Burns and Scalds

Definition

Burns are injuries caused to the skin or underlying tissues by direct heat or

extreme cold; scalds are burns caused by hot liquids or gases (such as steam).

The severity of burns is measured in two ways: by the depth of the

burn (see sidebar) and by the size of the affected area. Doctors use the

“

(TBSA) has been burned. In adults, the head and neck together count as

9 percent of the body; each arm also counts as 9 percent. The front of the

trunk, the back, and each leg are considered to each represent 18 percent

of the TBSA. Doctors count only second- and third-degree burns in estimating

the affected areas of the body.

Thermal burns (and scalds) are defined as burns caused directly by

heat or by chemical reactions that release heat. They are divided into several

categories according to the specific cause:

rule of nines” to evaluate how much of a person’s total body surface area

•

fire. Flame burns may take the form of a sudden flash burn produced

by a flammable liquid or gas igniting. Pouring lighter fluid

on burning charcoal is a common cause of flash burns.

Flame burns. This type of burn results from direct contact with

•

like a heated iron or cooking pan. Scalds are contact burns caused

by hot liquids or gases.

Contact burns. These burns are caused by touching a hot object

•

wire or in rare cases by lightning. Electrical burns are serious

because they can cause serious injury to internal organs that is not

obvious from the size of the skin burn.

•

caused by welding equipment, radiation

therapy for cancer, or overexposure to

sunlight or tanning equipment. Sunburn

is a common form of radiation burn.

Radiation burns. Radiation burns can be

•

caused by either strongly alkaline materials

like lye, or by strong acids like sulfuric

acid and nitric acid. Some acids are

strong enough to eat through the skin and

muscles down to the underlying bone.

Thermal burns affecting a person

be as dangerous as burns affecting the surface of

the body. The tissues of the airway can be burned

by breathing in superheated air from a fire, toxic

gases, smoke, or steam. In the United States, most

people who die in house or office fires die from

smoke inhalation rather than from skin burns.

Skin can also be burned by exposure to cold,

either by lengthy exposure to cold outdoors

(frostbite) or by brief exposure to extremely cold

materials like dry ice.

Chemical burns. Chemical burns can be’s airway can

Description

The experience of a burn varies considerably

depending on the cause of the burn, the parts

of the body that are affected, the severity of the

burn, and the situation in which the burn

occurred. Human soft tissue will burn at any

temperature above 115°F (46°C). Most burns

are accidental; however, about 10 percent of

cases of child abuse involve intentional burning

or scalding of the child.

Demographics

Burns are commonplace injuries worldwide, partly because they have so

many potential causes. In the United States, about one million people

seek treatment for burns in hospital emergency rooms each year. This

figure actually represents a decline from the early 1960s, when the

number was about two million. About 40,000 people are hospitalized for

burn injuries each year rather than being treated as outpatients; of those

admitted to hospitals, 60 percent, or 25,000 people, are sent to one of

the 125 hospitals in the United States with specialized burn centers.

According to the American Burn Association, there are about 4,000

deaths from burns each year in the United States, 3,500 from house fires

and the remaining 500 from automobile and aircraft crashes, contact

with electricity, chemicals or hot liquids and substances. About 75 percent

of these deaths occurred at the scene of the accident or on the way to the

hospital.

Burn injuries vary according to age group:

•

and younger are caused by scalds (65 percent) and contact burns

(20 percent). These injuries often occur when children pull

pots and pans containing hot food or boiling water from a stove

top.

Infants and children: most burn injuries in children four years

•

about 88,000 are treated in hospital emergency rooms each year.

The most common causes in this age group are hair curlers, curling

irons, room heaters, ovens and ranges, clothing irons, gasoline,

and fireworks.

Adolescents and children between the ages of four and fourteen:

•

injuries than women; 70 percent of patients admitted to specialized

burn centers are male. Forty-three percent of these severe injuries

occurred at the person

8 percent in the workplace; and 32 percent in other locations.

Among adults, men are more likely to require hospitalization for burn’s home; 17 percent on the street or highway;

Causes and Symptoms

Burns are caused by exposure to a source of heat, whether direct flame,

electricity, radiation, contact with a hot object, or chemicals. Airway

burns are caused by breathing in steam, heated air from a fire, or smoke

and toxic gases.

Symptoms of first-degree burns include pain and reddening of the

affected area. Second-degree burns produce blisters as well as reddened

skin and pain. Third-degree burns are painless because the nerve endings

in the affected area have been destroyed. The affected skin may be white

or charred, and is usually dry or leathery.

