Burns (HB)

The four main types of burns are: thermal, chemical, electrical, and steam. Regardless of the cause, the tissue will be damaged in a few distinct ways.

Superficial burns are just that–superficial. You will see some local redness in the area, and there may be a bit of pain. Superficial burns do not penetrate deeper layers of the body–they stay outside the skin. Most sunburns are superficial.

Partial Thickness burns are similar to superficial burns in that they only damage the outer layer of skin. They are a little more severe because they produce blisters. Any burn that produces blisters is considered partial thickness.

Full Thickness burns involve deeper structures in the tissue. These cause damage that can include muscle tissue, fascia, and bone. Full-thickness burns are always considered serious and carry a high risk of infection. Full-thickness burns may not have associated pain if the nerves have been destroyed.

Burns are rarely only one category. Less severe burns typically surround more severe burns. So you may have an area of full-thickness bordered by an area of partial-thickness burns, which is then bordered by superficial.

Critical burns are any burns that meet certain criteria. These criteria are:

• Any burns that involve the respiratory system.
• Partial burns greater than 10% of the patient’s body surface.
• Partial or full-thickness burns to the face, hands, or genitals.
• Any full-thickness burns.
• Burns from chemicals or electricity.
• Burns to children or the elderly.
• Any patient with the above needs to be considered SERIOUS and should be evacuated as quickly and safely as possible.

Treatment

Stop the burning as soon as possible by removing the source of heat. The tissue will continue to burn after the thermal energy is removed. Think of cooking a steak—you remove it from the heat before it gets to the temperature you want since it will continue cooking while on the plate. People are made of meat.

Cooling the injured site as quickly as possible reduces the immediate damage and decreases the chances for disability later on. One of the easiest ways to do this is by immersion in water (just the affected part).

Chemical burns are dependent upon the type of chemical. Acids and bases need to be neutralized by the appropriate agent. Fortunately, flushing with copious amounts of water should work for both, but it needs to be continuous for thirty minutes. In a limited resource situation, this could present a challenge.

Dressing a burn is important as you want to prevent contamination (burns are very prone to infection, especially more extensive burns) and minimize hypothermia risk. Burns typically weep fluid, especially the more severe burns (or ones that cover a large area). This fluid will evaporate like any other fluid and can cause an evaporative cooling effect. The damaged skin is also unable to regulate temperature, and shell to core is impaired.

One of the best ways to dress a burn is with plastic wrap. It allows for inspection of the injury site and will not stick to the burn. If you don’t have access to plastic wrap, you should use clean cotton material and a waterproofing layer. Large burns are complicated to dress, and you need to account for swelling.

Burns are very painful, and you should anticipate pain management.