Burns

Burns are injuries to body tissues caused by heat, chemicals, electricity, radiation, or friction. They range from minor injuries that heal within days to severe, life-threatening conditions requiring extensive medical care. Burns are classified by depth (first, second, or third degree) and severity, which determines the appropriate treatment approach. Prompt and proper treatment is essential to prevent complications, reduce scarring, and promote healing.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. For severe burns or any burn covering a large area, seek immediate emergency medical attention. Call 911 for serious burn injuries.

Overview

Burns are among the most common injuries, affecting millions of people worldwide each year. They occur when body tissues are exposed to temperatures above 104°F (40°C), corrosive chemicals, electrical current, or radiation. The skin, being the body's largest organ and primary protective barrier, is most commonly affected, though burns can also damage deeper structures including muscles, bones, nerves, and blood vessels.

The severity of a burn depends on several factors: the temperature or strength of the heat source, duration of exposure, thickness of the skin in the affected area, and the person's age and health status. Burns are medically classified by depth of tissue damage (degrees) and by total body surface area (TBSA) involved, which helps healthcare providers determine treatment protocols and predict outcomes.

In the United States, approximately 450,000 people receive medical treatment for burns annually, with about 40,000 requiring hospitalization. While most burns are minor and heal without complications, severe burns can lead to infection, scarring, contractures, and even death. Children under 4 years and adults over 60 years are at highest risk for severe complications from burn injuries.

Symptoms

Burn symptoms vary significantly depending on the severity and type of burn. Understanding these symptoms helps determine the appropriate level of care needed and when to seek emergency medical attention.

First-Degree Burns (Superficial)

  • Red, non-blistered skin
  • Mild swelling
  • Pain and tenderness
  • Skin irritation - localized redness and sensitivity
  • Skin that blanches with pressure
  • Healing within 3-6 days without scarring

Second-Degree Burns (Partial Thickness)

Superficial Partial Thickness

  • Red, blistered skin
  • Severe pain
  • Swelling
  • Moist appearance
  • Blanches with pressure

Deep Partial Thickness

  • Red or white appearance
  • May or may not blister
  • Less painful due to nerve damage
  • Does not blanch with pressure
  • Dry or slightly moist

Third-Degree Burns (Full Thickness)

  • White, brown, or charred appearance
  • Leathery texture
  • Little to no pain (nerve endings destroyed)
  • No blanching with pressure
  • Dry appearance
  • Requires surgical intervention

Location-Specific Symptoms

Systemic Symptoms (Severe Burns)

  • Fever or hypothermia
  • Rapid heart rate
  • Low blood pressure
  • Decreased urine output
  • Confusion or altered mental status
  • Difficulty breathing (with inhalation injury)

Signs of Infection

  • Increased pain, redness, swelling
  • Pus or unusual drainage
  • Red streaking from the burn site
  • Fever and chills
  • Delayed healing
  • Foul odor from the wound

Causes

Burns result from exposure to various forms of energy that exceed the tissue's ability to dissipate heat or resist damage. Understanding the different types of burns helps in prevention and appropriate treatment.

Thermal Burns

The most common type of burn, caused by contact with hot objects, liquids, steam, or flames:

  • Scalds: Hot liquids (water, oil, soup) - most common in children
  • Contact burns: Hot surfaces (stoves, irons, heated metal)
  • Flame burns: Direct fire exposure, often involving clothing ignition
  • Steam burns: Superheated water vapor
  • Tar and asphalt burns: Extremely hot substances that adhere to skin

Chemical Burns

Caused by contact with corrosive substances:

  • Acids: Sulfuric acid, hydrochloric acid, nitric acid
  • Alkalis: Sodium hydroxide (lye), lime, ammonia
  • Household chemicals: Drain cleaners, oven cleaners, bleach
  • Industrial chemicals: Various corrosives in workplace settings
  • Organic compounds: Gasoline, paint thinners

Electrical Burns

Result from electrical current passing through the body:

  • Low voltage: Household current (110-220 volts)
  • High voltage: Power lines, industrial equipment (>1000 volts)
  • Lightning strikes: Extremely high voltage natural phenomena
  • Arc burns: From electrical arcing between conductors

