinsed off with water.
  6. It is forbidden to pour water on the skin if the burn is caused by organic aluminum compounds: they will catch fire.
  7. After treating the burn, you need to apply a sterile, but not tight bandage and wait for the arrival of the ambulance team or take the victim to the hospital on your own. Better if it is a burn center or department.

In case of chemical burns, it is good if you manage to take a little of the substance in a jar. This will help doctors determine what is causing the problem and quickly navigate further therapeutic measures.

General rules for first aid

The level of education in the field of first aid leaves much to be desired, therefore, eyewitnesses of the incident often make mistakes.Let’s give general rules.

  1. Even in the case of a thermal burn of the 1st degree, it is necessary to monitor the patient’s condition, his pulse, breathing, and reaction. Moreover, this must be done in more severe conditions.
  2. Blisters must not be opened for any kind of burn.
  3. It is forbidden to apply oils, compresses and other means, including folk.
  4. Do not rub the affected skin in case of frostbite, give the victim alcohol.
  5. It is important to take measures for your own safety, to protect your hands from infection with latex gloves, if possible.

If, in the course of providing first aid for burns, a person was given any painkillers or other means, you need to remember their name, then inform the medical specialist who receives the victim. This information can be important for the further treatment of burns.

Sources:

  • Fainshtein V.I. “Safety in the production and use of air separation products.”
  • Textbook D.V. Marchenko “First aid for injuries and accidents.”

GBUZ “Krasnoarmeiskaya Central District Hospital” – Thermal burns


Published: 25.02.

Thermal burns

Thermal burns are burns by flame, hot steam, hot or burning liquid, boiling water, from contact with hot objects, sunburn.Flame burns are the most common, with liquid burns in second place, and electric and arc burns in third place. Burns caused by other factors are observed in isolated cases.

In modern conditions of intensive industrialization, the ever-increasing use of heat sources in production and in everyday life, there is a tendency to an increase in the frequency of burns. According to the World Health Organization, burns rank third among other types of injury. Burns are often fatal, and among those who have recovered, many remain disabled.

The severity of the course of a burn injury largely depends on the area and depth of tissue damage. In our country, the following classification of burns has been adopted:

  • 1st degree burns are manifested by redness and swelling of the skin;
  • 2nd degree burns are characterized by the appearance of blisters filled with a transparent yellowish liquid.A naked basal layer remains under the exfoliated layer of the epidermis. With burns of the I-II degree, there are no morphological changes in the skin, than they fundamentally differ from deeper lesions.
  • III degree burns are divided into two types: III A degree burns – dermal – damage to the skin itself, but not to its entire thickness. At the same time, viable deep layers of the skin or appendages (hair bags, sweat and sebaceous glands, their excretory ducts) are preserved. With III B degree burns, skin necrosis occurs and a necrotic scab is formed.
  • IV degree burns are accompanied by necrosis of not only the skin, but also deeper tissues (muscles, tendons, bones, joints).

The severity of the burn depends on the area of ​​the affected tissue. It is expressed as a percentage relative to the area of ​​the entire surface of the skin. When roughly assessing the burn, the so-called “palm rule” is used: the area of ​​the human palm is equal to one percent of the body area.

In severe cases, a thermal burn can be complicated by a burn disease, during which it is customary to distinguish between periods:

– shock (the body’s response to a super-strong pain stimulus),

– acute toxemia (the second period of burn disease, arising 2-3 days after injury and lasting 7-8 days; characterized by the predominance of severe intoxication due to the effect on the body of toxic products coming from the affected tissues, and bacterial infection),

– septicotoxemia (a period that conditionally starts from the 10-12th day of the disease and is characterized by the development of infection, putrefactive processes in wounds and the penetration of microbes, their toxins and autolysis products of dead tissues into the bloodstream; staphylococcus, Pseudomonas aeruginosa and intestinal rods, proteus and their associations),

– recovery (or convalescence).

First aid for thermal burns

  1. The first thing to do as quickly as possible is to extinguish the flames (if any) on the victim’s clothing and skin. It is necessary to throw off burning clothes from a person or throw a cloth over his body in order to stop the access of air to the fire.

