Burn (injury)

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Classification and external resources
Electrical burn entrance wound on a person's back.

A burn is an injury to a person's skin or even flesh. Heat, cold, electricity, chemicals, friction, or radiation can be the cause of a burn.[1] Most burns are due to heat from hot liquids, solids, or fire.[2] While rates are similar for males and females the underlying causes often differ.[3] Among women in some areas, risk is related to use of open cooking fires or unsafe stoves.[3] Among men, risk is related to the work environments.[3] Alcoholism and smoking are other risk factors.[3] Burns can also occur as a result of self harm or violence between people.[3]

Burns can be very serious injuries, and in some cases can even cause death. Depending on how deep the burn goes and amount of skin affected, a burn can be a medical emergency. For children, at least five percent of the skin needs to be affected. Adults can tolerate up to ten percent of affected skin.

Burns of a certain extent affect the body as a whole: Common reactions are circulatory shock, systemic inflammatory response syndrome and sepsis.

Causes[change | change source]

In the United States, almost eight out of ten burns resulted from fire, flames, or hot liquids.[4] Most (69%) burn injuries occur at home or at work (9%),[5] and most are accidental, with 2% due to assault by another, and 1–2% resulting from a suicide attempt.[6] These sources can cause inhalation injury to the airway and/or lungs, occurring in about 6%.[7]

Characteristics[change | change source]

Burn Degree Diagram.svg

Burns are usually minor. They are usually Degree One to a minor Degree Two. Others are more powerful, such as Degree 3. People may get more powerful burns from high heat or radioactive items.

Degree One Burns[change | change source]

Degree One burns are minor and can be cured at home. They seldom leave scars. A person can get them from hot water, a minor sunburn, or by touching hot metal. It causes pain, but only the top layer of skin is burnt and no nerves are injured.

Degree Two Burns[change | change source]

Lund-Browder chart for estimating burn injury total body surface area.

Degree Two burns can be cured at home, but some people would prefer to take them to the hospital. This degree of burn goes into the second layer of skin.

Degree Three Burns[change | change source]

Degree Three burns are the most severe burns that most people can survive from. Although they may be severe, the chances of death are very low if treated at the hospital right away. It burns through all three layers of skin, leaving a scab.

Degree Four Burns[change | change source]

This degree of burn goes through the skin and destroys the nerves near it. There is no pain at the location of the 4th degree burn area, due to the destruction of the nerves, but there can be immense pain that occurs in the area surrounding the burn. Very few survive it. It must be treated at the hospital ASAP if it occurs and the person is still alive.

Names Layers involved Appearance Texture Sensation Healing Time Complications Example
Superficial (1st degree) Epidermis Red without blisters Dry Painful 5-10 days Repeated sunburns increase the risk of skin cancer later in life[8] A sunburn is a typical first degree burn.
Superficial partial thickness (2nd degree) Extends into superficial (papillary) dermis Red with clear blister. Blanches with pressure Moist Very Painful 2–4 weeks Local infection/cellulitis

Second degree burn of the thumb

Deep partial thickness (2nd degree) Extends into deep (reticular) dermis Red-and-white with bloody blisters. Less blanching. Moist Painful with deep pressure 4–8 weeks Scarring, contractures (may require excision and skin grafting) Second-degree burn caused by contact with boiling water
Full thickness (3rd degree) Extends through entire dermis Stiff and white/brown Dry, leathery Painless Prolonged and incomplete Scarring, contractures, amputation Eight day old third-degree burn caused by motorcycle muffler.
4th degree Extends through skin, subcutaneous tissue and into underlying muscle and bone Black; charred with eschar Dry Painless Requires excision Amputation, significant functional impairment, possible gangrene, and in some cases death. 4th degree burn

History[change | change source]

