Burns
LIFE-THREATENING DISORDERA major burn is a horrifying injury, necessitating painful treatment and a long period of rehabilitation. It’s often fatal or permanently disfiguring and incapacitating (emotionally and physically). In the United States, about 2.5 million people annually suffer burns. It’s the nation’s third leading cause of accidental death.
Causes
Thermal burns, the most common type, are caused by flame, flash, scald or contact with hot objects. Examples are residential fires, motor vehicle accidents, playing with matches, improperly stored gasoline, space heater or electrical malfunctions, or arson. Other causes include improper handling of firecrackers, scalding accidents, and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns in children are sometimes traced to parental abuse.
Chemical burns result from the contact, ingestion, inhalation, or injection of acids, alkalis, or vesicants that cause tissue injury and necrosis. Electrical burns result from coagulation necrosis caused by intense heat; they usually occur after contact with faulty electrical wiring or high-voltage power lines or when electric cords are chewed (by young children). Friction or abrasion burns happen when the skin is rubbed harshly against a coarse surface. Sunburn, of course, follows excessive exposure to sunlight.
Signs and symptoms
Symptoms will vary depending on the degree of burn. Suspect burn injury when the patient presents with blisters, pain, peeling skin, red skin, edema, white or charred skin, or signs of shock. Suspect an airway burn if you see charred mouth, burned lips, burns on the head, neck, or face; wheezing, change in voice, difficulty breathing and coughing; singed nose hairs or eyebrows; or dark carbon-stained mucous.
Diagnosis
The depth of damage to the skin and tissue and the size of the burn are important factors in burn assessment.
Depth of skin and tissue damage
A traditional method gauges burn depth by degrees, although most burns are a combination of different degrees and thicknesses. (See Depth of burn.)
First-degree—Damage is limited to the epidermis, causing erythema and pain.
Second-degree—The epidermis and part of the dermis are damaged, producing blisters and mild-to-moderate edema and pain.
Third-degree—The epidermis and the dermis are damaged. No blisters appear, but white, brown, or black leathery tissue and thrombosed vessels are visible.
Fourth-degree—Damage extends through deeply charred subcutaneous tissue to muscle and bone.
Burn size
The size is usually expressed as the percentage of body surface area (BSA)
covered by the burn. The Rule of Nines chart most commonly provides this estimate, although the Lund-Browder classification is more accurate because it allows for BSA changes with age. A correlation of the burn’s depth and size permits an estimate of its severity.
covered by the burn. The Rule of Nines chart most commonly provides this estimate, although the Lund-Browder classification is more accurate because it allows for BSA changes with age. A correlation of the burn’s depth and size permits an estimate of its severity.
Major—third-degree burns on more than 10% of BSA; second-degree burns on more than 25% of adult BSA (more than 20% in children); burns of hands, face, feet, or genitalia; burns complicated by fractures or respiratory damage; electrical burns; all burns in poor-risk patients
Moderate—third-degree burns on 2% to 10% of BSA; second-degree burns on 15% to 25% of adult BSA (10% to 20% in children)
