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| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| DiseasesDB = 1791 |
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| ICD10 = {{ICD10|T|20||t|20}}-{{ICD10|T|31||t|20}} |
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| ICD9 = {{ICD9|940}}-{{ICD9|949.99}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D002056 |
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| }}
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| {{SI}}
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| {{CMG}}
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| __NOTOC__ | | __NOTOC__ |
| '''Associate Editor-In-Chief:''' {{CZ}}
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| {{Editor Help}} | | '''For patient information, click [[Burns (patient information)|here]]''' |
| | {{Burn}} |
| | {{CMG}} '''Associate Editor-In-Chief:''' {{CZ}} '''Associate Editor-in-Chief:''' {{EAM}} |
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| ==Overview==
| | Keywords and : Fluid rescuscitation, Stress ulcers, Inhalation injury, Burn wound care, Skin substitutes, Electric injury, Hypermetabolis, Nutrition |
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| A '''burn''' is an [[injury]] caused by [[heat]], [[Temperature|cold]], [[electricity]], [[chemicals]], [[light]], [[radiation]], or [[friction]].<ref> Burns [http://www.nlm.nih.gov/medlineplus/burns.html MedlinePlus] Accessed [[February 25]], [[2008]]</ref><ref> Burns Topic Overview [http://www.webmd.com/a-to-z-guides/burns-topic-overview WebMD] Accessed [[February 27]], [[2008]]</ref> Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. [[Muscle]], [[bone]], [[blood vessel]], and [[Epidermis (skin)|epidermal tissue]] can all be damaged with subsequent pain due to profound injury to [[nerve ending]]s. Depending on the location affected and the degree of severity, a burn victim may experience a wide number of potentially fatal complications including [[shock (medical)|shock]], [[infection]], [[electrolyte imbalance]] and [[respiratory distress]].<ref> A review of the complications of burns, their origin and importance for illness and death - Abstract [http://www.ncbi.nlm.nih.gov/pubmed/448773 J Trauma. 1979 May;19(5):358-69.] Accessed [[February 27]], [[2008]]</ref> Beyond physical complications, burns can also result in severe psychological and emotional distress due to [[scarring]] and deformity.
| | ==[[Burn overview|Overview]]== |
| | ==[[Burn historical perspective|Historical Perspective]]== |
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| ==Classification by degree== | | ==[[Burn classification|Classification]]== |
| The most common system of classifying burns categorizes them as first-, second-, or third-degree. Sometimes this is extended to include a fourth or even up to a sixth degree, but most burns are first- to third-degree, with the higher-degree burns typically being used to classify burns post-mortem. The following are brief descriptions of these classes:<ref> Burn Degrees [http://www.lifespan.org/services/criticalcare/articles/burns/burns.htm Lifespan.com] Accessed February 24, 2008</ref>
| | ==[[Burn pathophysiology|Pathophysiology]]== |
| * '''First-degree burns''' are usually limited to redness ([[erythema]]), a white plaque and minor [[pain]] at the site of injury. These burns only involve the [[Epidermis (skin)|epidermis]].
| | ==[[Burn causes|Causes]]== |
| * '''Second-degree burns''' manifest as erythema with superficial [[blister]]ing of the skin, and can involve more or less pain depending on the level of [[nerve]] involvement. Second-degree burns involve the superficial (papillary) [[dermis]] and may also involve the deep (reticular) dermis layer.
| | ==[[Burn epidemiology and demographics|Epidemiology and Demographics]]== |
| * '''Third-degree burns''' occur when most of the epidermis is lost with damage to underlying [[ligaments]], [[tendons]] and muscle. Burn victims will exhibit charring of the skin, and sometimes hard eschars will be present. An eschar is a scab that has separated from the unaffected part of the body. These types of burns are often considered painless, because nerve endings have been destroyed in the burned area. Hair follicles and sweat glands may also be lost due to complete destruction of the dermis. Third degree burns result in scarring and may be fatal if the affected area is significantly large. If extensive enough, it can increase the risk of infection, including bacterial, and can result in death.
| | ==[[Burn natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *'''Fourth-degree burns''' damage bone tissue and may result in a condition called [[compartment syndrome]], which threatens both the life of the limb and the patient.
| | ==Diagnosis== |
| * '''Fifth-degree burns''' are burns in which most of the [[hypodermis]] is lost, charring and exposing the muscle underneath. Sometimes, fifth-degree burns can be fatal.
| | [[Burn history and symptoms|History and Symptoms]] | [[Burn physical examination|Physical Examination]] | [[Burn laboratory findings|Laboratory Findings]] | [[Burn electrocardiogram | Electrocardiogram]] | [[Burn X-ray | X-ray]] |[[Burn CT|CT]] | [[Burn MRI|MRI]] | [[Burn other imaging findings|Other Imaging Findings]] | [[Burn other diagnostic studies|Other Diagnostic Studies]] |
| * '''Sixth-degree burns''', the most severe form, are burn types in which almost all the muscle tissue in the area is destroyed, leaving almost nothing but charred bone. Often, sixth-degree burns are fatal.
