Burns are an extremely common cause of morbidity and mortality in the world. The World Health Organization (WHO) estimates that, worldwide, there are around 180,000 deaths every year from burns.
Burns can be caused by a number of potential mechanisms, including heat-related burns (thermal burns), chemical burns, radiation burns, electrical burns, and even friction. The first-aid and management of burns are determined by a number of factors. One of the most important of these factors is the degree of burn.
This guide will help you gain a deeper understanding of burns, how they are classified, their degree, symptoms, how to treat them at home, and when to seek professional medical treatment.
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What Are Burns and Why Classification Matters
Burns are damage to the skin or other tissues caused by heat or another source, such as radiation, electricity, chemical contact, or friction. How burns are classified can play a significant role in how they are managed, so understanding this can help you determine when to seek medical care and when you can manage your burn at home.
What Are Burns?
There are six categories of burns based on the mechanisms of injury.
Scald injuries are caused by hot liquids, grease, or steam. These can be the result of being splashed or immersion. Contact burns are the result of the skin and tissues coming into contact with a hot surface. Fire burns can be caused by flash or flames. These three groups of burns are all types of thermal burns.
The other three groups of burns are chemical burns, electrical burns, and radiation burns. Friction can also cause burns. Electrical burns are caused by an overloading of cells by electricity and may cause more internal injuries. Radiation burns result when radiation damages the cells, causing cell damage and death. Chemical burns usually result from either acids or bases.
The mechanism of injury can influence the treatment needed. Electrical and fire-related burns often require medical attention and hospitalization, whereas friction burns can generally be treated as an outpatient.
The Importance of Classification
The classification of burns by thickness helps guide treatment. Generally, the higher the degree of the burn, the more medical care it requires. Higher-degree burns also usually require longer recovery times and have more potential for complications. The amount of the body affected by a burn (calculated as a percentage of total body surface area or TBSA) also guides treatment and prognosis.
The Degrees of Burns: Explained in Detail
The degree of a burn plays a key role in the treatment and recovery process. Let’s review the degree of burns in detail. The degree of a burn is determined by which layers of skin or deeper tissues the burn has damaged.
First-Degree Burns (Superficial Burns)
First-degree burns are often known as superficial burns. These burns only affect the outermost layer of skin, the epidermis. Superficial burns are characterized by redness and minor pain but not blisters. With first-degree burns, there may be swelling. Superficial burns are generally dry and heal quickly within 5 to 10 days without scarring. Superficial burns are often caused by brief hot water exposure or may be an injury like a mild sunburn.
Second-Degree Burns (Partial Thickness Burns)
Second-degree burns penetrate deeper into the skin. These burns affect the superficial dermis layer of the skin. These can be subdivided by superficial or deep partial thickness burns depending on how far into the dermis they penetrate. Second-degree burns are usually associated with more intense pain than first- degree burns and are also associated with blisters. The skin under the blisters are red or pink and will turn white (blanch) if pressure is applied. They generally heal with minimal scarring but may take 2-3 weeks to resolve. A more severe sunburn with blistering or a hot liquid burn that blisters are examples of second-degree burns.
Third-Degree Burns (Full Thickness Burns)
Third-degree burns are full thickness. The burn penetrates the full epidermis and dermis skin layers and goes into the tissues underlying the skin, such as the subcutaneous fat. It may be surprising to know that these burns are not painful though there are often second-degree burns around the deeper burn that can be painful. This is because the nerve endings are destroyed. Third-degree burns appear white or brown and charred. They may feel leathery or firm when you touch them. If you press on a third-degree burn, there is no blanching. Full-thickness burns are more serious and require medical attention. These burns may take more than 8 weeks to health and usually form more significant scars. Depending on the extent of the burns across the body, these may make you more susceptible to infection and other complications. Third-degree burns may result from flames, radiation, electricity, steam, or chemicals.
Fourth-Degree Burns (Beyond Full Thickness)
Fourth-degree burns (and beyond) penetrate through the subcutaneous fat into other tissues, such as muscle or bone. These burns always require medical attention. People with fourth-degree burns are often in critical condition. These burns are rare and carry a higher risk of long-term injuries, complications, and even death. Electricity injuries are one of the potential causes of fourth-degree burns.