Radiation Burns

  • Ultraviolet radiation: Sunburn, tanning beds
  • Ionizing radiation: X-rays, nuclear materials
  • Infrared radiation: Heat lamps, lasers
  • Medical radiation: Radiation therapy side effects

Friction Burns

  • Road rash from motor vehicle accidents
  • Rope burns
  • Sports-related sliding injuries
  • Industrial machinery contact

Common Scenarios

Home Environment

  • Cooking accidents (grease fires, hot liquids)
  • Bathroom injuries (hot water, steam)
  • Appliance contact (irons, space heaters)
  • Chemical exposure (cleaning products)

Workplace Injuries

  • Industrial accidents
  • Chemical spills
  • Electrical incidents
  • Welding and metalwork

Recreational Activities

  • Campfire accidents
  • Fireworks injuries
  • Sunburn from outdoor activities
  • Hot surface contact during sports

Risk Factors

Certain factors increase the likelihood of sustaining burns or experiencing more severe burn injuries. Understanding these risk factors helps in prevention and risk mitigation.

Age-Related Risk Factors

  • Young children (under 4 years):
    • Curiosity and exploration behavior
    • Limited understanding of dangers
    • Thinner skin, more severe injuries
    • Higher surface area to body weight ratio
  • Elderly (over 65 years):
    • Slower reaction times
    • Reduced sensation and mobility
    • Thinner skin and slower healing
    • Higher mortality rates from burns

Occupational Risk Factors

  • High-risk occupations:
    • Restaurant and food service workers
    • Firefighters and emergency responders
    • Industrial workers (welding, metalwork)
    • Chemical plant employees
    • Electrical workers
    • Healthcare workers (radiation exposure)

Environmental Risk Factors

  • Home environment:
    • Lack of smoke detectors
    • Faulty electrical wiring
    • Improperly stored chemicals
    • Space heaters and open flames
    • Hot water heater temperature >120°F
  • Geographic factors:
    • Areas with high UV radiation
    • Regions prone to wildfires
    • Industrial areas with chemical exposure

Behavioral Risk Factors

  • Alcohol or substance abuse (impaired judgment)
  • Risk-taking behaviors
  • Lack of safety awareness
  • Improper use of equipment
  • Ignoring safety protocols

Medical Risk Factors

  • Conditions affecting healing:
    • Diabetes mellitus
    • Peripheral vascular disease
    • Immunocompromised states
    • Malnutrition
    • Chronic steroid use
  • Conditions affecting sensation:
    • Neuropathy
    • Spinal cord injuries
    • Mental health conditions

Protective Factors

  • Proper safety equipment use
  • Safety training and education
  • Working smoke detectors
  • Fire extinguishers and first aid supplies
  • Appropriate storage of hazardous materials
  • Regular equipment maintenance

Diagnosis

Diagnosis of burns involves immediate assessment of severity, extent, and depth to guide treatment decisions. Healthcare providers use standardized classification systems and assessment tools.

Initial Assessment

Primary Survey (ABCs)

  • Airway: Check for inhalation injury, facial burns
  • Breathing: Assess respiratory function, oxygen saturation
  • Circulation: Evaluate cardiovascular status, fluid needs
  • Disability: Neurological assessment
  • Exposure: Full body examination for extent of burns

Burn Assessment

Depth Classification

  • First-degree (superficial):
    • Involves epidermis only
    • Red, painful, no blisters
    • Heals in 3-6 days without scarring
  • Second-degree (partial thickness):
    • Involves epidermis and dermis
    • Superficial: blisters, very painful
    • Deep: less painful, may appear white
  • Third-degree (full thickness):
    • Through epidermis and dermis
    • White, brown, or charred appearance
    • Painless due to nerve destruction
  • Fourth-degree:
    • Extends to muscle, bone
    • Charred appearance
    • Requires amputation consideration

Size Assessment

Rule of Nines (Adults):

  • Head and neck: 9%
  • Each arm: 9%
  • Front torso: 18%
  • Back torso: 18%
  • Each leg: 18%
  • Genitalia: 1%

