Burns

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Definition

A burn is damage to the skin and sometimes to the underlying tissues. Burns are categorized according to the depth and extent of the damage to the skin:

  • Superficial burn (also called first-degree burn)
    • Mildest type of burn
    • Often caused by ultraviolet light, or very short (“flash") flame exposure
    • Affects only the outer layer of the skin (epidermis)
    • Normally does not cause scarring
    • Takes about 3-6 days to heal
  • Superficial partial-thickness burn (also called second-degree burn)
    • Often caused by a scald (spill or splash) or short (“flash”) flame exposure
    • Affects the outer layer of the skin more deeply, usually causing blistering
    • May or may not cause scarring, but often does cause long-term skin color changes
    • Takes about 1-3 weeks to heal
  • Deep partial-thickness burn (also called second-degree burn)
    • Often caused by a scald (spill), may involve flame, oil, or grease
    • Affects the outer and underlying layer of skin (dermis), causing blistering
    • Usually causes scarring
    • Usually takes more than three weeks to heal
  • Full-thickness burn (also called third-degree burn)
    • Very serious
    • Often caused by scald (immersion), may involve flame, steam, oil, grease, chemicals, or high-voltage electricity
    • Damages all layers of the skin, and may involve the tissues underneath (muscle and bone)
    • Causes scarring
    • Will heal only at the wound edges by scarring, unless skin grafting is done
Classification of Skin Burns
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Causes

Burns can be caused by:

  • Heat or flame (thermal burns)
    • Hot foods or drinks such as boiling water, tea, or coffee
    • Hot oil or grease
    • Hot tap water
    • Direct heat such as stoves, heaters, or curling irons
    • Direct flame
    • Flammable liquids such as gasoline
    • Fireworks
  • Chemicals (chemical burn)—strong acids or strong bases such as:
    • Cleaning products
    • Battery fluid
    • Pool chemicals
    • Drain cleaners
  • Sunlight (sunburn) or tanning beds
  • Electricity (electrical burn)
    • Damaged electrical cords
    • Electrical outlets
    • High-voltage wires
    • Lightning
  • Radiation (radiation burn)

Risk Factors

Burns are more common in males, and in those aged under 4 years. Other factors that may increase the chance of burns include:

  • Smoking
  • Alcohol use
  • Illegal drug use
  • Low socioeconomic status
  • Absent or non-functioning smoke detectors
  • Substandard or older housing
  • Unsupervised or improperly supervised children
  • Using tap water hotter than 120° F

Symptoms

Burn symptoms and signs vary depending on the type of burn.

Superficial Burn

  • Burned area turns red and is painful
  • The area blanches (turns white) when you press on it
  • The area may swell, but it is dry and there is no blistering

Superficial Partial-Thickness Burn

  • Blisters
  • The area is moist, red, and weeping
  • The area blanches (turns white) when you press on it
  • Painful to air and temperature

Deep Partial-Thickness Burn

  • Blisters, usually loose and easily unroofed
  • The area can be wet or waxy dry
  • The skin color can vary from patchy, to cheesy white, to red
  • The area does not blanch (turn white) with pressure
  • May or may not be painful, can perceive pressure

Full-Thickness Burn

  • Skin can appear waxy white, leathery gray, or charred and blackened
  • May not be painful if nerves have been damaged, the only sensation may be deep pressure

Diagnosis

The doctor will ask how the burn occurred and will examine the burned area.

Treatment will depend on the cause of the burn, how deep the burn is, and how much of the body the burn covers. Doctors have methods and charts to estimate the total percentage of body surface area (TBSA) affected by the injury. This estimate is age dependent. For example, the head represents a larger percentage of surface area in a baby than in an adult.

Treatment

Quick treatment is important and can lessen the damage to the tissues. First aid for minor burns may involve:

  • Cooling the burn with running water or a cold damp cloth. Do not use ice—this may result in more damage to the skin.
  • Do not use butter, grease, oils, or ointments on the burn.
  • Cover the burn with sterile gauze or a clean cloth.
  • Do not use a fluffy cloth such as a towel or blanket.
  • Take an over-the-counter pain reliever, like acetaminophen (Tylenol).
  • Do not break or pop any blisters. This may result in an infection.
  • If you see signs of an infection, get medical attention. Signs of infection include:
    • Increased pain
    • Redness
    • Fever
    • Swelling
    • Oozing of pus

Once a minor burn is completely cooled, you can consider using a fragrance-free lotion or moisturizer to prevent drying and make the area more comfortable.

