A burn is an injury to the skin and other tissues typically caused by heat, cold, chemicals, electricity, radiation, or friction. Most burns are minor, and the injured person doesn’t need to be hospitalized. However, some burns require emergency treatment, and around 6.5 percent of all burns have to be treated in a specialized burn center. Whether or not a patient requires specialized treatment depends on a range of factors. These include the depth of the burns, the surface area of the body that was burned, and the age and health of the patient.
About 86 percent of burns are thermal burns. These are injuries caused by excessive heat, and they are usually due to contact with steam, flames, hot liquids, or hot surfaces. Forty-three percent are from fire or flames, 34 percent from scalds, and nine percent from hot objects. Other types of burns include electrical burns, friction burns, and chemical burns.
Risk Factors for Thermal Burns
Anyone can suffer a thermal burn, but some people are more at risk than others. Children and males are especially at risk. Children are often in contact with hot liquids, while males tend to work in jobs that make burn injuries more likely. Thermal burns resulting from flames are more common during the summer when people use gasoline for outdoor activities. Alcohol consumption is also a risk factor in burn injuries among adults. In addition, not having smoke detectors in a building puts the occupants in danger of suffering burns.
How Thermal Burns Affect the Skin
To understand thermal burns, it’s important to know some basic facts about the skin. The skin is the largest organ of the human body, and it accounts for around 16 percent of an individual’s weight. It protects the body against infection, regulates temperature, and prevents fluid loss. The skin is made up of three layers, the epidermis, dermis, and hypodermis or subcutaneous tissue.
The epidermis is the thinner outer layer, while the dermis is a thicker, deeper layer, and the hypodermis is the innermost layer. The latter is made up of fat as well as connective tissues that surround larger blood vessels and nerves.The thickness of this layer varies throughout the body and also from one person to another.
Types of Burns
The severity of a burn injury depends on the number of skin layers that are affected. Burns were traditionally categorized by degree, but healthcare professionals now classify them based on whether they’re full, partial, or superficial. These more or less correspond with the three layers of the skin. However, many burn injuries involve all three types of burns.
A superficial burn is one that involves only the epidermis. This type of injury is red and painful, and the area turns white when it is touched. There are no blisters present, and the skin is moist.
Partial-thickness burns involve both the epidermis and some part of the dermis. This type of burn can be either superficial or deep, depending on how much of the dermis is affected. Superficial partial-thickness burns are also red and painful, and the burned area turns white when touched. The skin is mottled and moist, and both blisters and hairs are present.
With deep partial-thickness burns, sometimes the damage goes so deep that the nerve endings are destroyed. This means this type of burn isn’t always painful. If the sweat glands are also destroyed, the skin will be dry rather than moist. The hair is usually gone, and the area may not turn white when it is touched.
Full-thickness burns are the most severe since they affect all of the first two layers of the skin. This means hair follicles, nerve endings, small sweat glands, and small blood vessels are all destroyed. In the most serious cases, even bones and muscles are damaged. These burns are painless, and there’s no sensation to touch. The skin is dry, and it may be charred or pearly white. It may also appear leathery.
When to Seek Medical Attention for Thermal Burns
Minor burns can be treated at home, while more serious burns will require a doctor’s attention. Victims should seek emergency medical care for partial or full-thickness burns on the hands, feet, eyes, ears, or genitals. Any burn over a major joint should also be treated as an emergency. Other emergencies include:
- Full-thickness burn injuries that look dry or charred
- Partial-thickness burns that are larger than the injured person’s palm
- Any burn that results in uncontrollable pain
Some situations require that the victim be transported in an ambulance. These include:
- Large full or partial-thickness burns about the body
- Burns to the face that cause problems with breathing
- Significant exposure to smoke in a closed room
- Loss of consciousness
Treatment and Recovery
Burn wounds change in the days following injury as inflammation sets in, and healing begins. Older adults and those who are ill often take longer to heal even when their thermal burns are superficial. Meanwhile, burns on the feet and lower leg tend to get deeper and more painful in the subsequent days, especially if the patient doesn’t keep the leg elevated.
Small superficial burn injuries don’t usually become infected. However, sometimes burn that were initially classified as superficial don’t heal, or they appear to be getting deeper. This can be a sign of infection. If a wound doesn’t seem like it will 14 days after the injury, more specialized treatment may be necessary.
A team of healthcare professionals, including emergency physicians, burn nurses, dietitians, dermatologists, and plastic surgeons, may be required to treat severe burns. Extensive partial-thickness and full-thickness burns require prolonged treatment. In addition to weeks or months of dressing changes, some patients need several plastic surgery procedures.
Physical therapy and pain management also form part of the treatment process. The effects of a serious burn injury aren’t only physical, and patients may also need mental health treatment. Many experience anxiety, depression, post-traumatic stress disorder, and sleep disturbances.
Prognosis
The outcome of a burn injury depends on several factors. Superficial burns have a good prognosis, but partial and full-thickness burns can have high mortality and mobility. Really young or really old patients are also at greater risk of having poor outcomes. Inhalation injuries and other co-morbidities also affect the outcome.
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