A burn is an injury to the tissue of the body, typically the skin. Burns can vary in severity from mild to life-threatening. Most burns only affect the uppermost layers of skin, but depending on the depth of the burn, underlying tissues can also be affected. Traditionally, burns are characterized by degree, with first being least severe and third being most. However, a more precise classification system referring to the thickness or depth of the wound is now more commonly used. For the sake of this article, burns will be described by thickness. For a comparison of the two classification systems, see the table below.
When burns extend through the epidermis and into the dermis, they are considered to be partial-thickness (second-degree) burns. The dermis itself is divided into two regions, the uppermost being the papillary region. This area is composed mostly of connective tissue and serves only to strengthen the connection between the epidermis and the dermis. Partial-thickness burns that only extend down to this layer of the skin are considered superficial.
Another contributing factor to burn severity is how much of the body is affected. The "rule of nines" is a method of approximation used to determine what percentage of the body is burned. Partial- or full-thickness burns on more than 15% of the body require immediate professional medical attention. The following approximations can be used for adults:
Additionally, the palm (not including the fingers or wrist area) is approximately 1% of the total surface area of the body, and can be used to approximate noncontiguous burn areas.
With superficial partial-thickness burns, the skin will be extremely red, appear wet and/or shiny, painful to the touch, and will form blisters. Once again, blanching may occur, but color will return quickly after pressure is removed.
Burns can be caused by a large variety of external factors. The most common types of burns are:
The three major goals for treating any burn are to prevent shock, relieve pain and discomfort, and reduce the risk of infection.
Small (less than 3 inches in diameter) partial-thickness burns:
If blisters are not broken, remove any jewelry or clothing from the area and run cool water over it for about 10 minutes. Take care to not open any blisters, as this will increase the risk of infection. If the blisters are broken, do not run cold water over the area and do not remove clothing that may be stuck to the burn surface. Doing so can increase the risk of shock.
Full-thickness burns or partial-thickness burns covering more than 15% of the body:
While waiting for medical professionals to arrive, start by ensuring the patient is no longer in contact with any burning or smoldering materials. Do not remove clothing that may be stuck to the burn surface, and cover the area with a sterile, non-adhesive bandage, a clean cloth, or a sheet (depending on what is available and how large the affected area is). Once again, be careful not to open any blisters. If the fingers or toes have been burned, use sterile, non-adhesive dressing to separate them. If possible, elevate the affected body part above the heart to reduce inflammation. If the patient is exhibiting signs of shock (clammy hands or feet, bluish skin tone, weak but fast pulse rate, rapid breathing, or low blood pressure) and hasn’t sustained a head, neck, back, or leg injury, start by laying them on their back. Elevate their feet about 12 inches to encourage blood flow back towards the vital organs and gently cover them with a coat or blanket to help stabilize their core temperature. Monitor the patient’s vital signs until medical help arrives.
The following precautions should be observed in dealing with any type of burn:
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WebMD. Burns – Topic Overview. WebMD. http://firstaid.webmd.com/tc/burns-topic-overview. Accessed May 24, 2018.