- Burns describe injury to various layers of the skin. The skin is an important organ that protects us against infections (from the "outside world"), Dehydration (water
loss), and overheating.
- First-degree burns affect the top
layer (epidermis) of the skin (i.e., least severe injury);
second-degree burns affect both the outer and the underlying
layer (dermis) of skin; third-degree burns (most severe)
affect all layers, including the deep layer of skin. The
dermis is where the hair follicles, blood vessels, nerve
endings (involved with sensation, temperature, and pain
reception), and sweat glands reside. Underneath the dermis
lie the muscles, nerves, larger blood vessels, and bones.
The extent of damage to the skin depends on the type, size,
and severity of the burn.
- Direct heat such as hot steam, fire, explosions, hot
water, friction (rubbing action produces heat), radiation,
sunrays, other heated objects or liquids.
- Chemicals such as sulfuric acid can burn the skin.
- Electricity (especially alternating currents) may also
burn the skin.
- Inhalation of fumes, smoke, or steam can cause burns.
- In children and the elderly, burns may be a sign of
physical abuse, or diseases such as Alzheimer's.
- First degree -- mild, with reddened
skin, pain, and swelling
- Second degree -- pain, swelling,
red skin with blisters (fluid-filled sac)
- Third degree -- the skin may be
charred and blackened, but often painless (due to underlying
- Inhalation burns -- there may be burned lips, mouth, and
- Face (eyebrows, nose hairs,
eyelashes, scalp hair) may be reddened or burned.
- Patient may have difficulty with
breathing or coughing.
- With severe burns the patient will be in Shock (falling
blood pressure, severe fluid and blood loss) and possibly
suffer symptoms of hysteria/dementia.
- Electrical burns with high voltage
(> 1000 V) commonly damage multiple organ
systems, and may be associated with cardiac arrest.
- Burns are at increased risk of being infected (as with
- History of exposure, symptoms,
occupation, illnesses, allergies, medications, and personal
- Medical exam by physician will
reveal the skin changes of burns.
- Inhalation victims may require chest X-Rays.
- Severe burns require admission to a hospital emergency
room or trauma/burn center for further evaluation of
the patient's vital signs (temperature, pulse, respiratory rate,
blood pressure), oxygen levels, blood chemistries, and
overall assessment of damage to internal organs and
- Smokers -- fall asleep while
- Arson victims
- Automobile accidents
- Lightning victims
- Fire fighters
- Laboratory workers
- Miners exposed to toxic fumes and
- Military personnel
- Depends on severity, size and type
- Minor burns --
- Protect the burn by covering it
with sterile gauze or bandage (avoid friction or pressure)
- Soaking in cool water may help
(not in cold climate)
- Pain management with
over-the-counter medications (Tylenol, aspirin, etc.)
- If the skin is not healing well
in a few days, or the burn is greater than 3 cm in
diameter, or the burn is over the face-contact a physician
- If the patient appears sick and
presents changes in alertness, confusion, fever, severe
pain, or loss of consciousness- seek immediate emergency
medical treatment, regardless of the type of the burn.
- Even small burns that result in
an open sore, loss of skin layers, or ulceration should be
discussed with (and possibly seen by) a physician. Often
an anti-infective cream, Silvadene, is prescribed.
- A Tetanus shot may be required if the patient's vaccine status is not up-to-date (Tetanus boosters
are usually given every 7-10 years).
- If you suspect an inhalation
burn, seek immediate emergency medical treatment.
- In all cases, keep the burn site
clean and do not apply ointments (unless prescribed),
creams, butter, toothpaste, or any household remedies
until you check with your physician.
- Do not burst the blisters or rub
- If the burn is severe, do not
soak it in ice water.
- If the burn is due to exposure to chemicals, radiation, electrocution, inhalation, or the patient is in Shock-call 911.
- Major injuries need to be seen by
a physician immediately.
- If someone is on fire-don't
panic. Douse with water if available, wrap in a thick wool
or cotton blanket, rug, or coat, roll them on the ground
to put out the flame (i.e., "stop, drop, and roll"), and
- Do not obstruct the airway --
make sure the patient can breathe.
- In severe burn injuries, do not
give anything by mouth and wait for trained professionals
- Follow and learn the procedures for burns if you work
in a hazardous
- For minor burns follow the steps
above or contact your doctor.
- For severe burns call 911.