2. Try to calm down the victim and the people around him.

  1. Carefully remove any smoldering debris from the injured person that did not get into the wound.Never rip off clothing stuck to the burn. Also, you can not touch the burnt body with your hands.
  2. If it is a sunburn, you need to transfer the affected person to the shade.
  3. Hold the affected part of the body for 10-20 minutes under a stream of cold running water (you can lower it into a container with cool clean water). This must be done so that the heated wound does not deepen and expand. In addition, it activates blood circulation in the wound. However, ice cannot be used to cool the burned area in order to avoid the likelihood of another injury – frostbite.
  4. Apply any available anti-burn agent (ointment, gel) to the affected surface, apply a sterile (if possible) dry bandage on top. You cannot use cotton wool, only gauze, bandage – fabric materials. It happens that there is no anti-burn agent or sterile bandages at hand, then any dry, clean bandage should be applied to the wound. You can not apply any folk remedies to the burn: vegetable oil, vodka solutions, kefir, sour cream, etc. You can also not apply Kalanchoe or aloe leaves and other “miracle remedies” to the burned skin.In case of a burn of the 1st degree (if there is no extensive damage to the skin or blisters), the bandage can not be applied at all, only an anti-burn gel can be applied.
  5. If there are extensive burns to the extremities – you must carefully fix them with a splint (any available means), raising the burned arms (legs).
  6. If a large area of ​​the body is burned and there are signs of burn shock (a person is weak, pale, he has increased anxiety, there is tachycardia and a drop in pressure, cold sweat appears, breathing and heart rhythm are disturbed), you should give him as much liquid as possible for drinking – juice , compote or plain clean water.Due to the intake of fluid into the body, intoxication caused by the penetration of decay products of burnt tissues into the blood will decrease.
  7. If the victim complains of pain, then in order to avoid pain shock, you should give him any available anesthetic (spazmalgon, analgin, etc.).
  8. In the absence of cardiac and (or) respiratory activity in a person, cardiopulmonary resuscitation (artificial respiration, chest compressions) should be performed.
  9. In case of severe burns, call an ambulance for hospitalization.

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

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

At home, you can independently treat superficial small burns without infection (without red edematous edges of the wound, without purulent discharge from the wound, fever, chills, increased pain in the wound, the appearance of twitching pain in the wound, etc.).etc.). Home treatment involves changing the dressings twice a day and applying an anti-burn agent. The lesion can be treated with hydrogen peroxide (3%), the skin around the burn – with iodine or brilliant green. An ointment for thermal burns (solcoseryl, panthenol, “rescuer”) and a sterile gauze bandage are applied to the wound.

The prognosis largely depends on the area of ​​the lesion, the degree of the lesion and the age of the victim. Mortality from burns is high in the elderly over 60 years old and children under 3 years old. However, even for patients of this age, burns cannot be considered a sentence.

It is worth remembering that correctly provided first aid for thermal burns is the key to rapid tissue repair with a minimum risk of scarring and scarring.

Department of medical prophylaxis of GBUZ “Krasnoarmeiskaya CRH”.


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REMINDER First aid for burns

When providing assistance with thermal burns, first of all, it is necessary to quickly remove the victim from the zone of fire or other damaging factor.If a person’s clothing catches on fire, throw a large piece of cloth over the victim, such as a blanket, coat or bag, to stop air from reaching the fire. Flames on clothes can also be extinguished with water, covered with sand. But in no case should the victim run in burning clothes.
After eliminating the causes that caused the burns, visually determine the degree of the burn:
• A degree I burn is characterized by redness and slight swelling of the skin.
• A second degree burn manifests itself in the form of blisters on the reddened skin, which may not form immediately.Burn blisters are filled with a clear yellowish liquid, when they rupture, the bright red painful surface of the growth layer of the skin is exposed.
• with a third degree burn, skin death occurs with the formation of a gray or black scab.
• in case of a 4th degree burn – necrosis and even charring of not only the skin, but also muscles, tendons and, in severe cases, bones.
Depending on the degree, it is necessary to cool the burn site as follows:
• burns I and II degree – with running water 10-15 minutes
• burns III and IV degree – apply a clean, damp bandage, cool in standing water.
After cooling, cover the burn with a moist, sterile dressing and keep the victim at rest.
If any clothing remains on the burned area, remove it. Cut off the adhered fabric around, in no case tear it off from the burn.
An ambulance must be called in the following cases:
• the area of ​​the burn is more than 5 palms of the victim
• a child or elderly person has been burned
• a third or fourth degree burn
• the groin area is burned
• the mouth, nose, head, respiratory tract are burned
• two limbs were burned.
In case of burns, do not:
• lubricate them with oil, cream, ointment, protein, etc., apply foam (panthenol) to the newly burnt place
• tear off adhered clothing
• pierce bubbles

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