The term ‘burn’ encompasses a range of tissue
injuries that includes thermal, electrical,
chemical, and radiation injuries. Common to
all of these is the destruction of cellular
membranes.
Thermal burns are caused not by any one substance,
but rather by the temperature of that substance.
They can be further classified as either hot
or cold injuries.
Electricity can cause extensive injury to
any tissue through which it travels. Electrical
burns can be difficult to identify initially
because the surface tissues may appear normal
despite extensive damage hiding below.
Chemical Burns are caused by substances that
are either basic or acidic. These substances
disrupt cellular membranes, resulting in cellular
dysfunction, leakage, and ultimately cell
death. It is critically important to recognize
chemical injuries early in order to stop further
injury through decontamination.
Radiation burn injuries are caused by exposure
to radioactive materials. These burns only
occur when radiation levels are extremely
high.
After identifying the cause, it is important
to determine the severity of injury. The severity
of a burn injury is related to the depth of
burn and the extent of involvement, represented
as the percent of body surfaced burned. 1st
degree burns include the epidermis only. 2nd
degree burns include portions of the dermis.
3rd degree burns involve all skin layers and
beyond.
In the setting of high temperature thermal
and chemical burns, the risk of inhalation
injury must be evaluated. Burn injuries to
the face, soot on the mucosa, and pharyngeal
edema are signs that the patient’s airway
has been exposed to high temperatures and
pose a risk to the patient’s airway.
Treatment must take in account both cause
and extent. Burn victims are at risk of dehydration
as well as edema, so intravenous therapy must
be administered carefully. Risk of infection
must also be considered with appropriate prophylaxis
when indicated. Finally, burn injuries are
painful, so analgesia is important.
