burn

^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]

Etiology

heat
chemicals
mechanical abrasion (friction)
sunlight
electricity
nuclear radiation

Pathology

1st burn is a partial epidermal thickness burn
2nd degree burn is full thickness epidermal burn with the dermis remaining largely intact
3rd degree burns are full thickness epithelial burns with damage to the underlying dermis
4th degree burn: similar to 3rd degree burn, but also involves muscle &/or bone
epithelial appendages within the dermis provide the seed for re-epithelialization for a burned area

Clinical manifestations

1st & second degree burns are hypersensitive & painful
3rd degree burns destroy nerves making them insensitive to pain
1st degree burns
- erythema
- tenderness
- edema
2nd degree burns
- same as 1st degree burns plus, blisters, shiny appearance, weeping
- 2nd degree, superficial partial-thickness burns
  - blisters or weeping wounds
  - blanch with pressure
  - painful to air, temperature, & pressure.
- second-degree, deep partial-thickness burn
  - destruction of the epidermis & the dermis
  - wet or dry wound painful only to pressure
  - may be any color, most commonly white, yellow, or red.
3rd degree burns
- skin charred with a leathery surface insensitive to pain or touch
- surface will not blanch because blood vessels are thrombosed
4th degree burn: similar to 3rd degree burn

Complications

50% of deaths associated with burns are due to complications of inhalation injury

Management

estimation of body surface area (BSA) burned
outpatient treatment (minor burns)
- 1st degree burns
- 2nd degree burns < 15% of BSA
- 3rd degree burns < 2% of BSA
- burns that spare the face, hands, feet & perineum
inpatient treatment (burn unit)
- more extensive burns
- 3rd degree burns
- chemical or electrical burns
- associated inhalation injury or major trauma
- burns that involve the face, hands, feet, genitals. perineum or major joints
- patients with significant medical problems
- special social, emotional, or rehabilitation intervention
1st degree burns
- cooling, ice or cold compresses
- analgesics
- emollient
- topical anesthetic
- 1st degree burns will heal spontaneously without scarring in 3-4 days
- dressing not indicated^[3]
2nd degree burns
- debridement
  - intact blisters may be left for 3-4 days if no sign of infection
  - bulky blisters may be decompress & devitalized skin removed
- gentle cleansing with antiseptic or mild soap
- topical antibiotics
  - bacitracin for very limited 2nd degree burns
  - silver sulfadiazine (Silvadene) is preferred agent for larger or deeper burns
- dressings
  - non-adherent gauze next to skin covered by bulky dressing
  - wounds of face & ears may be easier to treat without bandages
  - daily dressing changes (premedication may be required)
- tetanus prophylaxis
  - tetanus toxoid 0.5 mL SC booster
  - tetanus immune globulin (Hyper-Tet) 25 U IM plus tetanus toxoid 0.5 mL SC if never immunized
- 2nd degree burns heal spontaneously without scarring in 2-3 weeks
3rd degree burns
- generally requires skin grafting
- months may be required for healing
- scarring occurs
4th degree burn: referral to burn center
extensive burns (> 15% of BSA)
- may require fluid resuscitation
  - 2-4 mL x weight in kg x % 2nd or 3rd degree burn/24 hr
  - administer 1st 1/2 over 8 hours
- beta blocker (propranolol 1 mg/kg every 4 hours) may attenuate catabolic response to catecholamines^[2]
vitamin C 500 mg QD & vitamin A 10,000 IU QD may be helpful
if burn overlies a joint, attempt full range of motion at least 3 times/day
elevation of burned part to limit edema
diet
- 30 kcal/kg/day
- dietary protein 2.5 g/kg/day
- supplemental glutamine & arginine may diminish infections^[3]

More general terms

More specific terms

Additional terms

References

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1001-1002
↑ ^2.0 ^2.1 Journal Watch 21(23):188, 2001 Herndon DN et al Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345:1223, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11680441
↑ ^3.0 ^3.1 ^3.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
↑ Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S. Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers. J Am Acad Dermatol. 2012 May;66(5):e159-65 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20724028
↑ Alsbjorn B, Gilbert P, Hartmann B et al Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party. Burns. 2007 Mar;33(2):155-60. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17280913
↑ Hettiaratchy S, Papini R. Initial management of a major burn: II--assessment and resuscitation. BMJ. 2004 Jul 10;329(7457):101-3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15242917
↑ Alharbi Z, Piatkowski A, Dembinski R et al Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form. World J Emerg Surg. 2012 May 14;7(1):13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22583548
↑ Rex S Burn injuries. Curr Opin Crit Care. 2012 Dec;18(6):671-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23037877
↑ Greenhalgh DG. Management of burns. N Engl J Med. 2019;380:2349-59. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31189038
↑ National Institute of General Medical Sciences Burns https://www.nigms.nih.gov/education/fact-sheets/Pages/burns.aspx

Patient information

burn patient information

[ref1-1] Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1001-1002

[ref2-2] 2.0 ^2.1 Journal Watch 21(23):188, 2001 Herndon DN et al Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345:1223, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11680441

[ref3-3] 3.0 ^3.1 ^3.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.

[ref4-4] Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S. Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers. J Am Acad Dermatol. 2012 May;66(5):e159-65 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20724028

[ref5-5] Alsbjorn B, Gilbert P, Hartmann B et al Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party. Burns. 2007 Mar;33(2):155-60. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17280913

[ref6-6] Hettiaratchy S, Papini R. Initial management of a major burn: II--assessment and resuscitation. BMJ. 2004 Jul 10;329(7457):101-3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15242917

[ref7-7] Alharbi Z, Piatkowski A, Dembinski R et al Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form. World J Emerg Surg. 2012 May 14;7(1):13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22583548

[ref8-8] Rex S Burn injuries. Curr Opin Crit Care. 2012 Dec;18(6):671-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23037877

[ref9-9] Greenhalgh DG. Management of burns. N Engl J Med. 2019;380:2349-59. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31189038

[ref10-10] National Institute of General Medical Sciences Burns https://www.nigms.nih.gov/education/fact-sheets/Pages/burns.aspx

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

burn

Contents

Etiology

Pathology

Clinical manifestations

Complications

Management

More general terms

More specific terms

Additional terms

References

Patient information

Navigation menu

burn

Etiology

Pathology

Clinical manifestations

Complications

Management

More general terms

More specific terms

Additional terms

References

Patient information

Navigation menu

Search