❤️‍🩹First Aid Unit 8 – Burn Injuries – Classification and Treatment

What Are Burn Injuries?

• Burn injuries result from exposure to heat, chemicals, electricity, or radiation causing damage to the skin and underlying tissues
• Severity of burn injuries depends on factors such as temperature, duration of exposure, and depth of tissue damage
• Burns can range from minor superficial injuries affecting only the outer layer of skin (epidermis) to severe full-thickness burns penetrating deep into the dermis and subcutaneous tissues
• Burn injuries trigger a complex physiological response involving inflammation, fluid loss, and increased risk of infection
• Extensive burn injuries can lead to systemic complications such as hypovolemic shock, electrolyte imbalances, and organ dysfunction
• Burns on critical areas (face, hands, feet, genitals) or those covering a significant portion of the body surface area require prompt medical attention
• Inhalation injuries from smoke or chemical fumes can accompany burn injuries and pose additional respiratory complications

Types of Burns

• Thermal burns caused by exposure to hot objects, flames, steam, or scalding liquids are the most common type
• Chemical burns result from contact with strong acids, alkalis, or other corrosive substances causing tissue damage through direct chemical reactions
• Electrical burns occur when an electric current passes through the body generating heat and causing deep tissue damage along its path
• Radiation burns can result from prolonged exposure to ultraviolet light (sunburn) or from ionizing radiation sources such as X-rays or radioactive materials
• Friction burns occur when skin rubs against a rough surface generating heat and abrasion (road rash)
• Cold burns (frostbite) result from prolonged exposure to extremely cold temperatures leading to tissue freezing and cell death
• Inhalation burns affect the respiratory tract due to inhaling superheated air, steam, or toxic fumes causing airway swelling and breathing difficulties

Burn Classification Systems

• Burns are classified based on the depth of tissue damage to guide treatment decisions and assess prognosis
• First-degree (superficial) burns involve only the epidermis causing redness, pain, and mild swelling without blistering
  • Heal within a few days without scarring
  • Example: mild sunburn
• Second-degree (partial-thickness) burns extend into the dermis and are further subdivided into superficial and deep partial-thickness burns
  • Superficial partial-thickness burns cause blistering, severe pain, and redness but maintain intact dermal elements for regeneration
    • Usually heal within 2-3 weeks with minimal scarring
    • Example: scald from hot liquid
  • Deep partial-thickness burns have a mixed red and white appearance, diminished pain sensation, and slower healing potential
    • May require skin grafting and result in some scarring
• Third-degree (full-thickness) burns destroy the entire epidermis and dermis extending into the subcutaneous layer
  • Appear white, brown, or charred with a leathery texture and no pain sensation due to nerve damage
  • Require surgical intervention, skin grafting, and result in significant scarring
  • Example: prolonged contact with open flame
• Fourth-degree burns extend beyond the subcutaneous layer into underlying muscle, fascia, or bone
  • Most severe and potentially life-threatening
  • Often require extensive reconstructive surgery and carry a high risk of complications

Assessing Burn Severity

• Burn severity assessment considers both the depth and extent of the burn injury to guide treatment and determine prognosis
• The "rule of nines" is a quick method to estimate the percentage of total body surface area (TBSA) affected in adults
  • Each arm: 9%, each leg: 18%, anterior trunk: 18%, posterior trunk: 18%, head and neck: 9%, perineum: 1%
  • For children, the head and neck account for a larger proportion while the legs represent a smaller percentage
• The Lund-Browder chart provides a more accurate TBSA estimation taking into account age-related body proportions
• Burns involving >20% TBSA in adults or >10% in children are considered major burns requiring specialized care
• Circumferential burns encircling a limb or digit can impair circulation and may necessitate escharotomy (surgical release) to prevent compartment syndrome
• Inhalation injury severity is assessed based on signs such as singed nasal hair, carbonaceous sputum, hoarseness, and breathing difficulty
• Comorbidities, age extremes, and concomitant injuries also influence burn severity and treatment considerations

First Aid for Burns

• The primary goals of first aid for burns are to stop the burning process, cool the affected area, and prevent further injury
• For thermal burns, immediately remove the person from the heat source and cool the burn with running cool (not cold) water for at least 10-20 minutes
  • Avoid ice or very cold water as it can cause vasoconstriction and worsen tissue damage
• Remove any clothing or jewelry near the burn area unless adherent to the skin
  • If clothing is stuck to the burn, cut around it leaving the adherent portion in place
• Cover the burn with a clean, dry, non-adherent dressing or cloth to protect from infection and reduce pain
  • Avoid applying creams, ointments, or home remedies that can interfere with medical assessment and treatment
• For chemical burns, brush off any dry chemical and irrigate the area with copious amounts of water for at least 20 minutes
  • Consult the chemical's safety data sheet (SDS) for specific first aid instructions
• Electrical burns require ensuring scene safety and disconnecting the power source before approaching the victim
  • Check for other injuries such as falls or cardiac arrhythmias
• Elevate burned extremities above the level of the heart to reduce swelling
• Monitor the person's vital signs, keep them warm to prevent hypothermia, and provide reassurance
• Seek immediate medical attention for severe burns, burns on critical areas, or any concerning symptoms

Advanced Treatment Methods

• Advanced burn treatment focuses on wound care, fluid resuscitation, pain management, and preventing complications
• Cleansing and debridement of the burn wound remove dead tissue, foreign material, and blisters to promote healing and prevent infection
  • Performed under sterile conditions using surgical tools, enzymatic agents, or hydrotherapy
• Topical antimicrobial dressings containing silver sulfadiazine, silver foam, or honey help prevent and treat wound infections
• Regular dressing changes maintain a moist wound environment and allow monitoring of healing progress
• Fluid resuscitation using the Parkland formula ($4 \text{ mL} \times \text{TBSA percentage} \times \text{body weight in kg}$) replaces fluid losses and maintains hemodynamic stability
  • Typically involves isotonic crystalloid solutions such as Lactated Ringer's administered intravenously
• Pain management with opioid analgesics, anxiolytics, and non-pharmacological techniques (relaxation, distraction) is crucial for patient comfort and cooperation
• Nutritional support with high-calorie, high-protein diets promotes wound healing and counteracts the hypermetabolic response to burn injury
• Early ambulation and physical therapy help maintain joint range of motion, prevent contractures, and reduce the risk of thromboembolism
• Skin grafting using autografts (patient's own skin), allografts (cadaveric skin), or xenografts (animal-derived) can provide temporary or permanent wound coverage
  • Techniques include split-thickness grafts, full-thickness grafts, and cultured epithelial autografts
• Advanced wound care products such as dermal substitutes, growth factors, and negative pressure wound therapy may be used in select cases

Complications and Long-Term Care

• Burn injuries can lead to various local and systemic complications requiring ongoing management
• Infection is a common complication due to the loss of skin barrier and immunosuppression
  • Regularly monitor for signs of infection (fever, redness, purulent discharge) and treat promptly with antibiotics
• Scarring and contractures can cause functional and aesthetic impairments
  • Scar management techniques include pressure garments, silicone gel sheeting, and massage therapy
  • Reconstructive surgeries such as contracture release, tissue expansion, and flap procedures may be necessary
• Hypertrophic scars and keloids are abnormal proliferative responses to burn injury
  • Treated with intralesional corticosteroids, cryotherapy, laser therapy, or surgical excision
• Pruritus (itching) is a common and distressing symptom during burn wound healing
  • Managed with moisturizers, antihistamines, and gabapentinoids
• Psychosocial support addressing post-traumatic stress, anxiety, depression, and body image concerns is essential for comprehensive burn care
• Rehabilitation and occupational therapy help restore function, adapt to limitations, and reintegrate into daily activities
• Long-term follow-up with a multidisciplinary burn care team ensures ongoing assessment, treatment adjustments, and early detection of complications
• Patient education on proper wound care, sun protection, and recognizing signs of complications empowers self-management and improves outcomes

Prevention and Safety Measures

• Implementing prevention and safety measures is crucial to reduce the incidence and severity of burn injuries
• Install and maintain smoke alarms on every level of homes and workplaces to ensure early detection of fires
• Develop and practice fire escape plans with multiple exit routes and designated meeting points
• Keep fire extinguishers readily accessible and ensure proper training on their use
• Childproof homes by placing barriers around heat sources (stoves, fireplaces) and storing flammable materials out of reach
• Set water heater temperatures below 120°F (48.9°C) to prevent scalding injuries
• Use caution when handling hot liquids and cooking equipment, employing oven mitts, long-handled utensils, and splash guards
• Promote electrical safety by avoiding overloaded outlets, replacing frayed cords, and using ground-fault circuit interrupters (GFCIs) in high-risk areas
• Store and handle chemicals according to manufacturer instructions, wearing appropriate personal protective equipment (gloves, goggles)
• Encourage sun safety habits such as wearing protective clothing, applying broad-spectrum sunscreen, and limiting midday sun exposure
• Educate on the dangers of fireworks and promote professional displays as safer alternatives
• Support community burn prevention programs targeting high-risk populations and promoting awareness of burn hazards
• Advocate for policies and regulations that enhance burn safety standards in products, buildings, and public spaces