Burns are among the most common injuries affecting human skin integrity, caused by exposure to heat, chemicals, electricity, friction, cold, or radiation. They range in severity from superficial redness to life-threatening full-thickness injuries that damage multiple layers of the skin and underlying tissues. Understanding the types, depth, complications, and management of burns is crucial for healthcare professionals, nursing students, and even the general public.
This article explores burns in detail—covering classifications, pathophysiology, clinical features, and treatment strategies—while also highlighting nursing considerations and complications such as inhalation injury and carbon monoxide poisoning.
What is a Burn?
A burn is defined as damage to the skin or other body tissues caused by heat, chemicals, electricity, sunlight, radiation, or friction. The severity of a burn depends on multiple factors:
- Cause of injury
- Depth of skin damage
- Size of burn (percentage of body surface area involved)
- Location of burn
- Presence of inhalation injury or systemic complications
Burns compromise skin integrity, making the body vulnerable to infection, fluid loss, and impaired temperature regulation.
Types of Burns
Burns are classified into seven major types depending on their cause.
Thermal Burns
- Cause: Contact with hot objects, liquids, steam, or flames.
- Examples: Fire burns, scalds from boiling water, steam injuries.
- Common: Most frequent type of burn.
- Features: Ranges from mild redness to deep tissue damage depending on exposure.
Chemical Burns
- Cause: Contact with toxic or corrosive substances such as acids, alkalis, or solvents.
- Examples: Bleach, gasoline, paint thinner.
- Features: Painful, may continue to worsen if chemical is not neutralized. Both skin and internal organ damage possible.
Radiation Burns
- Cause: Prolonged exposure to radiation.
- Examples: Sunburns from UV rays, side effects of cancer radiation therapy.
- Features: Redness, peeling, and long-term risk of skin cancer.
Inhalation Burns
- Cause: Inhaling smoke, flame, or toxic gases during fire accidents.
- Examples: Carbon monoxide poisoning, thermal damage to airways.
- Features: Burns to respiratory tract, risk of airway obstruction, hypoxia, and death.
Friction Burns
- Cause: Skin rubbing against a rough surface.
- Examples: Road rash, carpet burn, treadmill friction burns.
- Features: Combination of abrasion and thermal injury.
Cold Burns
- Cause: Exposure to extreme cold.
- Examples: Frostbite.
- Features: Tissue freezing, necrosis, numbness.
Electrical Burns
- Cause: Electrical current passing through body.
- Examples: Electric shocks, lightning injuries.
- Complications: Cardiac arrhythmias, muscle breakdown (rhabdomyolysis), fractures from sudden contractions.
Burn Injury Depth (Degrees of Burns)
Burns are categorized based on depth and tissue involvement.
First Degree (Superficial Burn)
- Involves only the epidermis.
- Appearance: Pink, red, painful, no blisters.
- Blanching: Present.
- Healing: Within a few days, no scarring.
- Example: Mild sunburn.
Second Degree (Superficial Partial Thickness Burn)
- Involves epidermis and part of dermis.
- Appearance: Blisters, shiny, moist.
- Symptoms: Very painful due to exposed nerve endings.
- Blanching: Present.
- Healing: Takes 2–6 weeks. May leave pigmentation changes.
Third Degree (Full-Thickness Burn)
-
Involves epidermis, dermis, and hypodermis (subcutaneous tissue).
- Appearance: Black, white, brown, leathery, charred.
- Symptoms: No pain (nerve endings destroyed).
- Healing: Skin will not heal on its own—requires grafting.
- Complication: Formation of eschar (dead tissue) which must be removed.
Layers of the Skin and Burn Impact
The skin has three major layers:
- Epidermis: Outermost protective barrier. Superficial burns affect only this layer.
- Dermis: Middle layer containing nerves, sweat glands, and blood vessels. Partial-thickness burns extend here.
- Hypodermis: Deepest layer composed of fat and connective tissue. Full-thickness burns extend into this layer.
Burn Location and Clinical Significance
The location of the burn plays a key role in determining prognosis.
- Respiratory burns: Involving face, neck, or chest—risk of airway compromise.
- Disability-related burns: Hands, feet, joints, and eyes—may impair mobility and vision.
