Burn

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This article is about the injury. For other uses, see Burn (disambiguation).
Burn
Classification and external resources
ICD-10 T20.-T31.
ICD-9 940-949
MeSH D002056

A burn is a type of injury that may be caused by heat, electricity, chemicals, light,
radiation, or friction.[1][2] Burns can be highly variable in terms of the tissue affected, the
severity, and resultant complications. Muscle, bone, blood vessel, dermal and epidermal
tissue can all be damaged with subsequent pain due to profound injury to nerves.
Depending on the location affected and the degree of severity, a burn victim may
experience a wide number of potentially fatal complications including shock, infection,
electrolyte imbalance and respiratory distress.[3] Beyond physical complications, burns
can also result in severe psychological and emotional distress due to scarring and
deformity.

Contents
[hide]
 1 Classification
 2 By degree
 3 Other classifications
 4 Causes
o 4.1 Scalding
 5 Management
 6 Reactions and complications
 7 See also
 8 References

 9 External links

[edit] Classification
Second-degree burn

The traditional system of classifying burns categorizes them as first-, second-, or third-
degree. Most burns are first- to third-degree, with the higher-degree burns typically being
used to classify burns postmortem.[4]

This system is however being replaced by one reflecting the need for surgical
intervention. The burn depths are described as either superficial, superficial partial-
thickness, deep partial-thickness, or full-thickness.[5] The following are brief descriptions
of these classes:

[edit] By degree

Second-degree burn caused by contact with glue at 145 °C

 First-degree burns are usually limited to redness (erythema), a white plaque and
minor pain at the site of injury. These burns involve only the epidermis. Most
sunburns can be included as first-degree burns.
 Second-degree burns manifest as erythema with superficial blistering of the skin,
and can involve more or less pain depending on the level of nerve involvement.
Second-degree burns involve the superficial (papillary) dermis and may also
involve the deep (reticular) dermis layer.
 Major second-degree burn caused by contact with boiling water

 Third-degree burns occur when the epidermis is lost with damage to the
subcutaneous tissue. Burn victims will exhibit charring and extreme damage of
the epidermis, and sometimes hard eschar will be present. Third-degree burns
result in scarring and victims will also exhibit the loss of hair shafts and keratin.
These burns may require grafting.
 Fourth-degree burns damage muscle, tendon, and ligament tissue, thus result in
charring and catastrophic damage of the hypodermis. In some instances the
hypodermis tissue may be partially or completely burned away as well as this may
result in a condition called compartment syndrome, which threatens both the life
and the limb of the patient. Grafting is required if the burn does not prove to be
fatal.

[edit] Other classifications

A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided
into superficial and deep categories) and "Full Thickness" relates more precisely to the
epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and
predict outcome.

Table 1. A description of the traditional and current classifications of burns.

Traditional
Nomenclature Depth Clinical findings
nomenclature
Superficial Erythema, minor
first degree Epidermis involvement
thickness pain, lack of blisters
Partial thickness Blisters, clear fluid,
second degree Superficial (papillary) dermis
– superficial and pain
Partial thickness
third degree Deep (reticular) dermis Whiter appearance
– deep
Epidermis, Dermis, and partial
damage to subcutaneous fat,
Full thickness fourth degree
eschar formation and minimal
pain, requires grafts.
Complete destruction of
Hard, leather-like
Epidermis, Dermis,
eschar, purple fluid,
Subdermal Fifth degree Subcutaneous fat, and
no sensation
underlying tissue and possibly
(insensate)
fascia, bone, or muscle
* It should however be noted that although fourth-degree is not a technical term, it is
often used to describe burns that reach muscle and bone. Third-degree sufficiently
describes all burns of this nature.

An even simpler, more accurate and more descriptive classification is epidermal, dermal
and full thickness. Dermal injuries are subdivided into superficial, mid and deep.

Main article: Total body surface area

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 (superficial thickness
burns are not counted). The rule of nines is used as a quick and useful way to estimate the
affected TBSA.

[edit] Causes
Burns are caused by a wide variety of substances and external sources such as exposure
to chemicals, friction, electricity, radiation, and heat.