Recognizing the Degrees of Burns in Daily Life
Recognizing the degree of a burn can help you determine what type of care you may need and when to seek medical attention.
Symptoms and Signs Across Burn Degrees
Burns may also be more severe if they cross over a joint line or if they are circumferential (go all the way around a body part).
Quick Tips for Identifying Burn Severity
Here are some quick tips for identifying the severity of a burn.
- What color is the skin?
- Does it blister?
- Is it painful?
- If you touch it, does it turn white (blanching)?
- What texture is the skin?
- How much of the body is affected?
- Can you see other tissues under the skin?
- Does the burn cross over a joint line (elbow, knee, etc.)?
- Is the burn circumferential?
First Aid and Treatment by Burn Degree
Now that you know how to identify the severity of a burn and the degree, let’s talk about first aid and burn management.
Treating First-Degree Burns
First-degree burns are generally minor and can be managed at home or in an outpatient setting.
The first step to managing second-degree burns is to remove the heat source and to cool the burn using tools such as cool water or aloe vera. Do not apply ice directly to the skin.
The management of first-degree burns usually focuses on pain control and protecting the damaged skin. First-degree burns can be treated with oral medications for pain, such as ibuprofen or Tylenol, and topical medications, such as petroleum gauze.
Cleaning the skin and keeping the burn covered with a non-stick bandage is usually sufficient for management. Your healthcare provider may prescribe a topical medication to help with pain control such as Silvadene. It is important to monitor the burn for healing and signs of infection as burned skin is more susceptible to infection.
Caring for Second-Degree Burns
The severity of second-degree burns depends on the percentage of the body that is burned. A burn that covers more than 20% of the body is considered severe. The management of these burns is dependent on their severity. Like with first-degree burns, the first step is to remove the source of the burn after ensuring the safety of people around the area. If clothing is burned or stuck to the skin, leave it in place until the person is evaluated by a medical professional. Don’t pop or remove blistered skin unless specifically directed by a healthcare provider as even blistered skin can provide some protection of the underlying tissues. The next step is to cool the burn.
Cooling should occur within 3 hours of the injury and should be cooled until pain is improved or at least 20 minutes. Cool running water is the best option for cooling. Ice can cause decreased blood flow to the injured tissue, increasing the risk for damage. Once the burn is cooled, it should be covered with a non-stick dressing to protect the damaged skin. If the burn is caused by a chemical, remove the contaminated clothing immediately and thoroughly rinse the damaged skin with running water for at least 30 mins. The exception to cooling a burn is electrical contact injuries. These burns should be covered and the burn victim should be taken for immediate medical attention.
People with burns covering a large portion of their body should also seek urgent evaluation by a healthcare provider. This is also true for second-degree burns that are circumferential or cross a joint line. Another reason to seek immediate medical treatment is if there is any concern for smoke inhalation, such as shortness of breath, soot or burns in the mouth or nose, or chest pain.
Third- and Fourth-Degree Burns
Third- and fourth-degree burns are severe and require emergent medical attention. Some third-degree burns can be managed in a regular hospital setting, but more significant third-degree and nearly all fourth-degree burns may require transportation to a burn center.
People with third- and fourth-degree burns often require significant amounts of IV fluids for resuscitation. The volume of fluids given in the hospital is calculated using the Parkland formula. This calculation is made using the patient’s weight and the percentage of TBSA burned. Additional testing and evaluation may be necessary depending on the mechanism of injury.
Third- and fourth-degree burns may require longer recovery times and are more likely to result in long-term disability or death. It is vitally important that people with third- and fourth-degree burns be evaluated immediately after injury to give them the best prognosis.
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Key Takeaways:
- Burns are a significant source of morbidity and mortality worldwide.
- Recognizing the mechanism of injury and the severity of the burn can help you decide what type of treatment is needed
- First-degree burns are generally minor and can be treated at home
- Third-degree and Fourth-degree burns are severe and require immediate medical attention
- People with signs of smoke inhalation require immediate medical attention
The quicker burns are evaluated and treated the better. Understanding burns and being able to quickly recognize severe burns is the key to getting the right kind of medical care. Share this guide to educate your friends and family about burn safety and care.
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