A Brief Description Of Burns

Definition: A burn is defined as any damage to the body's tissues caused by heat, chemicals, electricity, sunlight, or radiation. 

Scalds from hot liquids and steam, building fires and flammable liquids and gases are the most common causes of burns.

Burns are characterized by severe skin damage that causes the affected skin cells to die.

Types Of Burns: There are three types of burns:

• First-degree burns damage only the outer layer of skin
• Second-degree burns damage the outer layer and the layer underneath
• Third-degree burns damage or destroy the deepest layer of skin and tissues underneath.

There is also a fourth-degree burns. This type of burn includes all of the symptoms of a third-degree burn and also extends beyond the skin into tendons and bones.

Clinical Features: Burns can cause swelling, blistering, scarring and, in serious cases, shock, and even death. They also can lead to infections because they damage your skin's protective barrier.

• In first-degree burns: red, nonblistered skin
• Second-degree burns: blisters and some thickening of the skin
• Third-degree burns: widespread thickness with a white, leathery appearance

Immediate First Aid For Burns

• Airway, breathing, circulation
• Burns caused by heat: remove the person from the source. Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes. Cover the burn using cling film, layered, rather than wrapped around a limb
• Electrical burns: switch off power supply, remove the person from the source.
• Chemical burns: brush any powder off then irrigate with water. Attempts to neutralize the chemical are not recommended.

Assessing The Extent of the Burn

Wallace's Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%

Lund and Browder chart: the most accurate method the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA

Cases Which Need Referral to Secondary care

• all deep dermal and fullthickness burns.
• superficial dermal burns of more than 10% TBSA in adults, or more than 5% TBSA in children
• superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
• any inhalation injury
• any electrical or chemical burn injury
• suspicion of nonaccidental injury

Management of Burns

• initial first aid as above
• review referral criteria to ensure can be managed in primary care
• superficial epidermal: symptomatic relief analgesia, emollients etc
• superficial dermal: cleanse wound, leave blister intact, nonadherent dressing,
• avoid topical creams, 
• review in 24 hours