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| ==Other classifications== | | ==Treatment== |
| A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.
| | [[Burn medical therapy|Medical Therapy]] | [[Burn surgery|Surgery]] | [[Burn prevention|Prevention]] | [[Burn cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Burn future or investigational therapies|Future or Investigational Therapies]] |
| | ==Case Studies== |
| | [[Burn case study one|Case #1]] |
| | ==Related Chapters== |
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| '''''Table 1.'' A description of the traditional and current classifications of burns.'''
| | *[[Bruise]] |
| {|class="wikitable"
| | *[[Chemical burn]] |
| |{{bgcolor-gold}}|'''Nomenclature'''||{{bgcolor-gold}}|'''Traditional nomenclature'''||{{bgcolor-gold}}|'''Depth'''||{{bgcolor-gold}}|'''Clinical findings'''
| | *[[Friction burn]] |
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| | *[[Radiation burn]] |
| |Superficial thickness||First-degree||Epidermis involvement||[[Erythema]], minor pain, lack of blisters
| | *[[Sunburn]] |
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| |Partial thickness — superficial||Second-degree||Superficial (papillary) [[dermis]]||Blisters, clear fluid, and pain
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| |Partial thickness — deep||Second-degree||Deep (reticular) dermis||Whiter appearance, with decreased pain. Difficult to distinguish from full thickness
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| |Full thickness||Third- or fourth-degree||Dermis and underlying tissue and possibly [[fascia]], [[bone]], or [[muscle]]||Hard, leather-like eschar, purple fluid, no sensation (insensate)
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| |}
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| '''''Table 2.'' Scald Time (Hot Water)'''
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| {|class="wikitable"
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| |{{bgcolor-gold}}|'''Temperature'''|| {{bgcolor-gold}}|'''Max duration until injury'''
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| | 155F (68.3C) || 1 second
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| |-
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| | 145F (62.9C) || 3 seconds
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| |-
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| | 135F (57.2C) || 10 seconds
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| |-
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| | 130F (54.4C) || 30 seconds
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| |-
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| | 125F (51.6C) || 2 minutes
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| |-
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| | 120F (48.8C) || 5 minutes
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| |}
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| {{main|Total body surface area}}
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| Burns can also be assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns (superficial thickness burns are not counted). The [[rule of nines]] is used as a quick and useful way to estimate the affected TBSA.
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| {| align="left"
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| {|class="wikitable"
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| |+ '''''Table 3''. Rule of nines for assessment of total body surface area affected by a burn - Adult'''
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| |{{bgcolor-gold}}|'''Anatomic structure'''||{{bgcolor-gold}}|'''Surface area'''
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| |Head||9%
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| |-
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| |Anterior Torso||18%
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| |-
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| |Posterior Torso||18%
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| |-
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| |Each Leg||18%
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| |-
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| |Each Arm||9%
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| |-
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| |Perineum||1%
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| |}
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| |}
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| {| align="center"
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| |-
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| {|class="wikitable"
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| |+ '''''Table 4''. Rule of nines for assessment of total body surface area affected by a burn - Infant'''
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| |{{bgcolor-gold}}|'''Anatomic structure'''||{{bgcolor-gold}}|'''Surface area'''
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| |Head||18%
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| |-
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| |Anterior Torso||18%
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| |-
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| |Posterior Torso||18%
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| |-
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| |Each Leg||14%
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| |-
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| |Each Arm||9%
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| |-
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| |Perineum||1%
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| |}
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| |}
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| ==Causes of burns==
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| Burns may be caused by a wide variety of substances and external sources such as exposure to chemicals, friction, electricity, radiation, and extreme temperatures, both hot and cold.
