What is thermal burn: Thermal Burns – StatPearls – NCBI Bookshelf

28.12.202215.07.2023 by alexxlab

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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]

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

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

Figure

Diagram of rule of 9s for adults. Contributed from Wiki commons user Jmarchn, CC By-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/

Figure

Diagram of rule of 9s modifications for pediatric patients. Contributed by Rian Kabir, MD

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): Jun 23, 2022. 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]

: Disclosure: Timothy Schaefer declares no relevant financial relationships with ineligible companies.
: Disclosure: Shruti Tannan declares no relevant financial relationships with ineligible companies.

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

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

Etiology

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

Pathophysiology

History and Physical

Evaluation

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

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

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

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.

Differential Diagnosis

Chemical burn
Electric burn
Heat/fire burn

Prognosis

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.

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

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

Figure

Diagram of rule of 9s for adults. Contributed from Wiki commons user Jmarchn, CC By-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/

Figure

Diagram of rule of 9s modifications for pediatric patients. Contributed by Rian Kabir, MD

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): Jun 23, 2022. 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]

: Disclosure: Timothy Schaefer declares no relevant financial relationships with ineligible companies.
: Disclosure: Shruti Tannan declares no relevant financial relationships with ineligible companies.

Thermal burns – GBUZ “Bryukhovets Central District Hospital” MZ KK

Thermal burns

Thermal burns ia with hot objects, sunburn. Flame burns are the most common, burns with liquids are recorded in second place, electric burns and burns with an electric arc flame are in third place. Burns caused by other factors are observed in isolated cases.

In modern conditions of intensive industrialization, the ever-increasing use of thermal energy sources in production and at home, there is a tendency to increase the frequency of burns. According to the World Health Organization, burns rank third among other types of injuries. Burns are often fatal, and among those who recover, many remain disabled.

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

1st degree burns skin redness and swelling;
· 2nd degree burns are characterized by blisters filled with a clear yellowish liquid. Under the exfoliated layer of the epidermis, an exposed basal layer remains. With burns of I-II degree, there are no morphological changes in the skin, which is how 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 burns of the III B degree, necrosis of the skin occurs and a necrotic scab forms.
IV degree burns are accompanied by necrosis not only of the skin, but also of deeper tissues (muscles, tendons, bones, joints).

The severity of the burn also depends on the area of the affected tissues. It is expressed as a percentage relative to the area of the entire surface of the skin. When estimating a burn, the so-called “rule of the palm” is used: the area of \u200b\u200bthe human palm is equal to one percent of the body area.

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

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

– acute toxemia (the second period of burn disease that occurs 2-3 days after injury and lasts 7-8 days; characterized by a 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 conditionally starting from the 10-12th day of the disease and characterized by the development of infection, putrefactive processes in wounds and the penetration of microbes and their toxins into the bloodstream and products of autolysis of dead tissues; in a burn wound, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus and their associations usually vegetate),

– recovery (or convalescence).

First aid for thermal burns

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 the victim and the people around him.

Carefully remove smoldering remains of things from the injured person that did not get into the wound. Never peel off clothing stuck to the burn. Also, you can not touch the burnt body with your hands.
If it is a sunburn, you need to move the injured person to the shade.
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 the blood circulation in the wound. However, ice should not be used to cool the burnt area in order to avoid the possibility of another injury – frostbite.
Apply any available anti-burn agent (ointment, gel) to the affected surface, apply a sterile (if possible) dry bandage on top. You can not use cotton wool, only gauze, bandage – fabric materials. It happens that there is neither an anti-burn agent nor sterile bandages at hand, then any dry, clean bandage should be applied to the wound. You can not apply any folk medicines 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. With a first degree burn (if neither extensive damage to the skin nor blisters is observed), the bandage can not be applied at all, only an anti-burn gel can be applied.
If there are extensive burns of the limbs, it is necessary to carefully fix them with a splint (any improvised means), lifting the burnt arms (legs).
If a large area of the body is burned and there are signs of burn shock (the person is weak, pale, he has increased anxiety, tachycardia and a drop in pressure, cold sweat appears, breathing and heart rhythm are disturbed), you should give him as much liquid as possible to drink – juice , compote or plain clean water. Due to the intake of fluid into the body, intoxication will decrease, which has arisen due to the penetration of decay products of burnt tissues into the blood.
If the victim complains of pain, then in order to avoid pain shock, you should give him any available painkiller (spasmalgon, analgin, etc.).
In the absence of cardiac and (or) respiratory activity, cardiopulmonary resuscitation (artificial respiration, chest compressions) should be performed.
In case of severe burns, call an ambulance to hospitalize the victim.