Most chemicals that cause severe chemical burns are strong acids or bases.[6] Chemical
burns are usually caused by caustic chemical compounds, such as sodium hydroxide,
silver nitrate, and more serious compounds (such as sulphuric acid and Nitric acid).[7]
Hydrofluoric acid can cause damage down to the bone and its burns are sometimes not
immediately evident.[8]

Electrical burns are caused by an exogenous electric shock. Common causes of

electrical burns include workplace injuries or being defibrillated or cardioverted without
a conductive gel. Lightning is a rare cause of electrical burns. The internal injuries
sustained may be disproportionate to the size of the burns seen, and the extent of the
damage is not always obvious. Such injuries may lead to cardiac arrhythmias, cardiac
arrest, and unexpected falls with resultant fractures.[9]

Radiation burns are caused by protracted exposure to UV light (as from the sun), tanning
booths, radiation therapy (as patients who are undergoing cancer therapy), sunlamps, and
X-rays. By far the most common burn associated with radiation is sun exposure,
specifically two wavelengths of light UVA, and UVB, the latter being more dangerous.
Tanning booths also emit these wavelengths and may cause similar damage to the skin
such as irritation, redness, swelling, and inflammation. More severe cases of sun burn
result in what is known as sun poisoning.

[edit] Scalding
Two-day-old scald caused by boiling radiator fluid.

Scalding is caused by hot liquids or gases, most commonly occurring from exposure to
high temperature tap water.[10] A blister is a "bubble" in the skin filled with serous fluid as
part of the body's reaction to the heat and nerve damage. The blister "roof" is dead. Steam
is a common gas that causes scalds. The injury is usually regional and usually does not
cause death. More damage can be caused if hot liquids enter an orifice. However, deaths
have occurred in more unusual circumstances, such as when people have accidentally
broken a steam pipe. The demographics that are of the highest risk to suffering from
scalding are young children, with their delicate skin, and the elderly over 65 years of age.

[edit] Management
A local anesthetic is usually sufficient in managing pain of minor first-degree and
second-degree burns. There is mixed evidence to suggest that Aloe vera sap (although sap
from leaves from other members of the Jade plant family--such as Kalanchoe--with
succulent leaves also seem to work) helps to heal the burn area[citation needed]. However,
systemic anti-inflammatory drugs such as naproxen or ibuprofen may be effective in
mitigating pain and swelling. Additionally, topical antibiotics such as Mycitracin are
useful in preventing infection to the damaged area.[11] Lidocaine can be administered to
the spot of injury and will generally negate most of the pain. Regardless of the cause, the
first step in managing a person with a burn is to stop the burning process at the source,
and cool the burn wound (but not the patient. It is essential to avoid the "lethal triad" of
hypothermia, acidosis and coagulopathy). For instance, with dry powder burns, the
powder should be brushed off first. With other burns the affected area should be rinsed
thoroughly with a large amount of clean water. Cold water should not be applied to a
person with extensive burns, however, as it may compromise the burn victim's
temperature status.

If the patient was involved in a fire accident, then it must be assumed that he or she has
sustained an inhalation injury until proven otherwise, and treatment should be managed
accordingly. At this stage of management, it is also critical to assess the airway status.
Any hint of burn injury to the lungs (e.g. through smoke inhalation) is considered a
medical emergency.

Once the burning process has been stopped, the patient should be volume resuscitated
according to the Parkland formula (4ml lactated ringers x TBSA(total body surface
area) % burned x pt. weight in kg.for first 24 hours), since such injuries can disturb a
person's osmotic balance. This formula dictates the amount of Lactated Ringer's solution
(Hartmann's solution) to deliver in the first twenty four hours after time of injury. This
formula excludes first degree burns, so erythema alone is discounted. Half of the fluid
should be given in the first eight hours post injury and the rest in the subsequent sixteen
hours. Inhalation injuries in conjunction with thermal burns initially require up to 40–
50% more fluid. The formula is a guide only and infusions must be tailored to the urine
output and central venous pressure. Inadequate fluid resuscitation causes renal failure and
death but over-resuscitation also causes morbidity and mortality. All resuscitation
formulae should be delivered as a goal directed therapy to prevent the complications of
hypovolaemic shock or over-hydration. Adequate pain management, including
administration of opioid analgesics and sometimes other medication (e.g. ketamine,
tranquilizers or general anesthetics), is important to alleviate the severe distress from the
burns.

Hyperbaric oxygenation has not been shown to be a useful adjunct to traditional

treatments.[12]

To help ease the suffering of a burn victim, they may be placed in a special burn recovery
bed which evenly distributes body weight and helps to prevent painful pressure points
and bed sores. Survival and outcome of severe burn injuries is remarkably improved if
the patient is treated in a specialized burn center/unit rather than a hospital. Serious burns,
especially if they cover large areas of the body, can result in death.

