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Burns
Author: C. Wayne Cruse, M.D.
Director, Tampa Bay Regional Burn Center
Associate Professor - Division of Plastic Surgery - University
of South Florida
Definitions:
1st degree burn......is a superficial, reddened area of
skin like a sunburn.
2nd degree burn.....is a blistered injury site which
may heal spontaneously after the blister fluid has bee removed.
3rd degree burn......is a burn through the entire skin
and will usually require surgical intervention for wound healing.
Scald........................May occur from scalding
hot water, grease or radiator fluid.
Thermal.............….May occur from flames,
usually deep burns.
Chemical............….May come from acid and
alkali, usually deep burns.
Electrical.................Either low voltage around a
house or high voltage at work
Explosion Flash......Usually superficial injuries.
Contact Burns........Usually deep and may occur from
muffler tail pipes, hot irons and stoves.
General Information:
- 2 million people in the U.S. each year are treated for
burn injuries.
- 100,000 of these patients require hospitalization
Initial Assessment:
- Did the burn occur in an open or closed environment. A
closed environment may be an indicator to look for
pulmonary problems.
- What was the time and circumstances of the burn?
- Are there any other concomitant injuries?
- Are there changes in sensorium?
Treatment Goals:
- Superficial burns heal spontaneously within the
first two weeks. Treatment consists of pain relief and
topical wound care to relieve pain and prevent infection.
- Deeper burns will not heal within 2 weeks and may
require surgical intervention and should be cared for by
a surgical specialist.
- The goal of burn care is to prevent infection and obtain
a closed injury site. This may be accomplished in minor
wounds by applying topical antibacterial creams. A minor
wound may also respond well to non-adherent guaze such as
vaseline impregnated gauze.
- Principles of wound care include: preventing desiccation
(drying) and preventing infection. Large wounds may
require attention to nutritional support, pain relief,
inhalation injuries and hospitalization.
- When a burn occurs, the initial therapy should include
cooling of the burn injury site. After that, treatment
should be rendered by the appropriate family practitioner
or regional burn center.
- Consider fluid administration - Lactated Ringer's
solution. You want a urinary output of 30 - 50 cc's.
- Tetanus Toxoid booster
- 3rd degree burns should be treated with topical
antibacterial agents and surgical therapy should be
contemplated.
Laboratory Data
- Baseline CBC
- Urine analysis
- Serum electrolytes
- Arterial blood gas
- Carboxyhemoglobin levels
- Chest x-ray/ other x-ray
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