- Infection-prone burns: Perineum, ears, eyes—exposed to high bacterial contamination.
- Compartment syndrome: Tight eschar can restrict blood circulation in extremities.
- Poor healing areas: Patients with diabetes, poor blood supply, or immune deficiency heal slowly.
Inhalation Injury
Burn injuries are not limited to skin; respiratory tract involvement is life-threatening.
Signs of Inhalation Injury
- Singed hair around nose, mouth, or neck
- Hoarseness or trouble talking
- Soot in mouth or sputum
- Confusion or anxiety due to low oxygen
Carbon Monoxide Poisoning
- Carbon monoxide (CO) binds to hemoglobin 200x faster than oxygen, preventing oxygen transport.
- Symptoms: Cherry red skin, headache, dizziness, confusion.
- Management: 100% oxygen therapy; sometimes hyperbaric oxygen therapy.
Potential Complications of Burns
Burn injuries can lead to severe complications if not managed properly:
- Infections: Open wounds serve as entry points for bacteria.
- Fluid loss and shock: Loss of plasma through damaged skin causes hypovolemic shock.
- Cardiac arrhythmias: Electrical burns may trigger life-threatening dysrhythmias.
- Rhabdomyolysis: Muscle breakdown releases myoglobin and hemoglobin, clogging kidneys.
- Respiratory distress: From smoke inhalation or airway swelling.
- Scarring and contractures: Long-term functional impairment.
Nursing and Medical Management of Burns
Treatment depends on the severity and type of burn.
First Aid for Burns
- Stop the burning process immediately.
- Remove patient from danger (fire, electricity, chemicals).
- Cool the burn with running water (not ice).
- Remove tight clothing and jewelry near burn site.
- Cover wound with sterile, non-adhesive dressing.
Hospital Care
- Fluid resuscitation: Using Parkland formula for severe burns.
- Pain management: Analgesics and sedation.
- Wound care: Debridement, antiseptics, dressing changes.
- Antibiotics: For infection prevention.
- Surgery: Skin grafting for deep burns.
- Rehabilitation: Physiotherapy and occupational therapy for mobility.
Burn Severity Assessment Tools
Doctors and nurses use standardized tools to assess burn severity:
Rule of Nines
- Body is divided into regions, each accounting for 9% of total body surface area (TBSA).
- Helps estimate fluid replacement needs.
Lund and Browder Chart
- More precise method considering age-related variations in body proportions.
Burn Prevention Strategies
Burns are largely preventable with safety measures:
- Avoid leaving children near hot stoves or open flames.
- Use protective gear when handling chemicals or electricity.
- Install smoke alarms and fire extinguishers at home.
- Educate workers in high-risk industries about burn safety.
- Use sunscreen to prevent radiation burns.
Comparative Table of Burn Degrees
| Degree of Burn | Skin Layer Affected | Appearance | Pain | Healing Time | Scarring |
|---|---|---|---|---|---|
| 1st Degree | Epidermis | Pink, red | Painful | Few days | None |
| 2nd Degree | Epidermis + Dermis | Blisters, shiny | Very painful | 2–6 weeks | Possible pigmentation |
| 3rd Degree | Epidermis + Dermis + Hypodermis | Black, leathery, white | No/limited pain | Needs grafting | Severe |
Frequently Asked Questions (FAQs)
Q1: What is the most common type of burn?
The most common type of burn is thermal burn, caused by hot liquids, fire, or steam.
Q2: How do I know if a burn is serious?
If the burn is deep, large, located on the face, hands, feet, or genitals, or caused by chemicals/electricity, it requires immediate medical attention.
Q3: Why do third-degree burns not cause pain?
Third-degree burns destroy nerve endings in the skin, leading to loss of sensation.
Q4: Can a person survive with 70% body burns?
Survival depends on age, overall health, and medical care. With modern burn units, survival rates have improved significantly, but prognosis remains poor for very extensive burns.
Q5: What is the role of nurses in burn management?
Nurses provide wound care, fluid resuscitation, pain relief, infection prevention, and emotional support to burn patients.
Q6: What is eschar in burns?
Eschar is a dry, dark, dead tissue covering a full-thickness burn that must be surgically removed.