[edit] Reactions and complications

Following a major burn injury, heart rate and peripheral vascular resistance increase. This
is due to the release of catecholamines from injured tissues, and the relative hypovolemia
that occurs from fluid volume shifts. Initially cardiac output decreases. At approximately
24 hours after burn injuries (for patients receiving fluid resuscitation) cardiac output
returns to normal, then increases to meet the hypermetabolic needs of the body.

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% TBS

 Full-thickness burn
 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.

Circumferential burns of extremities may compromise circulation. Elevation of limb may

help to prevent dependent edema. An Escharotomy may be required.

Acute Tubular Necrosis of the kidneys can be caused by myoglobin and hemoglobin
released from damaged muscles and red blood cells. This is common in electrical burns
or crush injuries where adequate fluid resuscitation has not been achieved.

[edit] See also

 List of burn centers in the United States

[edit] References
1. ^ Burns MedlinePlus Accessed February 25, 2008
2. ^ Burns Topic Overview WebMD Accessed February 27, 2008
3. ^ A review of the complications of burns, their origin and importance for illness
and death - Abstract J Trauma. 1979 May;19(5):358-69. Accessed February 27,
2008
4. ^ Burn Degrees Lifespan.org Accessed February 24, 2008
5. ^ Mertens DM, Jenkins ME, Warden GD (June 1997). "Outpatient burn
management". Nurs. Clin. North Am. 32 (2): 343–64. PMID 9115481.
6. ^ Chemical Burn Causes emedicine Health Accessed February 24, 2008
7. ^ Chemical Burn Causes eMedicine Accessed February 24, 2008
8. ^ Hydrofluoric Acid Burns emedicine Accessed February 24, 2008
9. ^ Electrical Burns: First Aid Mayo Clinic Accessed February 24, 2008
10. ^ Scald and Burn Care, Public Education City of Rochester Hills Accessed
February 24, 2008
11. ^ Minor Burns quickcare.org Accessed February 25, 2008
12. ^ Villanueva E, Bennett MH, Wasiak J, Lehm JP (2004). "Hyperbaric oxygen
therapy for thermal burns". Cochrane Database Syst Rev (3): CD004727.
doi:10.1002/14651858.CD004727.pub2. PMID 15266540.

[edit] External links

 Alisa Ann Ruch Burn Foundation
 Self help guide (NHS Direct)
 After the Injury- Children's Hospital Of Philadelphia

[hide]
v•d•e
 Foreign bodies, burns, corrosion, and frostbite (T15-T35, 930-959, 991.3)

Foreign
In alimentary tract (Bezoar)
body

Other Burn · Corrosion · Frostbite

Retrieved from "http://en.wikipedia.org/wiki/Burn"
Categories: Skin conditions resulting from physical factors | Medical emergencies |
Injuries
Hidden categories: All articles with unsourced statements | Articles with unsourced
statements from June 2009

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BURN
http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm

There are three levels of burns:

 First-degree burns affect only the outer layer of the skin. They cause pain,
redness, and swelling.
 Second-degree (partial thickness) burns affect both the outer and underlying layer
of skin. They cause pain, redness, swelling, and blistering.
 Third-degree (full thickness) burns extend into deeper tissues. They cause white
or blackened, charred skin that may be numb.

Considerations

Before giving first aid, evaluate how extensively burned the person is and try to
determine the depth of the most serious part of the burn. Then treat the entire burn
accordingly. If in doubt, treat it as a severe burn.

By giving immediate first aid before professional medical help arrives, you can help
lessen the severity of the burn. Prompt medical attention to serious burns can help
prevent scarring, disability, and deformity. Burns on the face, hands, feet, and genitals
can be particularly serious.

Children under age 4 and adults over age 60 have a higher chance of complications and
death from severe burns.

In case of a fire, you and the others there are at risk for carbon monoxide poisoning.
Anyone with symptoms of headache, numbness, weakness, or chest pain should be tested.
Causes

Burns can be caused by dry heat (like fire), wet heat (such as steam or hot liquids),
radiation, friction, heated objects, the sun, electricity, or chemicals.

Thermal burns are the most common type. Thermal burns occur when hot metals,
scalding liquids, steam, or flames come in contact with your skin. These are frequently
the result of fires, automobile accidents, playing with matches, improperly stored
gasoline, space heaters, and electrical malfunctions. Other causes include unsafe handling
of firecrackers and kitchen accidents (such as a child climbing on top of a stove or
grabbing a hot iron).

Burns to your airways can be caused by inhaling smoke, steam, superheated air, or toxic
fumes, often in a poorly ventilated space.

