Burns
Burns are thermal, chemical, electrical, or radiation injuries to the skin classified by depth from first to fourth degree, with the fourth most common traumatic injury overall and the highest mortality in patients over 60 years, burns over 40% total body surface area, or inhalation injury. First-line management is primary survey and airway protection, stopping the burning process, and, for burns of 20% total body surface area or more, lactated Ringer resuscitation at 2 mL per kilogram per percent total body surface area with the estimate titrated to urine output.
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What this article covers
- Overview
A burn is tissue injury from a thermal, chemical, electrical, or radiation agent, and burns are the fourth most common type of traumatic injury.
- Epidemiology
Burns are the fourth most common type of traumatic injury, caused by chemical, thermal, or electrical agents as well as ultraviolet or other radiation.
- Risk factors
Exposure to fire in an enclosed space, which raises the risk of both cutaneous burns and inhalation injury from smoke, carbon monoxide, and hydrogen cyanide.
- Pathophysiology
Burn depth defines four categories with distinct findings and healing courses: superficial (first degree): red, tender, no sloughing; not counted in TBSA; heals in about 1 week, no scar superficial…
- Clinical features
Depth of injury organizes the physical findings: superficial injuries show erythema, swelling, blisters, and tenderness, while deeper injuries progressively appear charred, leathery, or white, with pain diminishing as nerves are destroyed.
- Differential diagnosis
Nonaccidental trauma (inflicted bruising): often on the head and torso, sometimes patterned to an implement (hand, belt); unlike a burn, a bruise is tender, shows color variation over time, and fades…
- Diagnosis
The diagnosis of a burn is clinical, from the exposure history plus depth-graded findings: first-degree burns are excluded from TBSA, and the rule of nines estimates TBSA for second-degree burns or…
- Management
First, stop the burning process and complete the primary survey: remove clothing and constricting items, cooling adherent material with water first; secure the airway with cervical spine protection…
- Complications
Hypovolemic shock from third-spacing and insensible fluid loss, particularly above 20% TBSA in the first 24 hours; under-resuscitation risks shock and organ failure, over-resuscitation risks compartment syndrome and respiratory distress.
- Prognosis
Depth of injury determines healing time and scarring: superficial and superficial partial-thickness burns heal in 1 to 3 weeks without scarring; deep partial-thickness burns heal over 3 to 8 weeks…
- Prevention
Set the home water heater below 49 C (120 F) to reduce scald risk, particularly with infants or young children.
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