A burn is a traumatic injury to the skin, mucosa, or deeper tissues caused by thermal, electrical, chemical, or radiation exposure. Burns may be:
- Partial thickness: epidermis and part of dermis affected
- Full thickness: complete loss of epithelium and dermis
Burn injuries can cause devastating local damage, but systemic effects like shock, infection, and multi-organ failure are often fatal if not managed early.
Types and Depths of Burns
Superficial burns
- Red, painful, dry
- Blanch on pressure
- Heals in 3–6 days
- No scarring
Superficial partial-thickness burns
- Moist, red, blistering
- Painful, blanching
- Heal in 7–20 days
- May scar
Deep partial-thickness burns
- Blisters or waxy white
- Pain reduced due to nerve damage
- Healing time >21 days
- Scarring is common
Full-thickness burns
- Waxy white to black
- No blanching, no pain
- Require surgical treatment
Common Causes of Burns
Thermal injury: dry heat (flames), wet heat (boiling liquids, steam)
Electrical burns: deep burns with entry/exit wounds
Chemical burns: alkali/acid-based; industrial exposure
Radiation burns: sunburn, chronic exposure
Wallace’s Rule of 9s: Estimating Burn Area
| Body Area | % TBSA (Total Body Surface Area) |
|---|---|
| Head and neck | 9% |
| Each arm | 9% |
| Each leg | 18% |
| Front of torso | 18% |
| Back of torso | 18% |
| Perineum | 1% |
Clinical Features and Burn Grading
Burn features depend on depth and cause:
- Pain, redness, blistering (early)
- Eschar, dryness, insensitivity in deeper burns
- Systemic: tachycardia, hypotension, oliguria (in major burns)
Investigations in Burns
- FBC, U&E, Blood glucose
- ABG and chest X-ray if inhalation suspected
- ECG in electrical burns
- Crossmatch for anticipated transfusion
Local and Systemic Complications
Local
- Corneal burns → treated with tarsorrhaphy
- Circumferential burns → may need escharotomy
- Perineal burns → high risk of infection
Systemic
- Sepsis, DIC, ARDS
- Curling’s ulcer (gastric ulceration)
- Renal failure, stress ulcers
- Paralytic ileus, pancreatitis
Fluid Resuscitation
Parkland Formula
4 × body weight (kg) × %TBSA = mL of Ringer Lactate in 24 hrs
→ Half in first 8 hours, rest over next 16 hours
Muir-Barclay Formula
% burn × weight (kg) ÷ 2 = aliquots of fluid
Given over first 36 hrs in 4, 4, 4, 6, 6, 6-hr cycles
Use burn time (not hospital arrival time) for calculation.
Emergency Management and Burn Centre Referral
Major Burn Criteria:
- 10% TBSA in adults or >5% in children
- Face, hands, feet, genitalia, perineum burns
- Full-thickness burns
- Electrical/chemical/inhalational injuries
- Burns with trauma or comorbidities
Refer to burns center immediately.
Specific Burns: Eye, Perineal, Inhalational
Ocular burns: require ophthalmology consult
Perineal burns: catheterization, infection control
Inhalational: airway edema, bronchoscopy, humidified oxygen
Early and Late Complications
Early
- Infection (MRSA, Pseudomonas)
- Renal failure (hypovolemia, sepsis)
- Curling’s ulcer, paralytic ileus
Late
- Contractures
- Keloids
- Chronic pain or disability
Burn Wound Care and Surgical Interventions
Dressings: silver sulfadiazine, hydrogel
Escharotomy: for circumferential burns
Skin grafting: for full-thickness or infected wounds
Surgical debridement: early for best outcomes
Pediatric Burns: Special Considerations
- Higher surface area to weight ratio
- Fluid loss more critical
- Airway burns more severe
- Nutritional support essential
Prognosis and Rehabilitation
- Depends on depth, TBSA, and age
- Burns <10% TBSA heal well with minimal scarring
- Major burns → long-term rehab, physiotherapy, plastic surgery
- Scar revision, compression garments often needed
Key Takeaways for NEET PG and MBBS Exams
High-Yield Concepts:
- Wallace Rule of 9s
- Parkland formula
- Full vs partial thickness
- Curling’s ulcer, ARDS, sepsis
- Escharotomy, inhalational injury
- Early excision and grafting
FAQs
What is considered a major burn?
20% TBSA, or burns to face/perineum/hands, airway involvement, or <5/>60 years of age.
When to do an escharotomy?
Circumferential full-thickness burns with compromised circulation or breathing.
Best fluid for burn resuscitation?
Ringer lactate is the fluid of choice.
Conclusion
Burns are more than just skin injuries—they're complex systemic emergencies. Timely recognition, accurate fluid management, surgical intervention, and long-term care are vital to reduce mortality and disability. For MBBS students and NEET PG aspirants, mastering the classification, complications, and treatment protocols of burns is essential—not just for exams, but for life-saving practice.