Burns in children are sometimes traced to parental abuse.

Symptoms
 Blisters
 Pain (the degree of pain is not related to the severity of the burn -- the most
serious burns can be painless)
 Peeling skin
 Red skin
 Shock (watch for pale and clammy skin, weakness, bluish lips and fingernails,
and a drop in alertness)
 Swelling
 White or charred skin

Symptoms of an airways burn:

 Charred mouth; burned lips
 Burns on the head, face, or neck
 Wheezing
 Change in voice
 Difficulty breathing; coughing
 Singed nose hairs or eyebrows
 Dark, carbon-stained mucus

First Aid

FOR MINOR BURNS

1. If the skin is unbroken, run cool water over the area of the burn or soak it in a cool
water bath (not ice water). Keep the area submerged for at least 5 minutes. A
clean, cold, wet towel will also help reduce pain.
2. Calm and reassure the person.
 3. After flushing or soaking, cover the burn with a dry, sterile bandage or clean
dressing.
4. Protect the burn from pressure and friction.
5. Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling.
Do NOT give children under 12 aspirin. Once the skin has cooled, moisturizing
lotion also can help.
6. Minor burns will usually heal without further treatment. However, if a second-
degree burn covers an area more than 2 to 3 inches in diameter, or if it is located
on the hands, feet, face, groin, buttocks, or a major joint, treat the burn as a major
burn.
7. Make sure the person is up to date on tetanus immunization.

FOR MAJOR BURNS

1. If someone is on fire, tell the person to stop, drop, and roll. Wrap the person in
thick material to smother the flames (a wool or cotton coat, rug, or blanket).
Douse the person with water.
2. Call 911.
3. Make sure that the person is no longer in contact with smoldering materials.
However, do NOT remove burned clothing that is stuck to the skin.
4. Make sure the person is breathing. If breathing has stopped, or if the person's
airways are blocked, open the airways. If necessary, begin rescue breathing and
CPR.
5. Cover the burn area with a dry sterile bandage (if available) or clean cloth. A
sheet will do if the burned area is large. Do NOT apply any ointments. Avoid
breaking burn blisters.
6. If fingers or toes have been burned, separate them with dry, sterile, nonadhesive
dressings.
7. Elevate the body part that is burned above the level of the heart. Protect the burn
area from pressure and friction.
8. Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches,
and cover the person with a coat or blanket. However, do NOT place the person in
this shock position if a head, neck, back, or leg injury is suspected or if it makes
the person uncomfortable.
9. Continue to monitor the person's vital signs until medical help arrives. This means
pulse, rate of breathing, and blood pressure.

DO NOT
 Do NOT apply ointment, butter, ice, medications, cream, oil spray, or any
household remedy to a severe burn.
 Do NOT breathe, blow, or cough on the burn.
 Do NOT disturb blistered or dead skin.
 Do NOT remove clothing that is stuck to the skin.
 Do NOT give the person anything by mouth, if there is a severe burn.
 Do NOT immerse a severe burn in cold water. This can cause shock.
  Do NOT place a pillow under the person's head if there is an airways burn. This
can close the airways.

When to Contact a Medical Professional

Call 911 if:

 The burn is extensive (the size of your palm or larger).

 The burn is severe (third degree).
 You aren't sure how serious it is.
 The burn is caused by chemicals or electricity.
 The person shows signs of shock.
 The person inhaled smoke.
 Physical abuse is the known or suspected cause of the burn.

Call a doctor if your pain is still present after 48 hours.

Call immediately if signs of infection develop. These signs include increased pain,
redness, swelling, drainage or pus from the burn, swollen lymph nodes, red streaks
spreading from the burn, or fever.

Also call immediately if there are signs of dehydration: thirst, dry skin, dizziness,
lightheadedness, or decreased urination. Children, elderly, and anyone with a weakened
immune system (for example, HIV) should be seen right away.

Prevention

To help prevent burns:

 Install smoke alarms in your home. Check and change batteries regularly.
 Teach children about fire safety and the hazards of matches and fireworks.
 Keep children from climbing on top of a stove or grabbing hot items like irons
and oven doors.
 Turn pot handles toward the back of the stove so that children can't grab them and
they can't be accidentally knocked over.
 Place fire extinguishers in key locations at home, work, and school.
 Remove electrical cords from floors and keep them out of reach.
 Know about and practice fire escape routes at home, work, and school.
 Set temperature of water heater at 120 degrees or less.

Alternative Names

Second degree burn; First degree burn; Third degree burn