The symptoms of airway burns include:

•

Charred or burned mouth and lips; burns on the face or neck

•

Wheezing and difficulty breathing

•

Singed nose hairs or eyebrows

•

Coughing

•

Dark soot-colored mucus being coughed up

•

Changed voice

Diagnosis

The diagnosis of burns and scalds is usually obvious from the patient

situation and the appearance of the injury. Patients taken to the emergency

room will usually be given a chest x ray to check for evidence of

smoke inhalation or other injury to the airway.

Most of the evaluation in the hospital consists of determining the

extent of the patient

area of body surface covered by second- or third-degree burns. Another

quick measurement that can be used to estimate the size of the burn is

the area covered by an adult

body area. Emergency room doctors use these rules to tell whether a

patient should be sent to a specialized burn center:

’s’s injuries. The rule of nines is used to estimate the’s palm, which is about 1 percent of total

•

area (BSA)

Third-degree burns covering more than 5 percent of body surface

•

Second-degree burns covering more than 10 percent of BSA

•

or skin covering a major joint

Any second- or third-degree burn on the face, genitals, hands, feet,

•

Burns caused by electrical currents, lightning, or chemicals

•

broken bones, etc.)

Burns occurring together with other major injuries (head trauma,

•

Burns in patients with inhalation injuries

Treatment

Minor first-degree burns can be treated at home by cooling the injured

part by holding it under cool tap water for several minutes. Ice should not

be used because it can make the injury to the skin worse. Butter or margarine

should not be applied because oily substances will not help heal

the burn and may increase the danger of infection. Aspirin or Tylenol can

be taken to ease pain, and an antibiotic ointment can be applied to the

skin to reduce the risk of infection.

If a person

and roll

object or open flame and their clothing removed if possible. Burned

clothing that is stuck to the skin should not be removed, however. The

burned person should be doused with water and covered with a clean

sheet or other cloth while emergency services are called. Severe burns

should never be treated with ointments or other household remedies

while waiting for emergency help.

Treatment of severe burns in the hospital begins with an evaluation of

the patient

burned clothing and careful inspection of the burns. After the patient

burns have been washed with sterile solution, he or she will be given

intravenous fluids to prevent shock and dehydration. Painkillers are also

given intravenously to relieve the patient

The next step in burn treatment is surgical debridement (cutting

away) of open blisters and dead tissue. If the person

enough to require transfer to a burn center, they will be kept in the hospital

overnight to make sure that their airway has not been injured.

’s clothing is on fire, they should be told to “stop, drop,” to put out the fire. They should be pulled away from the hot’s airway and their blood circulation. The next step is removal of’s’s pain as quickly as possible.’s burns are not severe

Prognosis

The prognosis of burns and scalds varies from excellent to poor

depending on the location of the burn, its cause, the patient

overall health, and how quickly they received treatment. Minor burns

rarely cause long-term complications. Second-degree burns, however, can

become infected and the infection can spread into the bloodstream if not

treated promptly. Patients can also become dehydrated after a burn

injury. Anyone with a burn who notices red streaks or pus in the burned

area, increased pain, swollen lymph nodes near the burn, or fever; or

anyone who feels dizzy, lightheaded, extremely thirsty, or cannot urinate

after a burn should see their doctor at once.

According to the American Burn Association, 95 percent of patients

treated in specialized burn centers survive their injuries.

’s age and

Prevention

Prevention is one of the most important aspects of burn care, as public

health doctors estimate that 75 percent of burns are preventable. The

Centers for Disease Control and Prevention (CDC) recommend the following

preventive steps:

•

regularly.

Install smoke detectors in the home and check their batteries

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matches and fireworks.

Teach small children about fire safety, including the dangers of

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accidental scalding in the tub or shower.

Set the household water heater at 120°F (49°C) or lower to prevent

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of pots and frying pans toward the back of the stove to prevent

children from grabbing them.

Keep small children from climbing up on the stove; turn the handles

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Place fire extinguishers in key locations in the home and workplace.

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off the floor.

Keep electrical appliances in good repair and keep electrical cords

•

Practice fire escape routes in the home, school, and workplace.

The Future

Burns are likely to continue to be a common form of accidental injury.

Better education as well as further research into burn treatment may

help to lower the number of injuries and deaths caused by burns. One

of the most important factors in lowering the rate in the last twenty years

is the increased use of smoke detectors. A major new area of research is

the development of skin substitutes for covering major burns instead of

using grafts taken from the patient

’s own skin.

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