Burns

Description

• Tissue injuries caused by application of heat, chemicals, electricity, or irradiation
• Extent of injury (depth of burn) is a result of intensity and duration of exposure.
  • Superficial burn (formerly 1st degree) involves superficial layers of epidermis.
  • Partial-thickness burn (formerly 2nd degree) involves varying amounts of epidermis (with blister formation) and part of the dermis.
  • Full-thickness burn (formerly 3rd degree) involves destruction of all skin elements (full thickness) with coagulation of subdermal plexus.
• System(s) affected: endocrine/metabolic, pulmonary, skin/exocrine

Geriatric Considerations

• Prognosis is worse for severe burns.
• Patients >60 years of age account for 11% of all burns.

Pediatric Considerations
Consider child abuse or neglect when dealing with hot water burns in children; abuse accounts for 15% of pediatric burns. Special concerns are sharply demarcated wounds, immersion injuries, and suspect stories. Involve child welfare services early.

Epidemiology

• Fourth most common trauma worldwide
• Predominant age: 20 to 30 years; 13% are infants; 11% are >60 years of age.
• Predominant gender: Males account for 70%.

Incidence
Per year in the United States

• 1.2 to 2.0 million burns; 700,000 emergency room visits; 45,000 to 50,000 hospitalizations; 3,900 deaths from burn-related complications
• In children: 250,000 burns, 15,000 hospitalizations, 1,100 deaths
• Estimated total cost of $2 billion annually for burn care
• House fires cause 75% of deaths.
• Burn deaths are decreasing nationally due to improved prevention and treatment.
• Increase in burns from the illegal production of methamphetamines. Patients can present with a combination of chemical burn, thermal burn, and explosion injury.

Etiology and Pathophysiology

• Open flame and hot liquid are the most common causes of burns (heat usually ≥45°C): flame burns are more common in adults; scald burns are more common in children.
• Caustic chemicals or acids (may show little signs or symptoms for the first few days)
• Electricity (may have significant injury with very little damage to overlying skin)
• Excess sun exposure

Risk Factors

• Water heaters set too high
• Workplace exposure to chemicals, electricity, or irradiation
• Young children and older adults with thin skin are more susceptible to injury.
• Carelessness with burning cigarettes: related to 18% of fatal fires in 2006
• Inadequate or faulty electrical wiring
• Lack of smoke detectors: Lacking or nonfunctioning smoke alarms are implicated in 63% of residential fires.
• Arson: cause of 12.4% of fires that resulted in fatalities in 2012
• Low socioeconomic status has been associated with an increased risk of unintentional injury and mortality.

General Prevention

Home safety education should be a key mechanism for injury prevention.

• Families educated on home safety were more likely to have safe hot water temperatures.
• Safety education results in more families having functioning smoke alarms and increased use of fireguards.

Commonly Associated Conditions

Smoke inhalation syndrome

• May involve thermal burn to respiratory mucosa (e.g., trachea, bronchi) as well as carbon monoxide inhalation
• Occurs within 72 hours of burn
• Should be suspected in all burns occurring in an enclosed space or exposure to explosions