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This article describes a type of injury. For other meanings of the word, see burn.

In medicine, a burn is a type of injury to the skin caused by heat, cold, electricity, chemicals, friction or radiation (e.g. a sunburn).

Classification

• First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns usually extend only into the epidermis.
• Second-degree burns additionally fill with clear fluid, have superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.

• Evolution of a 2nd degree burn — One hour
• Evolution of a 2nd degree burn — One day
• Evolution of a 2nd degree burn — two days, the blister is appearing

• Third-degree burns additionally have charring of the skin, and produce hard, leather-like eschars. An eschar is a scab that has separated from the unaffected part of the body. Frequently, there is also purple fluid. These types of burns are often painless because nerve endings have been destroyed in the involved areas.

Burns that injure the tissues underlying the skin, such as the muscles or bones, are sometimes categorized as fourth-degree burns. These burns are broken down into three additional degrees: fourth-degree burns result in the skin being irretrievably lost, fifth-degree burns result in muscle being irretrievably lost, and sixth-degree burns result in bone being charred.

A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.

Table 1. A description of the traditional and current classifications of burns.

Serious burns, especially if they cover large areas of the body, can cause death; any hint of burn injury to the lungs (e.g. through smoke inhalation) is a medical emergency.

Chemical burns are usually caused by chemical compounds, such as sodium hydroxide (lye), silver nitrate, and more serious compounds (such as sulfuric acid). Most chemicals (but not all) that can cause moderate to severe chemical burns are strong acids or bases. Nitric acid, as an oxidizer, is possibly one of the worst burn-causing chemicals. Hydrofluoric acid can eat down to the bone and its burns are often not immediately evident. Most chemicals that can cause moderate to severe chemical burns are called caustic.

Electrical burns are generally symptoms of electric shock, being struck by lightning, being defibrillated or cardioverted without conductive gel, etc. The internal injuries sustained may be disproportionate to the size of the "burns" seen - as these are only the entry and exit wounds of the electrical current.

Survival and outcome (scars, contractures, complications) of severe burn injuries is remarkably improved if the patient is treated in a specialized burn center/unit rather than a hospital.

First Aid

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• The general and basic first aid treatment for most burns is to douse the affected area with cool water for at least 10 minutes in order to relieve the casualty’s pain and reduce swellings which could accompany a burn (Note that cold burns should not be doused with water). The burn should then be covered with a loose sterile and non-fluffy dressing to prevent infection. The dressing must not exert pressure on the wound, due to the burn being likely to swell and increase in size.

• Take note that chemical burns should be doused with cool water for at least 15 minutes in order to flush away any chemicals which could still be present on the wound. Any contaminated clothing, or any traces of the chemical which had caused the burn should also be removed in order to prevent further harm.

• Take note that electrical burns are usually located at the entry and exit points of the voltage which has passed through the casualty’s body and into the ground. These burns are usually 3rd degree/full thickness and should also be doused with water for 10 minutes. Note that if the casualty has been struck by a high voltage, the casualty may also cease respiration and could be unconscious. Hence artificial respiration or CPR should be performed if necessary. Also ensure that the casualty isn't still in contact with the electrical source before performing treatment.

• With larger burns the body has the potential to lose a large amount of body fluid, which can result in the casualty going into Hypovolaemic shock. Do not provide fluid when you suspect shock as this may induce vomiting. Hypovolaemic shock is a life threatening condition, thus medical assistance is imperative. When shock occurs, the first-aider should lie the casualty on the floor with his/her legs raised with the aid of a bystander or object, in order to divert blood flow to major organs in the torso. (The legs should be raised to around the shoulder length of a human kneeling on the floor)

• Note that the following situations require medical assistance:
  • Any burn to the face, hands, feet, or genitalia.
  • Any 3rd degree/full thickness burn, or any burn that covers a large area.
  • Any burn that can interfere with respiration.
  • Any burn to an infant or elderly person.
  • Any chemical or electrical burn.

Scald

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Scalding is a specific type of burning that is caused by hot fluids or gasses. Examples of common liquids that cause scalds are water and cooking oil. Steam is a common gas that causes scalds. The injury is usually regional and usually does not cause death. More damage can be caused if hot liquids enter an orifice. However, deaths have occurred in more unusual circumstances, such as when people have accidentally broken a steam pipe. Young children, with their delicate skin, can suffer a serious burn in a much shorter time of exposure than the average adult. Also, their small body surface area means even a small amount of hot/burning liquid can cause severe burns over a large area of the body.

Table 2. Scald Time (Hot Water)

Cold burn

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A cold burn (see frostbite) is a kind of burn which arises when the skin is in contact with a low-temperature body. They can be caused by prolonged contact with moderately cold bodies (snow for instance) or brief contact with very cold bodies such as dry ice, liquid helium, liquid nitrogen, or canned air, all of which can be used in the process of wart removal. In such a case, the heat transfers from the skin and organs to the external cold body (as opposed to most other situations where the body causing the burn is hotter, and transfers the heat into the skin and organs). The effects are very similar to a "regular" burn. The remedy is also the same as for any burn: for a small wound keep the injured organ under a flow of comfortably temperatured water; the heat will then transfer slowly from the water to the organs and help the wound. Further treatment or treatment of more extended wound also as usual.

Assessing burns

Burns are assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns (superficial thickness burns are not counted). The rule of nines is used as a quick and useful way to estimate the affected TBSA.

Management

The first step in managing a person with a burn is to stop the burning process. With dry powder burns, the powder should be brushed off first. With other burns, the affected area should be rinsed with a large amount of clean water to remove foreign bodies and help stop the burning process. Cold water should never be applied to any person with extensive burns, as it may severely compromise the burn victim's temperature status.

At this stage of management, it is also critical to assess airway status. If the patient was involved in a fire, then it must be assumed that he or she has sustained inhalation injury until proven otherwise, and treatment should be managed accordingly.

Once the burning process has been stopped, and airway status is ensured, the patient should be volume resuscitated according to the Parkland formula. This formula dictates that the amount of Lactated Ringer's solution to deliver in the first twenty four hours after time of injury is:

Fluid = 4cc x %TBSA x weight in kg

%TBSA excludes any first degree burn

Half of this fluid should be given in the first eight hours post injury and the rest in the subsequent sixteen hours. The formula is a guide only and infusions must be tailored to urine output and central venous pressure. Inadequate fluid resuscitation causes renal failure and death.

Treatment of low-grade burns

A local anesthetic is usually sufficient in managing pain of smaller first-degree and second-degree burns. Lidocaine can be administered to the spot of injury and will generally negate most pain.

See also

• Sunburn
• Radiation burn
• Bruise
• Branding iron
• Friction burn

References

• St. John Ambulance (2000). First aid: First on the Scene: Activity Book. pp. Chapter 19. ISBN 1-894070-20-8.

External links

• http://journalofburnsandwounds.com : Journal of Burns and Wounds - online open-access journal featuring articles on burn care and related research

• Articles lacking sources from November 2006
• Articles lacking sources from December 2006
• Medical emergencies
• Dermatology
• Injuries
• Causes of death
• Burns