Palm Method: Patient's palm = approximately 1% TBSA

Diagnostic Tests

Laboratory Studies

  • Complete blood count
  • Comprehensive metabolic panel
  • Arterial blood gas (if inhalation injury suspected)
  • Carboxyhemoglobin level
  • Urinalysis
  • Type and screen for blood products

Imaging Studies

  • Chest X-ray: Evaluate for inhalation injury
  • CT scan: Assess for internal injuries in trauma cases
  • Bronchoscopy: Direct visualization of airway injury

Special Considerations

Inhalation Injury Assessment

  • History of enclosed space fire
  • Facial burns or singed nasal hairs
  • Carbonaceous sputum
  • Hoarse voice or stridor
  • Respiratory distress

Chemical Burn Assessment

  • Identify the chemical agent
  • Duration of contact
  • Dilution or neutralization attempts
  • Systemic toxicity signs

Electrical Burn Assessment

  • Voltage and type of current
  • Entry and exit wound locations
  • Duration of contact
  • Cardiac rhythm monitoring
  • Neurological examination

Treatment Options

Burn treatment varies significantly based on severity, size, location, and type of burn. The goals are to preserve life, prevent infection, minimize scarring, and restore function.

Emergency Treatment

Initial Management

  • Stop the burning process:
    • Remove from heat source
    • Cool with room temperature water (15-20 minutes)
    • Remove clothing and jewelry (non-adherent)
    • Do not use ice or butter
  • Assess severity: Determine need for transfer to burn center
  • Pain management: Analgesics, cooling
  • Prevent hypothermia: Warm blankets after cooling

Minor Burn Treatment (Outpatient)

First-Degree Burns

  • Cooling: Cool water soaks or compresses
  • Pain relief: NSAIDs, topical anesthetics
  • Moisturizing: Aloe vera, petroleum jelly
  • Protection: Loose, breathable clothing
  • Avoid: Breaking blisters, using ice

Small Second-Degree Burns

  • Cleaning: Gentle cleansing with mild soap
  • Dressing: Sterile gauze with topical antibiotic
  • Daily care: Dressing changes, wound inspection
  • Protection: Keep clean and dry
  • Follow-up: Monitor for signs of infection

Severe Burn Treatment (Hospital/Burn Center)

Resuscitation

  • Fluid resuscitation: Parkland formula for >20% TBSA burns
  • Monitoring: Vital signs, urine output, mental status
  • Airway management: Intubation for inhalation injury
  • Pain control: IV opioids, multimodal approach

Wound Management

  • Debridement: Removal of dead tissue
    • Conservative debridement
    • Surgical debridement
    • Enzymatic debridement
  • Topical antimicrobials:
    • Silver sulfadiazine cream
    • Mafenide acetate
    • Silver-impregnated dressings
  • Dressing types:
    • Hydrocolloid dressings
    • Hydrogel dressings
    • Foam dressings
    • Biological dressings

Surgical Treatment

Early Excision and Grafting

  • Timing: Within 72 hours for deep burns
  • Techniques:
    • Tangential excision
    • Fascial excision
    • Split-thickness skin grafts
    • Full-thickness grafts
  • Temporary coverage:
    • Allografts (cadaver skin)
    • Xenografts (pig skin)
    • Synthetic substitutes

Specialized Treatments

Chemical Burns

  • Decontamination: Copious irrigation (except certain chemicals)
  • Specific antidotes: For specific chemical exposures
  • Systemic monitoring: For toxicity signs

Electrical Burns

  • Cardiac monitoring: For arrhythmias
  • Compartment assessment: For muscle swelling
  • Neurological evaluation: For nerve damage
  • Fasciotomy: If compartment syndrome develops

Supportive Care

  • Nutrition: High-calorie, high-protein diet
  • Physical therapy: Prevent contractures, maintain function
  • Occupational therapy: Activities of daily living
  • Psychological support: Mental health counseling
  • Infection prevention: Antimicrobials, isolation precautions

Prevention

Most burn injuries are preventable through proper safety measures, awareness, and preparation. Prevention strategies should target the most common causes and high-risk situations.