For more serious burns, like deep partial-thickness or full-thickness burns, seek medical attention or call emergency medical services. Until an emergency unit arrives:

  • Do not take off any clothing that is stuck to the burn.
  • Make sure the victim is not near, or in contact with, any smoldering materials or exposed to further smoke or heat.
  • Do not soak the burn in water, but you can cover the area with a cool, moist sterile bandage or clean cloth.
  • As with any severe injury, make sure the person is breathing and administer CPR if necessary.

Hospitalization

A doctor will decide if hospitalization is necessary based on many factors. These include age, the cause of the burn, and the extent and depth of the burn. Reasons to hospitalize a person who has more than a minor burn may include:

  • Age: younger than five years or older than 55 years
  • Suspected child abuse
  • Very small, deep burns on the hands, face, eyes, feet, or perineum (groin/genital area)
  • Extensive burn: using TBSA and age charts
  • Burns that may require complicated dressing changes, elevation, or continued physician observation
  • High-voltage injury or burn
  • Suspected or known inhalation injury
  • Circumferential burn
  • Other medical problems that predispose a person to infection, such as:

Medical Treatment for Major Burns

If the burn is serious, the following treatments may be administered in a hospital:

  • Oxygen to help with breathing
  • Intubation
  • IV fluids to replace those lost from the burn
  • Skin graft
  • Splints—placed on joints to help maintain mobility
  • Physical therapy, in the case of large burns

Prevention

Most burns are the result of accidents. To help reduce the chance of burns:

  • Teach children about fire prevention and keep dangerous materials out of reach.
  • Make sure smoke detectors are installed and in working order. Replace batteries twice a year. One way to remember to do this is to change the batteries the same days you change the clocks for daylight savings and standard times.
  • When cooking, keep pot handles turned toward the back of the stove.
  • Supervise young children in the kitchen and around fireworks.
  • Set the temperature on the water heater to less than 120° F and test the bath water before your child gets in.
  • Make sure children’s sleepwear is flame-resistant.
  • Don’t hold children in your arms or lap while cooking, serving, or eating hot foods or liquids.
  • Do not leave matches, lighters, candles, or burning cigarettes unattended.
  • Wear protective gloves and clothing when handling caustic chemicals.
  • Put protective covers on electrical outlets.
  • Do not wear loose-fitting sleeves while cooking.
  • Keep children and pets away from the stove while cooking.
  • Make sure electrical cords are not hanging over the edge of countertops.
  • Store chemicals and cleaners in a locked cabinet.
  • Children younger than one year can sustain partial-thickness burns from hot seat belt straps or buckles in car seats. Make sure car seats are not hot before putting a child in the seat. If you park in the sun, cover the seat with a towel.

Revision Information

  • American Burn Association

    http://www.ameriburn.org

  • National Library of Medicine - National Institutes of Health

    http://www.nlm.nih.gov

  • Canadian Burn Survivors Community

    http://canadianburnsurvivors.ca

  • Health Canada

    http://www.hc-sc.gc.ca

  • Behrman R, Kliegman R, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders; 2007.

  • Beers MH. The Merck Manual of Medical Information. 2nd ed. London, England: Simon and Schuster, Inc; 2003.

  • First aid for burns. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/safety-prevention/all-around/Pages/First-Aid-For-Burns.aspx. Updated September 2, 2014. Accessed November 3, 2014.

  • Goldman L, Ausiello D, eds Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia, PA: Saunders; 2008.

  • Major burns. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 24, 2014. Accessed November 3, 2014.

  • Marx J, Hockberger R, et al. Rosen's Emergency Medicine. 7th ed. St. Louis, MO: Mosby; 2009.

  • Minor burns. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed November 3, 2014.

  • Protect the ones you love: burns. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/SafeChild/Fact%5FSheets/Burns-Fact-Sheet-a.pdf. Accessed November 3, 2014.

  • Topical treatment and dressing of burns. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed November 3, 2014.