Burns

Key Points
Injury to the skin from direct contact with causative substance or action
Range from superficial (first degree) to full destruction of all skin layers (third degree)
Can occur in airways, eyes, and other areas in some cases
Can be life threatening

Burns are a common condition, affecting all sexes, ages and races, in which the skin or affected area is injured by contact with a substance or causative action. These can include exposure to heat, cold, friction, electricity and chemicals. The effects and severity of a burn is correlated to the length and area of exposure. Burns are further classified by severity. A first degree burn is superficial, consisting of reddened skin, pain, and lack of blistering. Second degree burns destroy the second layer of skin, and involving blistering of the affected area, tissue swelling, and severe pain. Third degree burns involve full destruction of all layers of skin and underlying tissue, in some cases even through muscle down to bone. Because of the destruction of nerves in the affected area, there is no pain accompanying third degree burns. With second, and especially third degree burns, extensive scarring is a major possibility.

Burns are further subdivided between minor and severe burns. A first degree burn or second degree burn smaller than 3 inches is considered minor, and can be successfully treated with first aid measures. Severe burns, extensive second degree and all third degree Burns, must be treated by health care professionals. Risk of death is directly correlated to the area of the skin which is burned, and the depth of that burn.

Burns in certain areas, such as airways, eyes, and burns with certain causatives, such as chemical burns, should be treated very specifically, often by health care professionals.

Differential Diagnosis (Other conditions with similar appearance)
Many conditions from exposure to infectious diseases to poisoning present symptoms which mimic that of burns. The following is a small sampling.

Frostbite
Anthrax
Aspergillosis
Rickettsial disease
Rat bite fever
Spider/tick bites
Ergot toxicity
Poisons

Diagnosis
Key Points
Diagnosis based on skin appearance
Further testing may be required to rule out similar appearing conditions or to determine the extent of the injury if it is internal

Burns are diagnosed based on the appearance of the affected area. Testing may be done if health care professionals are required to rule out other, similar appearing conditions. Injury is classified by severity in two distinct categories, depth and size.

Burn depth
First degree: characterized by superficial reddening of the skin, pain. No blistering is involved.

Second degree: characterized by destruction of the first two skin layers, causing blistering, tissue swelling, and moderate to severe pain.

Third degree: characterized by destruction of all skin layers, subcutaneous tissues, muscle, circulatory system, and sometimes bone. No pain is experienced due to nerve destruction.

Burn size
Minor: All first degree burns, and second degree burns less than 2-3 inches in diameter that do not occur on the hands, feet, face, groin, buttons, or major joint

Severe: Extensive second degree burns, and all third degree burns. Characterized by affectation of a large portion of the body

Treatment
Treatment is dependent on the manner and severity of burn
Treatment of minor burns often involves conventional first aid measures
Goal of treatment in severe burns is to maintain hydration and control infection
Severe Burns must be treated by health care professionals
*Very severe cases can result in death

OTC Options: Topical antibiotic, pain relievers (aspirin is not recommended for children or adolescents)

Burn treatment varies widely depending on the manner in which the injury occurred and the severity of said injury. With most minor burns, treatment can be accomplished without medical attention through various first aid measures. The first step in self-treatment is to run the affected area under cold water or immerse it for 10-15 minutes. Do not apply ice directly to the burn, unless it is located in the mouth. Then gently pat the area dry with a clean cloth, and cover the area with a sterile dressing, avoiding adhesives. Use of an OTC pain reliever such as acetaminophen, ibuprofen, naproxen or aspirin is recommended to assist with pain, however, aspirin is not recommended for affected persons who are adolescents or children. If a burn shows any signs of infection, seek the help of health care professionals.

Chemical Burns require immediate attention, so emergency medical care and Poison Control should be contacted. Remove the chemical and any affected clothing or items. Flush the affected area with water. After 15 minutes, apply cool compresses to relieve pain. Protect the affected area with a loose, dry dressing. The affected person should be closely watched for signs of shock.

Electrical Burns should be treated by health care professionals immediately, as it is difficult to determine the extent of damage from outward appearing symptoms. In the case of burns to the eye, unless the burn is superficial, health care professionals should treat the injury. If superficial, the eye should be flushed with cool water, unless contact increases symptoms. Lightly apply a cool compress to the eye.

Severe burns are difficult to treat, especially if they are extensive. If burns extend over greater than 50% of the body, risk of death increases enormously, mostly due to dehydration or infection. While waiting for emergency assistance, avoid any further contact with the causative agent, but do not remove clothing or immerse affected areas in water. Conduct CPR, if it is necessary, and cover affected areas with cool, moist cloths or bandages. Severe burns will be cleansed with bactericidal solutions if necessary, and dressings will be changed regularly to prevent infection. A tetanus vaccine may be given to assist in this. If the injury is not life-threatening, or after risk of death has passed, health care professionals may provide surgical options such as reconstructive surgery or skin grafts to alleviate scar tissue and other complications resulting from extensive injury.