A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation.
Burns can represent one of the most challenging types of trauma; injuries range from mild reddening of the skin through to severe tissue damage with additional complications of infection, hypothermia, electrolyte imbalance, respiratory and cardiac problems.
In determining the extent of the burn, a tool called the "Rule of Nines" is used. This tool is a formula that divides the surface area of the body into sections, each roughly 9%. Determining the amount of surface area burned helps to decide on treatment of the burn.
Burn injuries tend to be classified based on the total body surface area involved and the depth of injury. Burn are generally classified from first degree up to fourth degree.
Involves superficial epidermis layer, skin appears red, without blisters, and the texture is dry. It heals in 5-10 days without any complications.
Involves epidermis and superficial dermis layer, skin appears red, with blisters, and the texture is moist. It heals in 1-2 weeks may be associated with minimal complications.
Involves deep dermis layer, skin appears red, with exposing skin. Deep partial thickness burns may or may not be painful (nerve endings destroyed), may be moist or dry (sweat glands destroyed), hair is usually gone. It heals in 5-8 weeks may be associated with complications like local infection, scaring & contractures.
Extends through the entire epidermis and dermis layer, skin appears stiff, white / yellow / brown waxy, and the texture is leathery. Nerve endings, small blood vessels, hair follicles, sweat glands are all destroyed. It may take months to heals or may not heal completely. Such burns are associated with complications like systemic infections, scaring, contractures.
Extend through the entire dermis layer into underlying fat, connective tissue, muscle and bone may also be involved in very severe burns. Burns are painless with no sensation to touch, skin is pearly white or charred, dry and the texture is leathery. Burn treatment for severe wounds may require skin grafting, debridement, excision of dead tissue, and repair of damaged organs.
Evaluation of the burn wound itself should only occur once the patient has been stabilized. The extent and depth of the burn will help guide decisions regarding wound care, inpatient or outpatient care, and monitoring. Superficial burns or less serious burns, management may be in the outpatient or inpatient setting and may be managed with little more than simple pain medication and local application of antibiotic ointment. Any serious burns should be treated at a specialized burns unit, to be managed vigorously and may require prolonged treatment.
At the hospital they are often treated through trauma resuscitation, and the primary aim is to ensure airway support, breathing and circulatory stability is achieved and maintained, fluid resuscitation, blood transfusion, and wound management.
The following burns requiring hospitalization: Partial thickness burns >15% (>10% children), any full thickness burn, any elderly or infant burn, any burn to the face, hands, feet or genitalia, circumferential burns, inhalation injury, and if any significant pre-existing illness e.g. diabetes are present.
