What Is A Burn?

Overview

Burns are a global medical  problem associated with the death of 180,000 cases annually and the vast majority occurs in low to middle income countries. A burn is an injury to the skin and other organic tissues that may be due to several causes, leading to cell death and requires special healthcare, hospitalisation, and in some cases burns may be severe and fatal. 

Burns affect the skin which is the largest organ of the body, and it is made up of several layers.¹ The epidermis (the outermost layer of the skin) and the dermis which is (the middle layer of the skin contain blood vessels, lymph vessels, nerves, sweat glands, and hair follicles. The degree, and severity of the burn are determined according to the layer of the skin damaged.

Causes of burns

There are many factors that cause burn injuries, some of these factors are: 

• Friction
• Cold
• Heat
• Hot liquids or steam
• Hot metal, glass, or any other objects
• Radiation burns a side effect to radiation therapy used in treating cancer cells
• Chemicals such as strong acids, or detergents
• Electrical burns due to electric current contacting your body, may be fatal by causing  the heart to suddenly stop beating, 
• Sun burns or other sources of ultraviolet radiation
• Physical abuse

But the majority of burn injuries (43% of burns) are due to scalds which represent the most common cause of burn injuries.  

Signs and symptoms of burns

Signs and symptoms of burn injuries differ according to the severity of the burn. 

Burns in general are associated with: 

• Swelling 
• Pain (except third-degree burns due to nerve damage)
• Redness 
• Peeling skin
• Scarring may occur during healing
• Restricted movement in joints due to scarring and skin shrinkage

In the case of severe burns more serious complications that require immediate attention and care may occur such as:

• Extensive fluid loss and tissue damage
• Dehydration  in patients with widespread burns
• Shock  
• Electrolyte imbalance due to extensive burns where sodium, potassium and glucose are the most commonly affected electrolytes in burn patients
• Destruction of muscle tissue (rhabdomyolysis) in case of full thickness burns 
• Development and spread of infection complicating the burn condition and spread of infection through the bloodstream causes severe illness or death
• Hypothermia (extremely low body temperature) 

Airway burns may be associated with: 

• Burns on the head, face, neck, lips, and mouth 
• Coughing 
• Difficulty breathing 
• Changed voice 
• Wheezing
• Dark, black-stained mucus

Management and treatment for burns

First aid in case of burn injuries includes first determining if the type of burn the person has is minor, major or severe.  

Minor burns 

• Remain calm and reassure the patient
• If the skin is unbroken, run cool water over the area of the burn or apply cold wet compress for at least 30 minutes. Burn cooling is a critical step in the initial first response to injury and is considered as the best practice
• Apply moisturising  lotion such as petroleum jelly two to three times a day. Do not apply toothpaste, butter, ointment, or topical antibiotics
• After flushing the burn, cover it with a dry, non-stick, sterile, and clean bandage, to help protect the burn  from pressure and friction  
• Analgesics such as ibuprofen or acetaminophen will help to relieve pain and reduce inflammation.
• Protect the area from the sun andonce the burn heals, protect the skin from the sun to avoid scarring

Major and severe burns 

• Immediate medical attention and hospitalisation  in patients with severe burns
• Removal of clothing that may be burned or covered with chemicals
• Cool any burns with cold tap water for 30 minutes, dry the wound and then apply dressing on the wound 
• Assessment of airway and breathing (all patients with major burns should receive high-flow oxygen for 24 hours)² 
• Stop any external bleeding 
• In severe burns, plastic surgery may be needed to remove the burnt area of skin and replace it with a skin graft taken from another part of the body

FAQs

How are burns diagnosed?

Diagnosis of burns includes evaluation of the extent and the depth of the burn wound to determine the degree of severity of burns and classified into:³

• Minor: first degree anywhere in the body, second-degree burns that cover less than 10% of the body and burns less than 2 to 3 inches wide
• Moderate: second-degree burns covering 10% of the body
• Severe: third-degree burns covering more than 1% of the body are considered severe and require hospitalisation

How can I prevent burns?

About 50% of all burn accidents are preventable, an effective burn prevention plan is needed, some of these preventive steps include:

• Improve awareness of how to protect yourself and your children from burn injuries
• Check electrical plugs frequently and unplug appliances when not used 
• Don’t overload electrical outlets
• During power outages, use flashlights insteads of candles
• Teach children to stay away from matches and lighters
• Keep hot liquid and hot oil away from the reach of children 
• Avoid playing with fireworks
• Store harmful chemicals and chemicals out of reach of children 
• Apply safety regulations to housing designs
• Cookstoves design improvement regarding stability and prevention of access by children 
• Lower the temperature in hot water taps

Who is at risk of burns?

Burn injuries can happen to everyone but high-risk groups that are most likely to develop a burn injury or die from smoke inhalation are: 

• Children: young children are at higher risk to develop burns more than adults. Every day in the UK, 110 children are seen in emergency departments with burn injuries
• Elderly: elderly skin is thinner and more fragile, so they are more susceptible to acquire burn injuries
• Workers in various industries and trades such as the construction industry, manufacturing and food serving are at higher risk to be exposed to flame and heat routinely
• People with certain medical conditions such as diabetes, epilepsy or peripheral neuropathy may have reduced sensation or mobility increasing their risk of developing burn injuries
• People with disabilities: where the disability makes it difficult for them to move away from the source of heat 

How common are burns?

Burn injuries affect about 7 to 12 million people yearly (about 33,000 each day).⁴ About 13,000 burn injuries require medical care every year in England and Wales.⁵ 

What are the degrees of burns?

Burn injuries are classified according to the severity of the burn and how deep the skin surface are affected into: 

• First-degree (superficial) burns: mild burns that affect the outer surface of the skin (epidermis) only. The burn site is dry, painful, red but self-heals within a few days and long-term tissue damage is rare but usually includes skin colour changes⁶ 
• Second-degree burns:burns that involve partial thickness of the skin, involving epidermis and part of the dermis layer. Burn site is red, painful, swollen and blistered
• Third-degree burns:this type of burns involves full thickness of the skin, destroying the epidermis and dermis of the skin. Third-degree burns may also damage the underlying bone, muscles, and tendons. Burn sites appear white and charred and no feeling in these areas as nerve endings are destroyed  

When should I see a doctor?

Professional healthcare and hospitalisation  are needed in case: 

1. The burn is very large or deep, any burn that is bigger than your hand requires medical attention
2. It is a third-degree burns 
3. The burn is due to a chemical or electrical cause
4. The person shows signs of shock 
5. The pain is persistent after 48 hours in case of minor burns 
6. The person is developing signs of infection such as fever, swollen lymph nodes and drainage or pus from burned skin
7. The burns are causing white or charred skin
8. The burns are causing blisters
9. The patient has breathed in smoke or fumes, in which case  the patient will suffer from coughing, sore throat, facial burns and difficulty breathing

Summary

Burn injuries are a worldwide problem that are relatively common and are associated with considerable morbidity and mortality. Burn occurs due to several causes, signs and symptoms vary according to the severity of the burn. Treatment of burns focuses on speedy healing and prevention of infection and as the complications caused by burn injuries are severe and may be life-threatening. Therefore, prevention of the burn is the key; where the best way to treat a burn is to prevent it from happening in the first place.