What is a Burn?
A burn is damage to the body’s tissues that destroys skin cells. The skin serves as our primary defense against infection and helps regulate body temperature; when it is damaged, these functions are compromised.
Burns are primarily categorized by their depth:
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First-Degree (Superficial): Affects only the outer layer of skin (epidermis). Like a mild sunburn, it is red and painful but does not blister.
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Second-Degree (Partial-Thickness): Affects the outer and middle layers of skin (dermis). These are very painful and typically produce blisters.
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Third-Degree (Full-Thickness): Destroys all layers of the skin. The area may look white, leathery, or charred. Because the nerves are destroyed, these burns are often painless at the center.
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Fourth-Degree: These are the most severe, extending past the skin into muscle, tendon, or bone.
Causes of Burns
Most burns (75%) occur in the home, particularly in the kitchen or bathroom.
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Thermal: The most common cause, including flames, steam, and "scalds" from hot liquids. Scalds are the leading cause of burns in children under five.
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Chemical: Caused by strong acids or alkalis (like drain cleaners or industrial chemicals). These can continue to burn the skin until the chemical is completely washed away.
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Electrical: Caused by contact with a power source or lightning. These are dangerous because they often cause more damage inside the body than is visible on the skin.
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Radiation: Most commonly caused by overexposure to UV rays (sunburn), but also from X-rays or radiation therapy.
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Friction: "Road rash" or carpet burns caused by skin rubbing harshly against a surface.
Symptoms of Burns
Symptoms vary based on the depth and cause of the injury.
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Pain: First- and second-degree burns are typically the most painful. Third-degree burns may feel numb due to nerve damage.
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Redness and Swelling: Common in all burns.
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Blisters: A hallmark of second-degree burns. They may be "weeping" or moist.
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Skin Texture Changes: Third-degree burns may feel leathery, waxy, or hard.
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Inhalation Signs: If the burn occurred in a fire, look for soot around the nose or mouth, singed nasal hairs, a hoarse voice, or difficulty breathing. These are medical emergencies.
Diagnosis of Burns
Healthcare providers diagnose burns based on a physical examination to determine the "severity," which is a combination of depth and the amount of body surface area involved.
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The Rule of Nines: For adults, doctors use this to estimate the percentage of the body that is burned (e.g., each arm is 9%, the chest is 18%).
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Lund-Browder Chart: A more precise tool used for children, as their body proportions are different than adults.
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Clinical Evaluation: A doctor will check for circulation, sensation, and signs of infection. For electrical or chemical burns, they may order blood tests or an EKG to check for internal organ or heart damage.
Treatment of Burns
Treatment depends on the severity. Minor burns can be treated at home, but major burns require a specialized burn center.
Immediate First Aid (The "Six Cs")
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Clothing: Remove any clothing or jewelry near the burn before the area begins to swell. If clothing is stuck to the burn, do not pull it off; leave it for a professional.
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Cooling: Run lukewarm (not cold) tap water over the burn for 20 minutes. This stops the burning process. Do not use ice, as it can damage the tissue further.
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Cleaning: Gently wash the area with mild soap and water once cooled.
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Chemoprophylaxis: Use a simple non-scented ointment (like petroleum jelly) and ensure your tetanus shot is up to date.
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Covering: Use a clean, non-stick bandage or plastic wrap to protect the area.
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Comforting: Use over-the-counter pain relievers like ibuprofen or acetaminophen.
Professional Care Major burns require "fluid resuscitation" through an IV to prevent shock and may eventually require skin grafting, where healthy skin is moved from another part of the body to the wound site.
Prevention of Burns
Most burn injuries are preventable with basic safety measures.
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Water Safety: Set your water heater thermostat to below 120°F (49°C) to prevent accidental scalds. Always test bathwater with your elbow before putting a child in.
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Kitchen Safety: Turn pot handles toward the back of the stove so they cannot be knocked over. Keep hot liquids away from the edges of tables.
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Smoke Alarms: Install smoke detectors on every level of your home and test the batteries every six months.
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Sun Protection: Use broad-spectrum sunscreen and wear protective clothing to prevent radiation burns from the sun.
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Child Safety: Use outlet covers and keep electrical cords out of reach of children.