Guillaume Dupuytren (1777–1835) who developed the degree classification of burns

Cave paintings from more than 3,500 years ago document burns and their management.[9] The earliest Egyptian records on treating burns describes dressings prepared with milk from mothers of baby boys.[10] The 1500 BCE Edwin Smith Papyrus describes treatments using honey and the salve of resin.[9] Many other treatments have been used over the ages, including the use of tea leaves by the Chinese documented to 600 BCE, pig fat and vinegar by Hippocrates documented to 400 BCE, and wine and myrrh by Celsus documented to 100 CE.[9] French barber-surgeon Ambroise Paré was the first to describe different degrees of burns in the 1500s.[11] Guillaume Dupuytren expanded these degrees into six different severities in 1832.[9][12]

The first hospital to treat burns opened in 1843 in London, England and the development of modern burn care began in the late 1800s and early 1900s.[9][11] During World War I, Henry D. Dakin and Alexis Carrel developed standards for the cleaning and disinfecting of burns and wounds using sodium hypochlorite solutions, which significantly reduced mortality.[9] In the 1940s, the importance of early excision and skin grafting was acknowledged, and around the same time, fluid resuscitation and formulas to guide it were developed.[9] In the 1970s, researchers demonstrated the significance of the hypermetabolic state that follows large burns.[9]

Notes[change | change source]

  • National Burn Repository (PDF). American Burn Association. 2012.

References[change | change source]

  1. Herndon D, ed. (2012). "Chapter 4: Prevention of Burn Injuries". Total burn care (4th ed.). Edinburgh: Saunders. p. 46. ISBN 978-1-4377-2786-9.
  2. "Burns Fact sheet N°365". WHO. April 2014. Archived from the original on 2015-11-10. Retrieved 3 March 2016. Cite uses deprecated parameter |deadurl= (help)
  3. 3.0 3.1 3.2 3.3 3.4 "Burns". World Health Organization. September 2016. Archived from the original on 21 July 2017. Retrieved 1 August 2017. Cite uses deprecated parameter |deadurl= (help)
  4. National Burn Repository Pg. i
  5. "Burn Incidence and Treatment in the United States: 2012 Fact Sheet". American Burn Association. 2012. Archived from the original on 21 February 2013. Retrieved 20 April 2013. Cite uses deprecated parameter |deadurl= (help)
  6. Peck, MD (November 2011). "Epidemiology of burns throughout the world. Part I: Distribution and risk factors". Burns : journal of the International Society for Burn Injuries 37 (7): 1087–100. doi:10.1016/j.burns.2011.06.005. PMID 21802856. 
  7. Herndon D, ed. (2012). "Chapter 3: Epidemiological, Demographic, and Outcome Characteristics of Burn Injury". Total burn care (4th ed.). Edinburgh: Saunders. p. 23. ISBN 978-1-4377-2786-9.
  8. Buttaro, Terry (2012). Primary Care: A Collaborative Practice. Elsevier Health Sciences. p. 236. ISBN 9780323075855.
  9. 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Herndon D, ed. (2012). "Chapter 1: A Brief History of Acute Burn Care Management". Total burn care (4th ed.). Edinburgh: Saunders. p. 1. ISBN 978-1-4377-2786-9.
  10. Pećanac, M.; Janjić, Z.; Komarcević, A.; Pajić, M.; Dobanovacki, D.; Misković, SS. (2013). "Burns treatment in ancient times". Med Pregl 66 (5–6): 263–7. doi:10.1016/s0264-410x(02)00603-5. PMID 23888738. 
  11. 11.0 11.1 Song, David (5 September 2012). Plastic surgery (3rd ed.). Edinburgh: Saunders. p. 393.e1. ISBN 978-1-4557-1055-3. Archived from the original on 2 May 2016. Cite uses deprecated parameter |deadurl= (help)
  12. Wylock, Paul (2010). The life and times of Guillaume Dupuytren, 1777–1835. Brussels: Brussels University Press. p. 60. ISBN 978-90-5487-572-7. Archived from the original on 16 May 2016. Cite uses deprecated parameter |deadurl= (help)