Burns and scalds

Burns and scalds are common injuries that involve damage to the skin and underlying tissues caused by heat, chemicals, electricity, friction, or radiation. While burns usually result from contact with dry heat sources such as fire or hot objects, scalds are specifically caused by wet heat such as steam or hot liquids. The severity of burns and scalds depends on both the depth of tissue damage and the extent of body surface area affected. These injuries range from minor superficial burns that heal with minimal treatment to life-threatening injuries requiring intensive medical care.

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Causes of Burns and Scalds

1. Thermal Burns

   • Direct contact with flames, hot objects, heated metals, or boiling liquids.

   • Accidental kitchen injuries are among the most common causes.

2. Scalds

   • Result from hot water, steam, oil, or other hot liquids.

   • More frequent in children and elderly individuals due to thinner skin.

3. Chemical Burns

   • Caused by corrosive substances such as acids, alkalis, or strong cleaning agents.

   • Can penetrate deeply into skin and tissues, causing extensive damage.

4. Electrical Burns

   • Occur when electrical current passes through the body.

   • Damage may be both superficial and deep, including internal organs.

5. Radiation Burns

   • Prolonged sun exposure (sunburn).

   • Medical treatments such as radiotherapy.

6. Friction Burns

   • Caused by skin rubbing against a rough surface.

   • Often a combination of abrasion and heat damage.

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Types of Burns by Depth

1. Superficial (First-Degree Burns)

   • Affect only the epidermis (outer skin layer).

   • Symptoms: Redness, mild swelling, tenderness, no blisters.

   • Healing: Within 7 days, usually without scarring.

2. Partial Thickness (Second-Degree Burns)

   • Extend into the dermis (second skin layer).

   • Symptoms: Blisters, severe pain, swelling, red or mottled skin.

   • Healing: Two to three weeks, may cause scarring or pigment changes.

3. Full Thickness (Third-Degree Burns)

   • Destroy both epidermis and dermis, may affect fat, muscle, or bone.

   • Symptoms: White, charred, leathery skin, loss of sensation due to nerve damage.

   • Healing: Require surgical intervention such as skin grafting.

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Severity Classification by Extent

• Minor Burns: Small superficial or partial-thickness burns involving less than 10% of body surface area (BSA).

• Moderate Burns: Partial-thickness burns covering 10–20% BSA.

• Severe Burns: Full-thickness burns or partial-thickness burns covering more than 20% BSA, or any burns involving face, hands, feet, genitals, or major joints.

The “Rule of Nines” is often used to estimate body surface area affected:

• Head and neck: 9%

• Each arm: 9%

• Each leg: 18%

• Front of trunk: 18%

• Back of trunk: 18%

• Perineum: 1%

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Symptoms

• Redness, swelling, and blistering.

• Pain ranging from mild to severe, or absence of pain in deep burns.

• Peeling or charring of skin.

• Fluid loss leading to dehydration.

• In severe burns: shock, difficulty breathing, or infection.

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First Aid for Burns and Scalds

1. Stop the burning process

   • Remove the person from the source of heat.

   • For chemical burns, wash immediately with large amounts of water.

2. Cool the burn

   • Run cool (not cold) water over the burn for 20 minutes.

   • Avoid ice, as it may worsen tissue damage.

3. Protect the burn

   • Cover with a sterile, non-stick dressing or clean cloth.

   • Do not apply butter, oils, or toothpaste.

4. Relieve pain

   • Over-the-counter analgesics such as paracetamol or ibuprofen can be used.

5. Seek medical help if:

   • Burns cover large areas.

   • Burns are on face, hands, feet, or genitals.

   • The patient has signs of shock (pale, clammy skin, rapid breathing).

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Complications

• Infection: Damaged skin increases susceptibility to bacterial invasion.

• Fluid loss and dehydration: Severe burns can cause hypovolemic shock.

• Scarring and contractures: Deep burns may cause deformities requiring surgical correction.

• Inhalation injury: Breathing hot air or smoke may damage lungs.

• Systemic toxicity: Especially with chemical or electrical burns.

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Treatment

1. Pain Relief

• Paracetamol (acetaminophen) – 500 mg to 1 g every 4–6 hours as needed (maximum 4 g/day).

• Ibuprofen – 400 mg every 6–8 hours as needed (maximum 2400 mg/day).

• For severe pain: Opioids such as morphine may be required under hospital supervision.

2. Wound Care

• Clean with sterile saline.

• Apply protective dressings to prevent infection and promote healing.

• Silver-based preparations (e.g., silver sulfadiazine 1% cream) applied once or twice daily are commonly used.

3. Infection Control

• Topical antibiotics: Mupirocin ointment, bacitracin.

• In systemic infection: Oral or IV antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily) or ciprofloxacin depending on culture results.

4. Fluid Replacement

• Severe burns may require intravenous fluid resuscitation.

• The Parkland Formula is commonly used:

  • 4 mL × body weight (kg) × % of BSA burned.

  • Half given in the first 8 hours, the rest over 16 hours.

5. Surgical Interventions

• Debridement: Removal of dead tissue.

• Skin grafting: For deep full-thickness burns.

• Reconstructive surgery: To restore function and appearance.

6. Rehabilitation

• Physiotherapy to prevent contractures.

• Psychological support for trauma and disfigurement.

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Prevention

• Keep hot drinks and boiling liquids out of reach of children.

• Use protective gloves and safety equipment in workplaces.

• Install smoke alarms at home.

• Avoid leaving cooking unattended.

• Educate children about fire safety.