Muscle, bone, and blood vessels can also be injured
Most burns affect only the skin (epidermal tissue and dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an out-of-hospital setting, or may require more specialized treatment such as those available at specialized burn centers. Demographically, people sustaining burns in the United States tended to be male (70%) and to have suffered their injuries in a residential setting (43%). It is estimated that approximately 75% of deaths from burns and fires in the United States occur either at the scene of the incident or enroute to medical facilities. Demographically, people sustaining burns in the United States tended to be male (70%) and to have suffered their injuries in a residential setting (43%).[
The treatment of burns may include the removal of dead tissue , fluid resuscitation, administering antibiotics, and skin grafting.
Managing burn injuries properly is important because they are common, painful and can result in disfiguring and disabling scarring, amputation of affected parts or death in severe cases. Complications such as shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress may occur.While large burns can be fatal, modern treatments developed in the last 60 years have significantly improved the prognosis of such burns, especially in children and young adults. In the United States, approximately 1 out of every 25 people to suffer burns will die from their injuries. The majority of these fatalities occur either at the scene or on the way to hospital
Burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third, and fourth degrees
It is often difficult to accurately determine the depth of a burn. This is especially so in the case of second degree burns, which can continue to evolve over time. As such, a second-degree partial-thickness burn can progress to a third-degree burn over time even after initial treatment. Distinguishing between the superficial-thickness burn and the partial-thickness burn is important, as the former may heal spontaneously, whereas the latter often requires surgical excision and skin grafting.Currently, burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third, and fourth degrees. This system was devised by the French barber-surgeon Ambroise Pare and remains in use today
Electrical burns are caused by either an electric shock or an uncontrolled short circuit (a burn from a hot, electrified heating element is not considered an electrical burn). Common occurrences of electrical burns include workplace injuries, taser wounds, or being defibrillated or cardioverted without a conductive gel. Lightning is also a rare cause of electrical burns.Since normal physiology involves a vast number of applications of electrical forces, ranging from neuromuscular signaling to coordination of wound healing, biological systems are very vulnerable to application of supraphysiologic electric fields. Some electrocutions produce no external burns at all, as very little current is required to cause fibrillation of the heart muscle. Therefore, even when the injury does not involve any visible tissue damage, electrical shock survivors may experience significant internal injury. The internal injuries sustained may be disproportionate to the size of the burns seen .
is caused by hot liquids (water or oil) or gases (steam), most commonly occurring from exposure to high temperature tap water in baths or showers or spilled hot drinks. A so called immersion scald is created when an extremity is held under the surface of hot water, and is a common form of burn seen in child abuse. A blister is a "bubble" in the skin filled with serous fluid as part of the body's reaction to the heat and the subsequent inflammatory reaction. The blister "roof" is dead and the blister fluid contains toxic inflammatory mediators. Scald burns are more common in children, especially "spill scalds" from hot drinks and bath water scalds.
Generally scald burns are first or second degree burns, but third degree burns can result, especially with prolonged contact.
In order to determine the need for referral to a specialised burn unit, the American Burn Association devised a classification system to aid in the decision-making process. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area (TBSA) burnt, the involvement of specific anatomical zones, age of the person and associated injuries. Burns can also be assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns. First degree (erythema only, no blisters) burns are not included in this estimation. The rule of nines is used as a quick and useful way to estimate the affected TBSA. More accurate estimation can be made using Lund & Browder charts, which take into account the different proportions of body parts in adults and children. The size of a person's hand print (palm and fingers) is approximately 0.8% of their TBSA.
Major burns are defined as:
Age 10-50yrs: partial thickness burns >25% of total body surface area
Age 50: partial thickness burns >20% of total body surface area
Full thickness burns >10%
Burns involving the hands, face, feet or perineum
Burns that cross major joints
Circumferential burns to any extremity
Any burn associated with inhalational injury
Burns associated with fractures or other trauma
Burns in infants and the elderly
Burns in persons at high-risk of developing complications
These burns typically require referral to a specialised burn treatment center.
Moderate burns are defined as:
Age 10-50yrs: partial thickness burns involving 15-25% of total body surface area
Age 50: partial thickness burns involving 10-20% of total body surface area
Full thickness burns involving 2-10% of total body surface area
Persons suffering these burns often need to be hospitalised for burn care.
Complications from burn damages
Infection is a major complication of burns. Infection is linked to impaired resistance from disruption of the skin's mechanical integrity and generalized immune suppression. The skin barrier is replaced by eschar. This moist, protein rich avascular environment encourages microbial growth. Migration of immune cells is hampered, and there is a release of intermediaries that impede the immune response. Eschar also restricts distribution of systemically administered antibiotics because of its avascularity.
Risk factors of burn wound infection include:
Burn > 30% TBSA
Extremes in age (very young, very old)
Preexisting disease e.g. diabetes
Virulence and antibiotic resistance of colonizing organism
Failed skin graft
Improper initial burn wound care
Prolonged open burn wound
Burn wounds are prone to tetanus. A tetanus booster shot is required if individual has not been immunized within the last 5 years.
Other significant injuries are also damages
The presence of smoke inhalation injury, other significant injuries such as long bone fractures, and serious co-morbidities (heart disease, diabetes, psychiatric illness, suicidal intent etc.) will also adversely influence prognosis. Advances in resuscitation, surgical management, intensive care, control of infection, control of the hyper-metabolic response and rehabilitation have resulted in dramatic improvements in burn mortality and morbidity in the last 60 years. The modified Baux score determines the futility point for major burn injury. The Baux score is determined by adding the size of the burn (% TBSA) to the age of the patient. In most burn units a score of 140 or greater is a non-survivable injury, and comfort care should be offered. In children all burn injuries less than 100% TBSA should be considered a survivable injury.
Following a burn injury children can suffer significant psychological trauma in both the short- and long-term.
Burn injuries receive medical treatment
An estimated 500,000 burn injuries receive medical treatment yearly in the United States. The 2009 National Burn Repository reports the most common cause of burns as direct fire/flame (43%) followed by scalds (30%). Scald injuries were the predominant cause in children under the age of 5. Burns sustained at home accounted for 65.5% of all burn injuries in the United States that year, and had a mortality rate of 4% overall. This mortality rate was directly associated with advancing age, burn size, the presence of inhalational injury and the female sex
Additional resources provided by the author
Howard Roitman, Esq.
8921 W. Sahara Ave.
Las Vegas, Nevada