Burns Health Article

Definition

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

Description

Burns are characterized 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.

Demographics

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

The severity of the burn determines the type of treatment and also where the burned person 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 percent of an adult's body or less than 10 percent of a child's body, or a third-degree burn on less than 2 percent BSA. Moderate burns should be treated at a hospital. These are defined as first- or second-degree burns covering 15 percent to 25 percent of an adult's body or 10 percent to 20 percent of a child's body, or a third-degree burn on 2 percent to 10 percent 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 percent of an adult's body or more than 20 percent of a child's body, or a third-degree burn on more than 10 percent 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 abuse. 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 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.

When to call the doctor

A physician or healthcare professional should be consulted whenever first or second degree burns cover more than 15 percent of a person's body surface area (BSA) or third degree burns involve more than 2 percent of a victim's BSA.

Diagnosis

A physician will diagnose a burn based on visual examination and will also ask the burned person or family members questions to determine the best treatment. He or she may also check for smoke inhalation, carbon monoxide poisoning, cyanide poisoning, other event-related trauma, or, if suspected, evidence of child abuse.

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.