In case of superficial thermal burns of more than 10% of the body area of adults (in children – more than 5%) and with deeper burns from 5% of the body of an adult (respectively, more than 2. 5% of the body of a child), after first aid, mandatory medical assistance is required followed by hospitalization. Such burns lead to a violation of the general condition, threaten the life of the victim and may subsequently require surgical intervention.

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

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

The prognosis to a large extent depends on the area of the lesion, the degree of the lesion and the age of the victim. High mortality from burns in the elderly over 60 years and children under 3 years. However, even for patients of this age, burns cannot be considered a sentence.

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

Based on the materials of the Center for Medical Prevention of the Ministry of Health of the Krasnodar Territory.

Thermal burns: first aid, treatment

Causes of thermal burns

exposure to naked flames on the skin or clothing
contact with hot metal, cermet or other objects ( iron, frying pan, cooking panel, asphalt splashes, etc. )
exposure to hot liquid or steam
reaction to electrical damage to the body
exposure to the sun (sunburn)

Severity of thermal burns. Main symptoms

Thermal burn injuries are: I, II, III and IV degrees .

1st degree burns

1st degree burns are called superficial , or epidermal ¹ . Only the top layer of the skin is damaged. Symptoms will be swelling, soreness or burning, red color of the skin. These burns can be treated on their own. As a rule, it is possible to restore the skin in a few days. After healing, the damaged area of the skin will not differ in color from the rest of the skin, but temporary peeling may be present. 9. The damaging effect affects the deeper layers of the skin. Therefore, with such burns, along with reddening of the skin, swelling and pain, blisters with transparent contents form. Healing occurs within two weeks. Often, after complete skin repair, the damaged area will be either a darker or lighter shade compared to unaltered skin.

3rd degree burns

3rd degree burns called deep ¹ . The burn process involves all layers of the skin, including subcutaneous fatty tissue.

Skin structure

In this case, the symptoms, depending on the cause of the thermal burn, will vary. So, upon contact with an open fire or a hot object, a crust (scab) of a brownish color forms on the surface, and when the skin is scalded with hot liquid or steam, it is wet, white-gray.

Blisters may also form in deep burns.

Recovery of burn injuries takes up to 1.5 months. Skin grafting is often required. Upon healing, a violation of skin pigmentation remains, well-marked scars are formed.

IV degree burns

Burns IV degree not only kill the skin and membranes covering the muscles (fascia), muscles and bones can also be affected ² . A dark crust and areas of charring appear. Recovery is extremely slow, as a rule, surgical treatment, skin grafting is required. The issue of saving the affected parts of the body is being addressed.

Determining the area of a thermal burn. Injury severity index (ITI)

In most cases, even with a visual examination, the doctor can diagnose a thermal burn. If the person is conscious, you can ask about what happened and clarify the specific cause of the thermal burn.

To select the tactics of treatment of burn wounds, it is necessary to perform a diagnosis of the severity of the burn injury.

In combustiology, a branch of medicine dealing with the study of burns, to determine the burn area use the “rule of the palm” and the “rule of nines”.

Rule of the Palm

The area of one palm of the patient is 1% of the entire body surface ² . This rule is suitable for determining non-extensive burn injuries.

“Rule of nines”

In an adult, the area of the skin of the head is 9% of the area of the whole body. Upper limb – 9%, one lower limb – 18%, Front and back surface of the body – 18% each, genitals
and perineum – 1% ² .

Injury severity index

For a special assessment of the damage area, the injury severity index (ITP) is calculated. This indicator is based on an assessment of the depth and extent of the lesion and is expressed in arbitrary units.

For burns of I-II degrees, 1% of the burn area is equal to 1 unit.
For IIIa degree burns, 1% of the burn area is equal to 2 units.
For IIIb-IV degree burns, 1% of the burn area is equal to 3 units.

