Burn

Burn
Name	Burn
Field	Emergency medicine, Plastic surgery, Dermatology
Symptoms	Pain, blistering, erythema, charring
Complications	Sepsis, Acute respiratory distress syndrome, Keloid, Contracture
Onset	Immediate
Types	Thermal, chemical, electrical, radiation
Treatment	Cooling, analgesia, Fluid resuscitation, debridement, Skin grafting

Burn

Burns are acute tissue injuries caused by external agents that disrupt integumentary and deeper structures, producing pain, fluid loss, infection risk, and potential systemic shock. Management spans prehospital first aid, emergency resuscitation, surgical reconstruction, and rehabilitation involving specialists from Emergency medicine, Plastic surgery, Intensive care medicine, and Rehabilitation medicine. Epidemiology varies by geography, with major public health programs from organizations such as the World Health Organization, Centers for Disease Control and Prevention, and national burn registries guiding prevention.

Classification and Severity

Burns are classified by depth and extent. Depth categories include superficial (epidermal), partial-thickness (superficial and deep dermal), and full-thickness (subcutaneous and deeper), with corresponding examples such as sunburn, scalding, and flame injuries. Severity assessment uses total body surface area (TBSA) estimates via tools like the Rule of Nines, Lund and Browder chart, and paediatric adjustments, combined with patient factors such as age, comorbidity (for instance, chronic conditions tracked by World Health Organization datasets), and inhalation injury from events like the Station nightclub fire or structural fires documented by National Fire Protection Association. Major burns often meet criteria for specialist referral in regional burn centers such as those affiliated with Johns Hopkins Hospital, Massachusetts General Hospital, Royal Adelaide Hospital, and national trauma systems like NHS England trauma networks.

Causes and Mechanisms

Causative agents include thermal contact (flame, scald from hot liquids, contact), chemical exposure (acids, alkalis, oxidizers), electrical current (low-voltage household, high-voltage industrial), and ionizing radiation (therapeutic radiotherapy, nuclear incidents like Chernobyl disaster). Mechanistically, thermal burns produce coagulative necrosis and protein denaturation; chemical burns cause ongoing tissue destruction until neutralized (alkali saponification, acid coagulation); electrical injury causes deep tissue heat, arrhythmias, and compartment syndromes; radiation induces DNA damage, cell death, and delayed fibrosis as seen in survivors of Hiroshima and therapeutic complications in oncology patients treated at centers such as MD Anderson Cancer Center. Host responses involve inflammatory cascades mediated by cytokines studied in National Institutes of Health–funded research, leading to capillary leak, systemic inflammatory response syndrome, and multi-organ dysfunction in severe cases.

Clinical Presentation and Diagnosis

Presentation ranges from erythema and pain to eschar, painless charred tissue, and systemic signs such as hypotension or altered mental status. Examination documents depth, TBSA, circumferential involvement, and signs of inhalation injury including facial burns, singed nasal hair, and carbonaceous sputum noted in case series from American Burn Association centers. Diagnostic adjuncts include arterial blood gases, carboxyhemoglobin levels for smoke exposure, electrocardiography after electrical injury (arrhythmia risk recognized in American Heart Association guidelines), serum creatine kinase for rhabdomyolysis, and imaging (radiography, CT) for associated trauma or foreign bodies documented in trauma registries like Trauma Audit & Research Network. Microbiological surveillance targets pathogens reported in burn units such as Pseudomonas aeruginosa and Staphylococcus aureus.

Treatment and Acute Management

Immediate measures emphasize airway, breathing, circulation per Advanced Trauma Life Support principles, with early airway protection for inhalation injury and endotracheal intubation when indicated by criteria from societies like European Resuscitation Council. Fluid resuscitation uses formulae such as the Parkland formula calibrated to TBSA and weight, guided by urine output targets endorsed by American Burn Association protocols. Wound care includes cooling with running water (not ice), sterile dressing, early escharotomy for compartment relief as described in surgical texts from Oxford University Press and excision with tangential debridement followed by coverage via autograft or allograft from tissue banks affiliated with Association of Tissue Banks. Pain management uses multimodal analgesia including opioids per World Health Organization pain ladder adaptations and regional anesthesia techniques deployed in tertiary centers. Infection control integrates topical antimicrobials (silver-containing dressings), systemic antibiotics for documented Sepsis, and isolation practices used in intensive care units at hospitals like Mayo Clinic.

Complications and Long-term Care

Complications include wound infection, sepsis, hypertrophic scarring, contractures affecting function, chronic pain, and psychosocial sequelae requiring interventions from Psychiatry and social services. Reconstructive strategies use scar modulation, serial release procedures, tissue expansion, and microsurgical free flaps taught in fellowships at institutions such as Toulouse University Hospital and Duke University Hospital. Long-term care addresses occupational rehabilitation, prosthetics, and return-to-work programs coordinated with agencies like Department of Veterans Affairs where applicable. Surveillance for malignancy arising in chronic scars, historically reported in cases linked to Marjolin's ulcer, necessitates biopsy protocols in dermatology and surgical oncology clinics.

Prevention and Safety Measures

Prevention strategies encompass public health legislation, engineering controls, and education campaigns promoted by entities such as the World Health Organization, Centers for Disease Control and Prevention, and United Nations Children's Fund. Measures include smoke alarm mandates inspired by studies from National Fire Protection Association, safe cooking and heating initiatives in low-resource settings documented by Global Alliance for Clean Cookstoves, chemical labeling under Globally Harmonized System of Classification and Labelling of Chemicals, electrical safety standards by the International Electrotechnical Commission, and burn first-aid education integrated into curricula of emergency responders trained by Red Cross and St John Ambulance. Hospital-based prevention targets include protocols for safe hot-water thermostat settings, flame-resistant textiles regulated under standards from European Committee for Standardization, and vaccine programs reducing infectious contributors managed by Public Health England and national health ministries.

Category:Injuries