Burns

BASICS

DESCRIPTION

  • Tissue injuries caused by application of heat, chemicals, electricity, or irradiation
  • Extent of injury (depth of burn) results from the 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 the 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 protective 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 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 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 burns, thermal burns, and explosion injuries.

ETIOLOGY AND PATHOPHYSIOLOGY

  • Open flame and hot liquid are the most common causes of burns (heat usually ≥45°C): flame burns 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 (radiation)

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
  • Cyanide toxicity: Consider smoke inhalation, especially from fires involving artificial items/fabrics.

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