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Burn | classification and management

A burn is defined as an injury to the skin or other organic tissue caused by thermal trauma. It occurs when some or all of the cells in the skin or other tissues are destroyed by hot liquids (scalds), hot solids (contact burns), or flames (flame burns). Injuries to the skin or other organic tissues due to radiation, radioactivity, electricity, friction or contact with chemicals are also considered as burns
Burns may be distinguished and classified by their mechanism or cause, the degree or depth of the burn, the area of body surface that is burned, the region or part of the body affected, as well as the extent
A burn is defined as an injury to the skin or other organic tissue caused by thermal trauma

Classification by mechanism or cause

Thermal burns involve the skin and may present as:
Scalds – caused by hot liquid or steam;
Contact burns – caused by hot solids or items such as hot pressing irons and cooking utensils, as well as lighted cigarettes;
Flame burns – caused by flames or incandescent fi res, such as those started by lighted cigarettes, candles, lamps or stoves;
Chemical burns – caused by exposure to reactive chemical substances such as strong acids or alkalis;
Electrical burns – caused by an electrical current passing from an electrical outlet, cord or appliance through the body.

Inhalational burns are the result of breathing in superheated gases, steam, hot liquids or noxious products of incomplete combustion.
They cause thermal or chemical injury to the airways and lungs and accompany a skin burn in approximately 20% to 35% of cases. Inhalational burns are the most common cause of death among people suffering fi re-related burn

Classification by the degree and depth of a burn

First-Degree Burn – are burns which involve the outer most layer of skin and are usually associated with a sun burn. Such an injury may occur from too much exposure to the sun (gardening, sunbathing, etc.). The skin is usually still intact, but may appear to be red, very warm or hot to touch and painful. There may also be small blisters, and swelling in and around the area of injury.

Second-Degree Burn - occurs when the second layer of skin (dermis) is burned. This burn usually has the following characteristics: very red, blister formation, extremely painful and a fair amount of swelling. In general, if a second degree burn is smaller than 2-3 inches (7 centimeters) it may be treated as a minor burn. If the area burned is larger than this, or involves functional parts of the body such as feet, face, eye, ears, and groin or located over major joints, more in-depth medical attention is needed.

Third-Degree Burn – are NOT minor burns and should be evaluated and treated by a healthcare provider. A third-degree burn is a very serious burn, no matter what the size or area of the body that may be involved. A third-degree burn involves all layers of the skin and can cause permanent tissue damage. The skin may appear to be charred, blackened, or white. The skin texture may be very dry or leathery.

Fourth degree burns – This classification may be used when a burn involves the underlying fascia, muscles and even bones.

First Aid for Management of Burns

• Assess: (ABCDE)
- Airway
- Breathing: beware of inhalation and rapid airway compromise
- Circulation: fluid replacement
- Disability: compartment syndrome
- Exposure: percentage area of burn.

• Stop the burning process: cool the burn with running cool (not cold) water for at least 5 minutes. But do not use ice, as this may cause further skin damage. Do not over cool! If the victim starts to shiver, stop the cooling process.
• Remove all jewelry, watches, rings and clothing around the burned area as soon as possible.
• Administer an over-the-counter pain reliever such as ibuprofen or acetaminophen for pain control. Follow the directions on the label. Consult a physician or health care provider if pain is not relieved.
• Cover the burn with a sterile gauge bandage or clean cloth. Wrap the burned area loosely to avoid putting too much pressure on the burn tissue.
• Minor burns will usually heal without further treatment.
• For small area burns, apply soothing lotions that contains aloe vera to the burned area to help relieve the pain and discomfort.
• Seek medical attention if there is a persistent fever not relieved by medication or redness that may extend beyond the border of the burn or pain is not controlled by ibuprofen or acetaminophen.
• Drink plenty of fluids (electrolyte containing solutions such as gator aid) if the person appears to be dehydrated.

• Do not apply ice – this may cause further damage to the skin.
• Do not use any butter, ointments or other home remedies on the burn. Such substances may trap the heat in the tissue and makes the burn worse.
• Do not break any blisters…leave intact.
• Do not delay seeing medical attention if the burn is larger than the size of the victim’s palm.

Daily treatment

• Change the dressing daily (twice daily if possible) or as often as necessary to prevent seepage through the dressing. On each dressing change, remove any loose tissue.
• Inspect the wounds for discoloration or haemorrhage, which indicate developing infection.
• Fever is not a useful sign as it may persist until the burn wound is closed.
• Cellulitis in the surrounding tissue is a better indicator of infection.
• Give systemic antibiotics in cases of haemolytic streptococcal wound infection or septicaemia.
• Pseudomonas aeruginosa infection often results in septicaemia and death. Treat with systemic aminoglycosides.
• Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5% aqueous) is the cheapest, is applied with occlusive dressings but does not penetrate eschar. It depletes electrolytes and stains the local environment.
• Use silver sulfadiazine (1% miscible ointment) with a single layer dressing. It has limited eschar penetration and may cause neutropenia.
• Mafenide acetate (11% in a miscible ointment) is used without dressings. It penetrates eschar but causes acidosis. Alternating these agents is an appropriate strategy.


• Patient’s energy and protein requirements will be extremely high due to the catabolism of trauma, heat loss, infection and demands of tissue regeneration. If necessary, feed the patient through a nasogastric tube to ensure an adequate energy intake (up to 6000 kcal a day).
• Anaemia and malnutrition prevent burn wound healing and result in failure of skin grafts. Eggs and peanut oil and locally available supplements are good.


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