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| Most '''chemicals''' (but not all) that can cause moderate to severe chemical burns are strong [[acid]]s or [[base (chemistry)|bases]].<ref> Chemical Burn Causes [http://www.emedicinehealth.com/chemical_burns/page2_em.htm#Chemical%20Burn%20Causes emedicine Health] Accessed [[February 24]], [[2008]]</ref> Chemical burns are usually caused by [[caustic]] [[chemical compounds]], such as [[sodium hydroxide]], [[silver nitrate]], and more serious compounds (such as [[sulfuric acid]] and [[Nitric acid]]).<ref> Chemical Burn Causes [http://www.emedicine.com/emerg/topic73.htm eMedicine] Accessed [[February 24]], [[2008]]</ref> [[Hydrofluoric acid]] can cause damage down to the bone and its burns are sometimes not immediately evident.<ref> Hydrofluoric Acid Burns [http://www.emedicine.com/emerg/topic804.htm emedicine] Accessed [[February 24]], [[2008]]</ref>
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| '''Electrical burns''' are generally caused by an exogenous [[electric shock]], such as being struck by [[lightning]] or [[defibrillation|defibrillated or cardioverted]] without a conductive gel. The internal injuries sustained may be disproportionate to the size of the burns seen, and the extent of the damage is not always obvious. Such injuries may lead to [[cardiac arrhythmias]], [[cardiac arrest]], and unexpected falls with resultant [[fractures]].<ref> Electrical Burns: First Aid [http://www.mayoclinic.com/health/first-aid-electrical-burns/FA00027 Mayo Clinic] Accessed [[February 24]], [[2008]]</ref>
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| '''Radiation burns''' may be caused by protracted and overexposure to [[UV light]] (as from the sun), [[tanning booths]], [[radiation therapy]] (as patients who are undergoing [[cancer]] therapy), sunlamps, and [[X-rays]]. By far the most common burn associated with radiation is sun exposure, specifically two wavelengths of light [[Ultraviolet|UVA]], and [[UVB]], the latter being the more dangerous of the two. Tanning booths also emit these wavelengths and may cause similar damage to the skin such as irritation, redness, swelling, and [[inflammation]]. More severe cases of sun burn result in what is known as [[sun poisoning]].
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| ===Scalding===
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| [[Image:Scaldburn.jpg|thumb|150px|left|Two day-old scald caused by boiling radiator fluid.]]
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| '''Scalding''' is a specific type of burning that is caused by hot fluids or gases. They most commonly occur in the home from exposure to high temperature [[tap water]].<ref> Scald and Burn Care, Public Education [http://www.rochesterhills.org/city_services/fire_department/pubic_education/scald_and_burn_care.asp City of Rochester Hills] Accessed February 24, 2008</ref>
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| Steam is a common gas that causes scalds. The injury is usually regional and usually does not cause death. More damage can be caused if hot liquids enter an orifice. However, deaths have occurred in more unusual circumstances, such as when people have accidentally broken a steam pipe.
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| The demographics that are of the highest risk to suffering from scalding are young children, with their delicate skin, and the elderly over 65 years of age.
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| ===Cold burn===
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| [[Image:Frostbitten hands.jpg|thumb|left|150px|Frostbitten hands]]
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| A '''cold burn''' (see [[frostbite]]) is a kind of burn which arises when the skin is in contact with a low-temperature body.
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| They can be caused by prolonged contact with moderately cold bodies (snow and cold [[air]] for instance) or brief contact with very cold bodies such as dry ice, liquid helium, [[liquid nitrogen]], or liquid discharged from an upside-down gas duster. In such a case, the [[heat]] transfers from the skin and organs to the external cold body.
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| The effects are very similar to that of a burn caused by extreme heat. The remedy is also the same. For a minor cold burn, it is advisable to keep the injured organ under a flow of water of comfortable temperature. This will allow heat to transfer slowly from the water to the organs.
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| ==Management==
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| A [[local anesthetic]] is usually sufficient in managing pain of minor first-degree and second-degree burns. However, systemic anti-inflammatory drugs such as [[naproxen]] may be effective in mitigating pain and swelling. Additionally, topical antibiotics such as Mycitracin are useful in preventing infection to the damaged area.<ref> Minor Burns [http://quickcare.org/skin/burns.html quickcare.org] Accessed February 25, 2008</ref> [[Lidocaine]] can be administered to the spot of injury and will generally negate most of the pain. Regardless of the cause, the first step in managing a person with a burn is to stop the burning process at the source. For instance, with dry powder burns, the powder should be brushed off first. With other burns, such as those caused by exposure to chemicals, the affected area should be rinsed throughly with a large amount of clean water to remove the caustic agent and any [[foreign body|foreign bodies]]. Cold water should not be applied to a person with extensive burns, however, as it may compromise the burn victim's temperature status.
