burn
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Etiology
Pathology
- 1st burn is a partial epidermal thickness burn
- 2nd degree burn is full thickness epidermal burn with the dermis remaining largely intact
- 3rd degree burns are full thickness epithelial burns with damage to the underlying dermis
- 4th degree burn: similar to 3rd degree burn, but also involves muscle, tendon &/or bone
- epithelial appendages within the dermis provide the seed for re-epithelialization for a burned area
Clinical manifestations
- 1st & second degree burns are hypersensitive & painful
- 3rd degree burns destroy nerves making them insensitive to pain
- 1st degree burns
- 2nd degree burns
- same as 1st degree burns plus, blisters, shiny appearance, weeping
- 2nd degree, superficial partial-thickness burns
- second-degree, deep partial-thickness burn
- 3rd degree burns
- full-thickness burns destroy the entire epidermis & dermis, often extending into the subcutaneous fat
- skin charred with a leathery surface insensitive to pain or touch
- surface will not blanch because blood vessels are thrombosed
- 4th degree burn:
- burns extend beyond the skin & subcutaneous tissue into underlying structures such as muscle, tendon, or bone
Complications
- 50% of deaths associated with burns are due to complications of inhalation injury
Management
- estimation of body surface area (BSA) burned
- outpatient treatment (minor burns)
- 1st degree burns
- 2nd degree burns < 15% of BSA
- 3rd degree burns < 2% of BSA
- burns that spare the face, hands, feet & perineum
- inpatient treatment (burn unit)
- more extensive burns
- 3rd degree burns
- chemical or electrical burns
- associated inhalation injury or major trauma
- burns that involve the face, hands, feet, genitals. perineum or major joints
- patients with significant medical problems
- special social, emotional, or rehabilitation intervention
- 1st degree burns
- cooling, ice or cold compresses
- analgesics
- emollient
- topical anesthetic
- 1st degree burns will heal spontaneously without scarring in 3-4 days
- dressing not indicated[3]
- 2nd degree burns
- debridement
- intact blisters may be left for 3-4 days if no sign of infection
- bulky blisters may be decompress & devitalized skin removed
- gentle cleansing with antiseptic or mild soap
- topical antibiotics
- bacitracin for very limited 2nd degree burns
- silver sulfadiazine (Silvadene) is preferred agent for larger or deeper burns
- dressings
- tetanus prophylaxis
- tetanus toxoid 0.5 mL SC booster
- tetanus immune globulin (Hyper-Tet) 25 U IM plus tetanus toxoid 0.5 mL SC if never immunized
- 2nd degree burns heal spontaneously without scarring in 2-3 weeks
- debridement
- 3rd degree burns
- generally requires skin grafting
- months may be required for healing
- scarring occurs
- 4th degree burn: referral to burn center
- extensive burns (> 15% of BSA)
- may require fluid resuscitation
- 2-4 mL x weight in kg x % 2nd or 3rd degree burn/24 hr
- administer 1st 1/2 over 8 hours
- beta blocker (propranolol 1 mg/kg every 4 hours) may attenuate catabolic response to catecholamines[2]
- may require fluid resuscitation
- vitamin C 500 mg QD & vitamin A 10,000 IU QD may be helpful
- if burn overlies a joint, attempt full range of motion at least 3 times/day
- elevation of burned part to limit edema
- diet
- 30 kcal/kg/day
- dietary protein 2.5 g/kg/day
- supplemental glutamine & arginine may diminish infections[3]
More general terms
More specific terms
- chemical burn; corrosion
- first degree burn
- fourth degree burn
- ocular burn
- second degree burn
- sunburn
- thermal burn
- third degree burn
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1001-1002
- ↑ 2.0 2.1 Journal Watch 21(23):188, 2001 Herndon DN et al Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345:1223, 2001 PMID: https://pubmed.ncbi.nlm.nih.gov/11680441
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S. Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers. J Am Acad Dermatol. 2012 May;66(5):e159-65 PMID: https://pubmed.ncbi.nlm.nih.gov/20724028
- ↑ Alsbjorn B, Gilbert P, Hartmann B et al Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party. Burns. 2007 Mar;33(2):155-60. PMID: https://pubmed.ncbi.nlm.nih.gov/17280913
- ↑ Hettiaratchy S, Papini R. Initial management of a major burn: II--assessment and resuscitation. BMJ. 2004 Jul 10;329(7457):101-3 PMID: https://pubmed.ncbi.nlm.nih.gov/15242917
- ↑ Alharbi Z, Piatkowski A, Dembinski R et al Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form. World J Emerg Surg. 2012 May 14;7(1):13 PMID: https://pubmed.ncbi.nlm.nih.gov/22583548
- ↑ Rex S Burn injuries. Curr Opin Crit Care. 2012 Dec;18(6):671-6 PMID: https://pubmed.ncbi.nlm.nih.gov/23037877
- ↑ Greenhalgh DG. Management of burns. N Engl J Med. 2019;380:2349-59. PMID: https://pubmed.ncbi.nlm.nih.gov/31189038
- ↑ Jeschke MG, van Baar ME, Choudhry MA, et al. Burn injury. Nat Rev Dis Primers. 2020;6:11. PMID: https://pubmed.ncbi.nlm.nih.gov/32054846
- ↑ National Institute of General Medical Sciences Burns https://www.nigms.nih.gov/education/fact-sheets/Pages/burns.aspx