Definitions

A burn is the response of the skin, mucous membranes and subcutaneous tissues to thermal injury. A partial thickness burn does not destroy the skin epithelium or destroys only part of it, sub-classified into superficial and deep partial thickness. A full thickness burn destroys all sources of skin epithelial regrowth.

Common Causes

• Thermal injury: dry – flame, hot metal, sunburn; moist – hot liquids or gases.
  
• Electricity (deep burns at entry and exit sites, may cause cardiac arrest).
  
• Chemicals (usually industrial accidents with acid or alkali).
  
• Radiation (partial thickness initially, chronic deeper injury later).

Clinical Features

General

Specific

• Evidence of smoke inhalation (soot in nose or sputum, burns in the mouth, hoarseness).
  
• Eye or eyelid burns (early ophthalmological opinion).
  
• Circumferential burns (will need escharotomy).
  
• Hands, feet, genitalia, joints (will need specialist care).

Investigations

• FBC, U+E.
  
• If inhalation suspected: chest X-ray, arterial blood gases, CO estimation.
  
• Blood group and crossmatch.
  
• ECG/cardiac enzymes with electrical burns.

Complications

Immediate

• Smoke inhalation: commonest cause of death from burns.
  
• Circumferential burns → compartment syndrome (limbs → limb ischaemia; thorax → restrictive respiratory failure). Rx: escharotomy.

Early

• Hyperkalaemia (from cytolysis in large burns). Rx: insulin and dextrose.
  
• Acute renal failure (combination of hypovolaemia, sepsis, tissue toxins). Rx: aggressive early resuscitation, ensuring high GFR with fluid loading and diuretics, treat sepsis.
  
• Infection (Staphlococcus and MRSA, Streptococcus, E. coli, Klebsiella, Pseudomonas, yeasts). Treat established infection (10⁶ organisms present in wound biopsy) with systemic antibiotics. Early surgical excision.
  
• Stress ulceration (Curling’s ulcer). Prevent with PPI prophylaxis.

Late

Contractures.

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