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| If the patient was involved in a fire accident, then it must be assumed that he or she has sustained inhalation injury until proven otherwise, and treatment should be managed accordingly. At this stage of management, it is also critical to assess the airway status. Any hint of burn injury to the [[lung]]s (e.g. through [[smoke inhalation]]) is considered a [[medical emergency]]. Survival and outcome of severe burn injuries is remarkably improved if the patient is treated in a specialized burn center/unit rather than a hospital. Serious burns, especially if they cover large areas of the body, can result in death.
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| Once the burning process has been stopped, the patient should be volume resuscitated according to the Parkland formula, since such injuries can disturb a person's osmotic balance. This formula dictates the amount of [[Lactated Ringer's solution]] to deliver in the first twenty four hours after time of injury. This formula excludes first and most second degree burns. Half of the fluid should be given in the first eight hours post injury and the rest in the subsequent sixteen hours. The formula is a guide only and infusions must be tailored to the [[urine]] output and [[central venous pressure]]. Inadequate fluid resuscitation causes [[renal failure]] and [[death]].
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| == Treatment of low-grade burns ==
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| A [[local anesthetic]] is usually sufficient in managing pain of smaller first-degree and second-degree burns. [[Lidocaine]] can be administered to the spot of injury and will generally negate most pain.
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| ==Pathological Findings==
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| [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| {{clr}}
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn1.jpg|Edema due to Disseminated Intravascular Coagulation: Gross natural color burn case with view of face showing grotesque edema
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| image:Burn2.jpg|Face: Edema: Gross natural color severe body burns 24 hours anasarca
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn3.jpg|Anasarca: Gross natural color body burns 24 hours prior now anasarca
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| image:Burn4.jpg|Hand, gunshot entrance wound, intermediate range, powder burns ("freckling")
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn5.jpg|Skin: Thermal burn
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| image:Burn6.jpg|Trachea, thermal burn smoke inhalation
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn7.jpg|Lung, thermal burn smoke inhalation
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| image:Burn8.jpg|Chemical burn from topical asprin
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn9.jpg|Skin: Trauma wound electrical; skin: electrical burns on fingers
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| image:Burn10.jpg|Skin: Burns with gangrene
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn11.jpg|Skin: Trauma Wound Lightning; Lightning Burn
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| image:Burn12.jpg|Skin: Burns
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn13.jpg|Ischemia: Gross natural color close-up of liver with shock necrosis and a large area of necrosis beneath capsule quite good burn sepsis DIC
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| image:Burn14.jpg|Small intestine: Ischemia: Gross natural color frankly gangrenous gut shown rather close-up excellent example burn sepsis DIC
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn15.jpg|Kidney: Bilateral Cortical Necrosis: Gross natural color excellent gross example showing capsular and cut surfaces burn case
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| image:Burn16.jpg|Kidney: Acute Tubular Necrosis: Gross good example swollen cortex secondary to body burn
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn17.jpg|Kidney: Acute Pyelonephritis: Gross cut surface obvious abscesses burn case with Pseudomonas sepsis
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| image:Burn18.jpg|Brain: Bacterial Meningitis: Gross base of frontal lobes well shown meningitis burn case with Pseudomonas sepsis
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:Burn19.jpg|Stomach: Curlings Ulcers: Gross natural color multiple superficial mucosal ulcers well shown in fundus and prepyloric area in lesser curvature. A good example of burn patient
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| image:Burn20.jpg|Thyroid: Fibrosis: Gross natural color cross section into fibrotic and apparently contracted gland can be used as an example of burned out thyroiditis or what we used to call Riedels struma
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| </gallery>
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| </div>
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| ==References==
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| {{reflist|2}}
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| ==See also==
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| {{Commonscat|Burns}}
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| {{Wikisource1911Enc|Burns and Scalds}}
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| {{Wiktionary|scald}}
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| * [[Sunburn]]
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| * [[Radiation burn]]
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| * [[Bruise]]
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| * [[Friction burn]]
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| * [[Chemical burn]]
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| ==External links==
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| *[http://www.aarbf.org Alisa Ann Ruch Burn Foundation]
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| *http://journalofburnsandwounds.com : Journal of Burns and Wounds - online open-access journal featuring articles on burn care and related research
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| <br>
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| {{Consequences of external causes}} | | {{Consequences of external causes}} |
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| [[Category:Surgery]]
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| [[Category:Emergency medicine]]
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| [[Category:Dermatology]]
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
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