Burns: Causes and Classification

Causes of Burns

• Thermal injury: scald, flame, flash burns, and contact with hot metals/objects/materials
• Electrical injury
• Chemical burns: acid/alkali
• Cold injury: frostbite
• Ionizing radiation

Classification of Burns

• First-degree burn: • Involves epidermis only • Red and painful • No blisters • Heals rapidly in 5-7 days • By epithelialization without scarring

• Second-degree burn: • Involves epidermis and dermis • Mottled, red, and painful • With blisters • Heals in 14-21 days • Superficial burn heals, causing pigmentation • Deep burn heals, causing scarring and pigmentation

• Third-degree burn: • Involves full thickness of skin • Charred, painless, and insensitive • Thrombosis of superficial vessels • Requires grafting • Eschar is charred, denatured, and insensitive • Heals by re-epithelialization from wound edge

• Fourth-degree burn: • Involves underlying tissues: muscles, bones

Classification of Burns by Percentage

• Mild: • Partial thickness burn < 15% in adult or < 10% in children • Full thickness burn < 2% in adult or < 10% in children

• Moderate: • Second-degree burn 15-25% in adult or 10-20% in children • Third-degree burn 2-10% in adult or > 10% in children

• Major: • Second-degree burn > 25% in adult or > 20% in children • Third-degree burn > 10% in adult or > 10% in children • Burns involving eyes, ears, feet, hand, or perineum • All inhalational and electrical burns

Signs and Symptoms

• Blisters
• Pain
• Swelling
• White or charred skin
• Peeling skin

Complications

• Arrhythmia
• Dehydration
• Disfiguring scars and contractures
• Edema
• Organ failure
• Hypotension leading to shock

Assessment of Burns

• Burned surface area
• Depth of burn
• Wallace Rule of Nine: method to estimate burned surface area in adults and children

Management of Burns

• Stop the burning process
• ABCDE assessment
• Determine percentage area of burn (Rule of 9's)
• Good IV access and early fluid replacement
• Cool the area with tap water
• Clean and dress the wound
• Sedation and analgesia
• Assessment of percentage, degree, and type of burn for fluid management
• Chemoprophylaxis: tetanus toxoid, antibiotics, and local antiseptics

Fluid Resuscitation

• Ringer lactate is the fluid of choice
• Blood transfusion after 48 hours
• First 24 hours: crystalloids only
• After 24 hours: colloids like plasma, gelatin, and dextran
• Urine output: 30-50 ml/hr
• Albumin 5% to maintain serum albumin levels at 2 g/dl
• Sodium supplementation may be needed for burns > 20% BSA

Local Management

• Open Method: application of silver sulphadiazine without dressings
• Closed Method: with dressings to soothe and protect the wound

Learn about burns, wounds produced by various agents that cause injury and tissue destruction. Explore the causes such as thermal, electrical, chemical, cold injuries, and more. Understand the classification based on the thickness of skin involved.