Complications of burns

A serious complication of thermal burns is burn shock ² , the main manifestations of which are:

vomiting
pressure drop
decrease or cessation of urine production by the kidneys (oliguria and anuria)
chills and palpitations
pallor and dryness of the skin
motor excitation

Light shock develops with a deep burn of no more than 20% of the body surface, ITP 30-70 units.

Severe shock – with a burn of 20-40% of the body surface, ITP 71-130 units.

Extremely severe shock – burned more than 40% of the body surface,
ITP more than 130 units.

The shock period lasts from 10 hours to 3 days, depending on the severity of the shock.

From the 4th to the 14th day, due to the general effect on the body of the decay products of dead tissues and bacteria, acute burn toxemia occurs .

Burn shock is treated in a hospital, where adequate anesthesia is performed, bladder catheterization is carried out, and water and electrolyte balance is corrected. Artificial ventilation is often required.

Local complications of thermal burns include infection with bacteria and fungi, loss of function of the affected body part, severe scarring and contractures.

Treatment of thermal burns

Most household thermal burns, given their small size and mild severity, do not require medical attention.

However, it is important to provide correct first aid.

First aid for thermal burns

Stop contact with heat as soon as possible or extinguish burning clothing with water or a blanket.
Cool the area of thermal burn with cold water, ice, snow, cooling packs. This will allow to lower the temperature inside the tissues and reduce the damaging effects of heat.
The burnt part of the body is cut and removed. Adhering clothes are not torn off.
Formed blisters should not be pierced. You can use a sterile needle from a sterile syringe if the bubble is single and small. With multiple blisters, you need to seek medical help.

Ointments and creams for burns

What are the types of ointments for the treatment of burns, and how to choose the most effective one.

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Treatment of light superficial burns

In the treatment of first degree burns, soothing creams, aerosols, solutions containing panthenol, dexpanthenol, tannin are used. Changes in the lesion are completely reversible and healing occurs within a few days.

Treatment of II-III degree burns

The formation of blisters indicates a violation of the integrity of the skin, and necrosis of the skin or other tissues of the body is a predisposing factor for the development of infection. Therefore, burns of the second or more severe degrees are susceptible to infection by pathogens .

To prevent the development of purulent complications, proper care and treatment of the burn surface is important, both before seeking medical help and after medical intervention.

A fresh burn wound surface must be washed in order to decontaminate and mechanically remove foreign particles and microorganisms. Usually, solutions of furacilin, potassium permanganate, chlorhexidine are used. Then a 5% iodine solution is applied along the edges of the wound. Moreover, it should be noted that there are special forms of iodine, which are called povidone-iodine.

Treatment of thermal burns with preparations based on povidone-iodine (Betadine®)

For disinfection of the wound surface, it is recommended to use solution of povidone-iodine ( Betadine ^® ), which, unlike the above antiseptics, does not contain alcohol, approved for use on the entire surface of the burn, does not cause burning of injured tissues.

Povidone-iodine ( Betadine ^® ) contributes to the death of bacteria, fungi, protozoan unicellular microorganisms, viruses ³ . At the same time, the drug is practically not absorbed into the bloodstream ³, which indicates a high safety profile.

Antiseptic, disinfectant ointment Betadine ^® can be used to treat burns. The agent is applied to the burn surface 2-3 times a day with a thin layer. In the treatment of burns Betadine ^® ointment can be left under the dressing. In the treatment of infected wounds under wipes soaked in a solution or ointment Betadine ^® , during the first 5-7 days the edema and the amount of purulent discharge decreased, there was a decrease in pain ⁴ . The use of Betadine ^® solution or ointment is permitted in adults and children from the age of ³.

Instruction

Where can I buy Betadine® solution?

Buy

Find the nearest pharmacy0005

Iodine-based ointment

Iodine-based ointment: mechanism of action, scope. Ointment Betadine® based on povidone-iodine for the treatment of various skin diseases.

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Treatment of thermal burns at the stage of healing and maturation of the scar

Along with antiseptic therapy, external healing agents based on lanthanum salts, sodium deoxyribonucleate can be used. In some complicated cases, antibiotic treatment may be required. After healing, for the preventive and therapeutic purpose of developing rough scars, preparations based on silicone, hyaluronidase, and glucocorticosteroids are prescribed.

