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Burns

Definition

Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals.

Description

Burns are characterised by degree, based on the severity of the tissue damage. A first-degree burn causes redness and swelling in the outermost layers of skin (epidermis). A second-degree burn involves redness, swelling and blistering, and the damage may extend beneath the epidermis to deeper layers of skin (dermis). A third-degree burn, also called a full-thickness burn, destroys the entire depth of skin, causing significant scarring. Damage also may extend to the underlying fat, muscle, or bone.

The severity of the burn is also judged by the amount of body surface area (BSA) involved. Health care workers use the "rule of nines" to determine the percentage of BSA affected in patients more than 9 years old: each arm with its hand is 9% of BSA; each leg with its foot is 18%; the front of the torso is 18%; the back of the torso, including the buttocks, is 18%; the head and neck are 9%; and the genital area (perineum) is 1%. This rule cannot be applied to a young child's body proportions, so BSA is estimated using the palm of the patient's hand as a measure of 1% area.

The severity of the burn will determine not only the type of treatment, but also where the burn patient should receive treatment. Minor burns may be treated at home or in a doctor's office. These are defined as first- or second-degree burns covering less than 15% of an adult's body or less than 10% of a child's body, or a third-degree burn on less than 2% BSA. Moderate burns should be treated at a hospital. These are defined as first- or second-degree burns covering 15%-25% of an adult's body or 10%-20% of a child's body, or a third-degree burn on 2%-10% BSA. Critical, or major, burns are the most serious and should be treated in a specialized burn unit of a hospital. These are defined as first- or second-degree burns covering more than 25% of an adult's body or more than 20% of a child's body, or a third-degree burn on more than 10% BSA. In addition, burns involving the hands, feet, face, eyes, ears, or genitals are considered critical. Other factors influence the level of treatment needed, including associated injuries such as bone fractures and smoke inhalation, presence of a chronic disease, or a history of being abused. Also, children and the elderly are more vulnerable to complications from burn injuries and require more intensive care.

Causes and symptoms

Burns may be caused by even a brief encounter with heat greater than 120°F (49°C). The source of this heat may be the sun (causing a sunburn), hot liquids, steam, fire, electricity, friction (causing rug burns and rope burns), and chemicals (causing a caustic burn upon contact).

Signs of a burn are localized redness, swelling, and pain. A severe burn will also blister. The skin may also peel, appear white or charred, and feel numb. A burn may trigger a headache and fever. Extensive burns may induce shock, the symptoms of which are faintness, weakness, rapid pulse and breathing, pale and clammy skin, and bluish lips and fingernails.

Treatment

Burn treatment consists of relieving pain, preventing infection, and maintaining body fluids, electrolytes, and calorie intake while the body heals. Treatment of chemical or electrical burns is slightly different from the treatment of thermal burns but the objectives are the same.