Burns

Burn Care

Burn injuries account for nearly 700,000 visits to the emergency room each year. Although most burns are not life threatening, they can cause significant pain. Prompt identification of the type of burn and quick implementation of appropriate treatment can help minimize scarring and pain, and can also minimize the psychological impact of the injury.

There three types of burns:

  • Thermal burns
  • Chemical burns
  • Radiation burns

Thermal burns are the most common and are caused by contact with flame, heat or scalding liquids. Chemical and radiation burns are less common in children. All types of burns fall into one of three classifications based on severity.

1st degree burns – first-degree burns are superficial, involving only the uppermost layer of skin called the epidermis. Signs of a first degree burn include:

  • skin turns white or pales when pressure is applied
  • skin is red
  • tissue damage is minimal
  • swelling may be present but skin generally will not form blisters
  • the wound is red, dry and painful, and heals in about three to six days without scarring

2nd degree burns – second degree burns may also be called partial-thickness burns because they permeate deeper into the skin, involving both the upper layer – the epidermis – and the second layer – the dermis. Signs of a second degree burn include:

  • blisters forming very quickly or within 24 hours
  • skin does not pale when pressure is applied
  • the wound is red, wet and painful (although there will be decreasing pain, color and moisture with increasing depth into the dermis)
  • the deeper the burn the more likely it is to result in scarring

3rd degree burns – third degree burns may also be called full thickness burns because they extend completely through the skin to the subcutaneous tissue. These burns may also involve underlying structures like tendons, nerves, muscle or bone. Signs of a third degree burn include:

  • charring of the skin or skin that is a translucent white color with coagulated vessels visible below
  • the skin has no feeling, but the patient complains of pain (most likely a result of second degree burns to surrounding tissue)
  • healing is very slow and there may be extensive scarring
  • wounds vary from waxy white to charred and black with a leathery texture; the skin is usually dry and painless to the touch.

Causes of Burns

Most burns are preventable using inexpensive safety devices or taking simple steps to put dangerous objects or materials out of reach. Some of the most common causes of burns include:

  • contact with open flame by skin or clothing
  • contact with a hot object, such as a cigarette, iron, curling iron, etc.
  • scalds from a hot liquid – the thicker the liquid and the longer the contact with skin the greater the damage
  • steam burns, such as those that occur in industrial accidents or from automobile radiator accidents; steam burns often cause injury to the airways of the lungs
  • gas burns from inhalation of hot gas
  • electrical burns, including lightning
  • flash burns from rapid ignition of a flammable gas or liquid
  • tar burns
  • chemical burns from alkaline or acid substances

Initial Evaluation of Burns:

Getting a solid overview of the child’s general health and current condition is critical to the timely and effective treatment of burns. In some cases, the burn may not be the only injury the child has sustained. So treatment will most often begin with an initial evaluation that may include a variety of different tests. Some of these tests may be:

Laboratory tests – lab tests will be done as soon as possible after the burn so that they may serve as a baseline measurement of the child’s condition. This will help the doctors evaluate how the child’s condition changes over time as treatment progresses and healing begins. These tests may include:

  • cbc blood count – also called a complete blood count, this test looks at the number of white blood cells, red blood cells and platelets in the blood
  • chemistry profile – to determine kidney function, among other things
  • liver function tests
  • measurement of arterial blood gases
  • coagulation profile to determine how well the blood is clotting
  • urine analysis
  • blood type and screen
  • creatine phosphokinase and urine myoglobin to look for muscle breakdown and potential kidney impairment

Imaging studies – imaging tests will help the doctor determine if there other injuries in addition to the burn, as well as how a severe burn may have impacted other tissues. These tests may include:

  • chest X-ray – this is most often done if smoke inhalation is suspected or if a patient has required intubation in order to breathe
  • other X-rays – following an initial physical exam the doctor may order an X-ray to a specific body part if further injury is suspected
  • CT scan – a CT scan is an X-ray in which multiple images are taken and them compiled into a complete, cross-sectional view of soft tissue, bone and blood vessels. CT scans allow the doctor to see parts of the body that can’t be seen on a traditional X-ray.

Fiberoptic broncoscopy – this test may be performed on a child suspected of having an inhalation burn, and takes place after initial stabilization in an emergency department.