Burn Injury Prevention

Small children should not be left alone.
Use protective covers on sockets.
Install thermostats on the water pipes.
Install protective screens on radiators.
Mugs, plates, pots, pans with hot contents should be placed closer to the center of the table or on the far burners of the hob.
Keep matches and lighters out of the reach of children.
Electrical appliances placed on countertops should be moved closer to the wall – away from the water source.
Observe safe tanning practices. Stay in the open sun until 11.00 and after 16.00. Use sunscreen with at least 30 SPF.

Frequently Asked Questions

When should I seek medical attention for a thermal burn?

Urgently call an ambulance if:

burn area more than 5% (5 palms) of the body surface
burn of 3-4 degrees
smoke inhalation occurred, respiratory tract burned
burns of the face or neck, inguinal region, two limbs burned
burn injury occurred a eye
a child or an elderly person received a thermal injury

If purulent complications appear during the treatment of even small burns, a doctor’s consultation is necessary.

Is it possible to wet the skin after a burn?

Immediately after a thermal injury, it is even recommended to cool the skin with pure cold water. If a burn of 1 and 2 degrees – hold under running water for 10-15 minutes. If the burn is 3 and 4 degrees, use a clean, damp bandage to cool the damaged area of the skin. When cooling injured skin with water, do not rub or try to actively clean the wound.

It should be noted that during the healing period of burns, characterized by damage to the integrity of the skin, it is not recommended to contact with water, visit a sauna, bath, pool.

Can I bandage burnt skin?

Bandaging or a clean bandage is recommended for initial pre-hospital treatment of thermal burns and during the healing period. In this case, cotton wool or other pile materials should not be used.

Moshkova Elena Mikhailovna

Dermatovenereologist, Head of the CDO for the provision of paid services, St. Petersburg State Budgetary Institution of Healthcare “City Dermatovenerologic Dispensary”, St. Petersburg

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Ointments and creams for burns

What are the ointments for the treatment of burns, and how to choose the most effective one.

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References

Clinical recommendations “Thermal, chemical burns. Sun burns. Respiratory tract burns, 2020.
Mikhailovich V.A., Miroshnichenko A.G. “Guidelines for emergency physicians”, 4th edition, 2007.
Instructions for the medical use of Betadine®, solution, RU P N015282/03.
Mikhalsky V. V., Bogdanov A. E., Zhilina S. V., Prvidentsev A. I., Anikin A. I., Ulyanina A. A. «The use of the drug in the treatment of infected wounds».

What is thermal burn: Thermal Burns – StatPearls – NCBI Bookshelf

Thermal Burns – StatPearls – NCBI Bookshelf

Continuing Education Activity

Introduction

Etiology

Epidemiology

Pathophysiology

History and Physical

Evaluation

Treatment / Management

Differential Diagnosis

Prognosis

Enhancing Healthcare Team Outcomes

Review Questions

Figure

Figure

Figure

Figure

References

Thermal Burns – StatPearls – NCBI Bookshelf

Continuing Education Activity

Introduction

Etiology

Epidemiology

Pathophysiology

History and Physical

Evaluation

Treatment / Management

Differential Diagnosis

Prognosis

Enhancing Healthcare Team Outcomes

Review Questions

Figure

Figure

Figure

Figure

References

Thermal burns – GBUZ “Bryukhovets Central District Hospital” MZ KK

Thermal burns: first aid, treatment

Severity of thermal burns. Main symptoms

1st degree burns

3rd degree burns

IV degree burns

Determining the area of ​​a thermal burn. Injury severity index (ITI)

Rule of the Palm

“Rule of nines”

Injury severity index

Complications of burns

Treatment of thermal burns

First aid for thermal burns

Treatment of light superficial burns

Treatment of II-III degree burns

Treatment of thermal burns with preparations based on povidone-iodine (Betadine®)

Treatment of thermal burns at the stage of healing and maturation of the scar

Burn Injury Prevention

Frequently Asked Questions

When should I seek medical attention for a thermal burn?

Is it possible to wet the skin after a burn?

Can I bandage burnt skin?

References

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Determining the area of a thermal burn. Injury severity index (ITI)