Home Safety

Fire Prevention

  • Smoke detectors:
    • Install on every level of home
    • Test monthly, change batteries annually
    • Interconnected detectors preferred
  • Fire extinguishers:
    • ABC-type for home use
    • Kitchen, garage, workshop locations
    • Know proper usage technique
  • Escape planning:
    • Two exits from every room
    • Practice escape routes
    • Designated meeting place outside

Kitchen Safety

  • Cooking practices:
    • Never leave cooking unattended
    • Keep pot handles turned inward
    • Use back burners when possible
    • Keep flammable items away from heat
  • Hot liquid safety:
    • Test food temperature before serving
    • Use microwave-safe containers
    • Stir heated liquids before removing

Water Safety

  • Water heater temperature: Set to 120°F (49°C) or below
  • Bath safety:
    • Test water temperature before bathing
    • Use anti-scald devices
    • Supervise young children

Electrical Safety

  • Electrical maintenance:
    • Regular wiring inspections
    • Replace damaged cords immediately
    • Use GFCI outlets in wet areas
    • Avoid overloading circuits
  • Child safety:
    • Outlet covers and safety plugs
    • Cord management and hiding
    • Education about electrical dangers

Chemical Safety

  • Storage:
    • Original containers with labels
    • Locked cabinets away from children
    • Separate acids and bases
    • Cool, dry storage areas
  • Usage:
    • Read labels and safety data sheets
    • Use appropriate protective equipment
    • Ensure adequate ventilation
    • Never mix different chemicals

Workplace Safety

  • Personal protective equipment (PPE):
    • Heat-resistant gloves and clothing
    • Face shields and eye protection
    • Respiratory protection
    • Steel-toed boots
  • Training and procedures:
    • Regular safety training
    • Emergency response procedures
    • Equipment maintenance
    • Incident reporting systems

Sun Protection

  • UV protection:
    • Sunscreen SPF 30 or higher
    • Protective clothing and hats
    • Seek shade during peak hours (10 AM - 4 PM)
    • Avoid tanning beds

Child-Specific Prevention

  • Constant supervision around heat sources
  • Safety latches on cabinets
  • Stove knob covers
  • Fireplace screens and guards
  • Education appropriate for age level

When to See a Doctor

Call 911 immediately for:

  • Burns covering large areas of the body (>10% in adults, >5% in children)
  • Third-degree burns of any size
  • Electrical or chemical burns
  • Signs of inhalation injury (difficulty breathing, facial burns)
  • Burns on face, hands, feet, genitals, or major joints
  • Signs of shock (rapid pulse, confusion, cold/clammy skin)

Seek urgent medical care for:

  • Second-degree burns larger than 3 inches in diameter
  • Burns that won't stop bleeding
  • Signs of infection (increased pain, pus, red streaking, fever)
  • Burns in high-risk patients (elderly, diabetic, immunocompromised)
  • Any burn in infants under 1 year old
  • Severe wrist pain or knee pain with burns

Schedule routine care for:

  • Minor burns not healing within expected timeframe
  • Concerns about scarring or cosmetic appearance
  • Need for tetanus vaccination update
  • Follow-up wound care assessment
  • Persistent skin irritation after healing

Burn center referral criteria:

  • Partial thickness burns >10% TBSA
  • Full thickness burns >5% TBSA
  • Burns involving face, hands, feet, genitalia, perineum, major joints
  • Electrical burns including lightning injury
  • Chemical burns
  • Inhalation injury
  • Burn injury with preexisting medical conditions
  • Burns with concomitant trauma

Related Conditions

References

  1. Jeschke MG, van Baar ME, Choudhry MA, et al. Burn injury. Nat Rev Dis Primers. 2020;6(1):11.
  2. American Burn Association. Burn Incidence Fact Sheet. 2022. Available at: https://ameriburn.org/who-we-are/media/burn-incidence-fact-sheet/
  3. Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011;37(7):1087-1100.
  4. Church D, Elsayed S, Reid O, et al. Burn wound infections. Clin Microbiol Rev. 2006;19(2):403-434.
  5. Singer AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med. 2008;359(10):1037-1046.