Burn Causes & Classifications

Burn Causes & Classifications

Burn Sources

Thermal

Electrical

Chemical

Radiation

Inhalation

*90% of burns-most common*

Caused by FLAME/FLASH, SCALD, or contact with HOT OBJECTS

Severity depends on:

• Duration of contact

• Temperature of agent

• Extent of the burn

• Age

Caused by intense heat generated from an electrical current passing through the body causing heat coagulation.

• Common entry sites: hands & skull

• Common exit sites: heels

Severity depends on:

• Pathway of current

• Amount of voltage

• Duration of time current flow sustained

• Surface area

Caused by exposure to a caustic agent either through contact, inhalation, or ingestion

Severity depends on:

• Chemical/concentration

• Duration of contact

• Volume/Surface area exposed

Acids (toilet bowl cleaners, drain cleaners; etc.) ​​​​​​​​​​​​​​​:Cause coagulation necrosis of tissues

Alkalis (ammonia, bleach, oven cleaners, cement, fertilizers, etc.): Cause liquefaction necrosis (protein hydrolysis & melting)

Caused by exposure to radiation causing damage to the skin & tisue

Severity depends on:

• Duration

• Exposure level

Causes damage below the skin to the nerves, vessels & organ functions along its path resulting in tissue anoxia & death

*Causes risk for cardiac dysthymias or cardiac arrest, respiratory arrest, severe metabolic acidosis, and/or Myoglobinuria (Myoglobin from injured muscle & Hgb from damaged RBCs travel to kidneys =AKI)*

*Can occur in absence of burn to skin*

Hot Air

Noxious Chemicals

Lower airway injury (trachea, bronchioles, & alveoli):

*Pulmonary edema may not appear until 12-48 hrs (ARDS)*

• Manifestation: AMS, dyspnea, facial burns/singed nasal/facial hair, hoarseness, wheezing

*Causes damage to respiratory tract leading to airway compromise & pulmonary edema*

Upper airway injury (above the vocal cords): cause massive swelling w/ rapid onset → air obstruction (an emergency)!

• Manifestations: blisters/edema, copious secretions, difficulty swallowing, hoarseness, stridor, airway obstruction

CO displaces O2 on Hgb (carboxyhemoglobin) & leads to O2 deficiency in the body (hypoxia)

• COHbg levels >20% critical

• Manifestations: headache, dizziness, nausea, confusion, tachycardia, tachypnea, coma, death

Carbon monoxide (CO) poisoning

Cyanide Gas

Released by burning plastics, nylon, polyurethane.

• Manifestations: headache, dizziness, tachycardia, seizures, dysrhythmias

Burns are classified by...

Extent

Depth

Severity

Total body surface area TBSA (Size) indicates how aggressively the patient will need to be resuscitated

Used for Peds

Rule of Palmss: Victim’s palm approximates 1% of their TBSA. (Used for small or patchy burns)

*Superficial

• Damaged Layer: Only epidermal layer/intact

• Appearance: Pink to redden areas w/ mild edema, no blisters, blanch w/ pressure

• Sensation: Painful/tender, sensitive to heat

Ex: Sunburn

Partial Thickness Burns

Involves the entire EPIDERMIS & portions of DERMIS (Blisters & Weeps)

Superficial

Deep

• Damaged Layer: Entire epidermis & some portions of the dermis layer

• Appearance: Blisters, moist, pink to red, weeping, blanches with pressure, mild to moderate edema

• Sensation: Painful to temperature & air

• Healing time: 3 weeks, usually no scarring, but minor pigment changes

• Ex’s: Scalds, brief hot object contact

• Treatment: Small burns (cleaned/topical antibiotic. Large burns may need referral to burn center.

• Damaged layer: entire epidermis & deep into dermis (damage hair follicle & glandular tissue)

• Appearance: Blisters rare (unroofed), wet or waxy dryvariable color (patchy to cheesy red to white), does not blanch with pressure, moderate edema

• Sensation: Painful & sensitive to touch

• Healing time: 2-6 weeks, scarring likely, possible grafting

• Ex’s: Scalds, flames, prolong contact with hot object, grease, chemicals

Full Thickness Burns

Involves destruction of the entire EPIDERMIS & DERMIS into the subcutaneous fat layer - Involves all elements of, nerve endings, fat, muscle, bone (Skin Does Not Regrow)

• Damaged Layer: Through the entire epidermis & dermis & can extend in the subcutaneous fat.

• Appearance: Vary from waxy-white, to yellow, Brown, to dry & leathery gray maybe charred & black or hard, skin is dry/inelastic, no blanching with pressure, severe edema (no blisters)

• Sensation: Usually no pain, or pain to deep pressure only (nerve endings destroyed)

• Healing time: Rare, unless surgically treated (skin grafting), then weeks to months.

- High risk for infection*

- Substantial scar &/or contractures

• Ex’s: Scalds, flames, prolong contact with hot object, grease, chemicals, electricity

• Treatment: burn center referral

• Damage: Invoves all layers, extends into muscle, bone, & tendons, Leads to loss of the burned part (potentially life-threatening)

• Appearance: Blacken or charred, dry, leathery eschar. (no blisters, no edema)

• Sensation: No pain, damaged nerves

• Healing time: Never, unless surgically treated (grafting), then weeks to months

• Ex’s: Flames, electricity, grease, tar, chemicals

• Treatment: burn center referral

*Differs with each cause

Deep Full Thickness Burns

Circumferential Burns

Cases where a full thickness burn affects the entire circumference of a digit, extremity, or even the torso

Major Risk for Compartment Syndrome where edema acts as a tourniquet, impairing circulation

Assess for adequate distal circulation & perfusion in extremity

Signs/symptoms:

• ↑ Pain

• Tightness

• Numbness

• ↓ Pulse or absent

Intervention: Escharotomy (surgical procedure) is an incision longitudinally to release taut skin