Burns are injuries of the skin involving the epidermis and dermis to
varying degrees. 86% of burn injuries are thermal, 4% electrical, and
3% chemical, with the other 7% attributable to varying miscellaneous
sources such as radiation injury (Schaefer & Szymanski, 2020). The
majority of burns are small and superficial, requiring little
intervention. extensive burns, however, require treatment as major
trauma and can evoke systemic response.
Violation of the integumentary layer removes the body's first line of
defense against infection, which is the primary way in which burns
can have significant consequences for overall health. In the case of
severe burns, the role of the skin in retaining fluid is also
compromised and patients can suffer significant electrolyte
imbalances as a result of incredibly large and rapid shifts of fluids
(Schaefer & Szymanski, 2020).
Burns are classified first by the cause or type of burn: Thermal,
electrical, chemical (further divided into acid or alkali burns),
radiation, friction, or cold exposure (Schaefer & Szymanski, 2020).
Extent of the burn is determined by percentage of total body surface
area involved [TBSA]. Burns are then classified by depth: first degree
or superficial involves only the epidermis, second degree or partial
thickness burns involve both the epidermis and dermis, and third
degree or full thickness burns violate all layers of the skin and extend
into subcutaneous tissues (Schaefer & Szymanski, 2020).
Superficial burns are characterized by a warm, dry, red, painful, soft,
and blanching area which is rarely blistered in appearance. Partial
thickness burns are similarly painful, red, soft, and blanching, but are
often blistered and moist in appearance. Full thickness burns are
characterized by little to no pain; a white, brown, or charred
appearance; a firm and leathery texture to palpation; and no
blanching with palpation.
Diagnosis of burns and their extent is primarily visual, although in
extensive burns labs such as CBC and chemistry panel are warranted.
Similarly, if inhalation injury is suspected a carboxyhemoglobin level
should be obtained.
Otherwise, percent TBSA is determined by the Rule of Nines, the
Lund & Browder chart (more accurate, especially in pediatrics), and
the Palmar Surface Rule for small burns (Schaefer & Szymanski,
2020). When calculating percent TBSA, only partial and full thickness
burns are considered and superficial burns are excluded.
Schaefer, T. J., & Szymanski, K. D. (2020). Burn Evaluation And
Management. PubMed; StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430741/
