Thermal Burns

The cold Chicago winter months are getting into full swing and we have been seeing increased cases of burns secondary to contact with heat, electrical currents, hot water and flames.

According to the American Burn Association, 500,000 burn injuries are treated in medical facilities each year.  This includes 4000 deaths, which occur mostly in residential fires.  The majority of burns occur from fire (46%), scalds (32%), contact with hot objects (8%), electricity (4%), or chemical agents (3%). 

 

With thermal burns, the degree of injury sustained is dependent on the amount of heat or temperature, the duration of the exposure, and the intrinsic structure of the burned tissue that determines its heat conductivity.  The young and elderly are more likely to sustain deep burns because their skin is generally thinner than that of adults.  It’s important to understand the basic burn nomenclature in order to classify the type of burn injury.

 

Burn Depth Classification

		Depth	Clinical findings
Superficial thickness	First degree	Epidermis involvement	Erythema, minor pain, lack of blisters
Partial thickness-superficial	Second degree	Superficial papillary dermis	Blisters, clear fluid and pain
Partial thickness-deep	Second degree	Deep reticular dermis	Whiter appearance with decreased pain
Full thickness	Third or fourth degree	Dermis and underlying tissue (including fascia, bone, muscle)	Hard, leather like eschar, no sensation (insensate)

 

Special burns include electrical injuries, chemical burns and radiation burns.  These often require specialized care and often need to be transferred to burn centers.  With electrical injuries, extent of injury may not be apparent because damage occurs deep within tissues.  Electricity contracts muscles so watch for associated injuries including cardiac arrhythmias, myoglobinuria, and compartment syndromes.  Chemical burns require prolonged irrigation.  Radiation burn care is the same as other burns in first 24 hours and first few weeks. Wound breakdown may occur later in the course. 

 

There is a tendency to focus on burn wounds due to their painful nature.  However, all burn patients must be approached in a systematic manner focusing on the ABCs first.  Especially when some burn patients have associated traumatic injuries/comorbidities that must be identified, recognized and addressed first.  Important elements to manage during secondary survey include wound care, pain management, wound infection/debridement/antibiotics, possible surgery.

  

Resources:

Rosen’s Emergency Medicine: Concepts and clinical practice. 7^th edition. Pages 758-767.

Care of the Burn Patient in the Hospital. www.worldburn.org

American Burn Association. www.ameriburn.org

 

This post submitted by Dr. Neha Dave