Burns

Picture of a heat burn on the side of the arm by iStock

• Heat, chemical, or electrical injury to the skin, nerves, blood vessels, and internal organs can cause burns.
• Burns that involve the hands, face, feet, genitals, or cover an extremity (arm or leg) or the chest is particularly dangerous.
• This article is designed as an introduction to burns; there are books and special journals devoted to burned patients and their care; we urge the reader to visit the first two references below for additional information.
   

The severity of a burn determines the symptoms a person who is burned experiences.

• First-degree burns cause red skin and local pain only. Sunburn is an example of a first-degree burn.
• Second-degree burns cause blisters and more pronounced swelling. The skin may slough (peel).
• Third-degree burns cause white or black charred skin and loss of pain sensitivity (insensate) because of nerve damage in the deeper tissues. When encompassing (completely around) an extremity (arm or leg), these burns can constrict and cut off circulation, leading to limb loss.
• "Burn or smoke-exposed" patients may develop shortness of breath; inhalation of smoke and toxins may cause death, even if they have little or no skin burns. This shortness of breath is a medical emergency, even in people that have little or no skin or mucus membrane burns.

Treat burns in the following ways:

• Cool the burned area with moist, clean, cool cloths.
• Rinse with tap water, and clean with soap and water.
• Apply a layer of silver sulfadiazine cream (Silvadene) morning and evening. (Do not use Silvadene near the eyes.) Cover with gauze dressings. Clean off all Silvadene cream with soap and water with each dressing change.
• Blisters may rupture. Remove the dead skin with sterile scissors and tweezers.
• Flush chemical burns with water until all burning pain has stopped. Remove all contaminated clothes.
• Oral antibiotics are usually recommended to prevent infection. If an infection develops, continue antibiotics for at least five days after all signs of infection have gone away. Let the doctor know about drug allergies so the correct antibiotic can be prescribed. Some oral antibiotics can cause sensitivity to the sun, so use sunscreen (at least SPF 15).
• Pain may be relieved with 1-2 acetaminophen (Tylenol) every 4 hours or 1-2 ibuprofen (Advil, Motrin) every 6-8 hours.
• Patients with facial burns, evidence of potential lung involvement (for example, soot in mouth), circumferential limb or torso burns, 20 or 30 burns of 10 % or greater body surface burns may require specialized treatment that addresses the various needs such as airway protection and function, fluid loss and hydration problems, pain control and other burn-related problems. These specialized treatments (s) are usually instituted in conjunction with several specialists in a Trauma center.

• Serious burns and burns to the hands, face, feet, or genitals; those that circumscribe (go completely around) an extremity (arm or leg); or those that involve more than 10% of the body require immediate emergency medical attention. The burn percentage in adults: rule of nines helps determine the percent of the body affected. The surface of one's palm is about 1% body surface area. The patient with limb or life-threatening burns should be transported by ambulance to the nearest Trauma center hospital by ambulance, or if available, a trauma/burn center.
• Consult a doctor for treatment with available medications and advanced treatment facilities; usually, this is a doctor trained in the care of burns who is located in a regional burn center hospital. Oftentimes, severely burned patients, are stabilized and transferred to the burn centers.