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Burns

Burns is a topic covered in the 5-Minute Clinical Consult.

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Basics

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.
    • 1st degree involves superficial layers of epidermis.
    • 2nd degree involves varying amounts of epidermis (with blister formation) and part of the dermis.
    • 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

  • Predominant age: 30 years; 13% infants; 11% >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 owing to 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 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 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

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

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Citation

Stephens, Mark B., et al., editors. "Burns." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116098/3.4/Burns.
Burns. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116098/3.4/Burns. Accessed June 19, 2019.
Burns. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116098/3.4/Burns
Burns [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116098/3.4/Burns.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Burns ID - 116098 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116098/3.4/Burns PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -