Burn injury: When to seek emergency medical care

At a Glance:

What are burns?

Severe skin damage that causes the cells to die is called a burn. It can range from minor to major injuries. Depending on the severity of the burn, the course of treatment changes.

Some tips when dealing with burn injuries are:

• Small scalds with some redness can be treated at home, while burns with blisters, deeper depth, larger surface area, or affecting major joints like spine or ankle need medical attention.
• Never apply ice to a burn. It can damage the affected area even more and slow down the healing process.

What are the symptoms of a burn?

The severity of a burn depends on the extent of the damage i.e. the depth of the skin it affects. A minor burn can be distinguished from a more serious one that requires medical attention through the classification of burns. The following are the types, ranging from minor to severe:

First-degree burn:

It causes minimal skin damage since only the outer layer (epidermis) is damaged. First-degree burns heal within 7-10 days without leaving a scar. It is accompanied by:

• Redness
• Minor swelling
• Pain

Second-degree burn (Partial thickness):

The damage extends beyond the epidermis into the second layer of skin (dermis), and the burn is more serious. Depending on its extent, it may heal within 2-3 weeks. There may be pigment changes in the skin. It is accompanied by:

• Redness
• Blisters
• Pain

Third-degree burn (Full-thickness):

The damage reaches the fat layer under the skin, making it an extremely severe burn injury. They require immediate medical attention, and there is no set timeline for their healing. The pain may not be felt if the nerve endings are damaged. Surgery may also be required to prevent scarring. The symptoms may be:

• Stiff, waxy skin
• Leathery skin
• Dark brown color
• Undeveloped blisters

Fourth-degree burn:

This is the most severe burn category. The damage extends well beyond the skin and may even affect muscles and bones. Similar to third-degree burns, there may be no pain felt if the nerve endings are damaged. Symptoms are:

• Blackened skin
• Charred skin
• Absence of pain

While a first-degree or second-degree burn may be treated at home, third-degree and fourth-degree burns require medical attention. Even in the case of the former two, if the affected area is large or the burn is on a major joint like the spine, ankle, elbow, etc, it is advisable to seek medical help.

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What are the causes of burns?

Burns can be caused by several substances. Some of them based on the category of burns are:

• First-degree burn:
  • Sunburns
  • Scalds from hot liquid/surface
  • Minor electrical burns

• Second-degree burn:
  • Severe sunburns
  • Accidents with hot boiling water
  • Accidents with flame

• Third-degree burn:
  • Exposure to fire
  • Burns from electricity or lightning
  • Prolonged exposure to hot liquids/objects
  • Chemical burns

Fourth-degree burns are caused due to similar circumstances as third-degree burns. The extent of the damage increases though, and so does the long-term outlook for recovery.

How to manage burns?

First aid for minor burns

Minor burns that cause pain, blisters, superficial redness or are smaller than 3 inches in diameter do not require emergency care. With proper care at home, they resolve within a few weeks.

• Cooldown the burn under cool, running water for 20 minutes total duration. Avoid the use of cold water or ice (ice slush) as they restrict blood circulation and increase the depth of the burn.
• Do not break the blisters. If the blister breaks, clean with clean water and mild soap (optional).
• Use lotion or moisturizer only once the burn is cooled to prevent drying and pain relief.
• Apply plastic (cling) wrap to burn wound to prevent heat loss.
• For chemical burns, clean with copious amounts of water to dilute chemical exposure.
• Use sterilized gauze bandage to loosely wrap the burn to keep the air off and protect blistered skin.
• If needed, over-the-counter medicines may be used for pain relief.

When to see a doctor

Seek immediate care for major burns that are deep or larger than 3 inches in diameter, covering the face, hands, feet, groin, or major joint. Also, burns that appear charred or patchy or that leave the skin dry and leathery need immediate attention.

The doctor may prescribe the following depending on the severity of the burn:

• IV fluids to prevent dehydration and organ damage.
• Burn cream to maintain moisture lock, prevent infection and facilitate healing.
• Tetanus shot and antibiotics to prevent infection.
• Pain medicines.

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What is emergency care for serious burns?

The treatments rendered in the first 4 hours of the incident can make a lot of difference in saving the life of the patient. Initial assessment, management of burn, evaluation of burn size, and fluid replacement plays a major role in the first 24 hours after burn injury. The ABCDE approach mentioned below is a priority response to address the complications of burns quickly and efficiently. The emergency care for serious burns is required to:

1. To stop the burn
2. For essential ABCDE monitoring, the following is required:
   • Airway maintenance
   • Breathing and ventilation
   • Circulation and cardiac status
   • Disability, neurological deficit, and gross deformity
   • Examine associated injuries and maintain warm Environment
3. To determine the extent of the burn, use the Rule of 9’s to assess the body surface area that has gotten burned. This helps to guide treatment decisions.

In some cases, surgical procedures may be necessary:

• Decompression to ease breathing.
• Reconstruction and skin grafting to assist healing and enhance cosmetic appeal.
• Nasogastric tubing for feeding.

What are the complications of burns?

Complications generally arise with third-degree or fourth-degree burns, wherein the body is exposed to outside infections through broken skin, risks blood loss, etc. Some of them are:

• Risk of infections: Severe burns make the body vulnerable to bacterial infections like tetanus and can even cause sepsis. Both of them are life-threatening conditions.
• Hypovolemia (low blood volume): Blood vessel damage can lead to loss of fluids in the body. Due to the loss of blood and fluids, the heart may not be able to pump enough blood to all the body parts.
• Hypothermia (low body temperature): While this seems uncharacteristic for a burn, the increased loss of blood can cause the body temperature to drop to dangerous levels.
• Bone and joint problems: Deep burns can affect the movement of certain joints. When scar tissue forms over the burns on a joint, it may cause the skin, muscles, or tendons to tighten or shorten, which displaces them.
• Scarring: Third-degree and fourth-degree burns may require skin grafting and surgeries.

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How to prevent burns?

It is essential to follow prevention routines at home to avoid burn injuries. Children, especially, are vulnerable to burns. Proper precautionary measures can help to prevent burn injuries for everyone at home.

• Never leave items on the stove unattended.
• Keep children out of the kitchen.
• Do not wear synthetic or loose-fitting clothes in the kitchen.
• Discard electronics with damaged or exposed wires.
• Keep chemicals, matches, lighters, etc. out of the reach of pets and children.
• Wear gloves and other protective gear while using chemicals.
• Keep the temperature of the geyser between 49°C – 54°C.
• Wear sunscreen and avoid peak sunlight.
• Smoke away from the bed and curtains.

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Conclusion:

The severity of burns depends on their extent i.e. the area of damaged skin and the depth. As a rule of thumb, if the burn is deep or larger than 3 inches in diameter, covering the face, hands, feet, groin, or major joint, it is essential to seek medical attention. This generally occurs in the case of third-degree or fourth-degree burns. Always take the necessary precautions at home to prevent the possibility of any minor or life-threatening burn injuries. 

Read more about Burns symptoms, causes and treatment

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References:

1. “Burns: Types, treatments, and more”. Healthline. Reviewed by Modern Weng. Accessed on 30 August 2019. https://www.healthline.com/health/burns
2. “What are the types and degrees of burns?”. Web MD. Reviewed by Carol DerSarkissian. Accessed on 30 August 2019. https://www.webmd.com/first-aid/types-degrees-burns#1
3. “Management of burns”. World Health Organization. Accessed on 30 August 2019. https://www.who.int/surgery/publications/Burns_management.pdf
4. “Burns/ management of burn wounds”. The Royal Children’s Hospital, Melbourne. Accessed on 30 August 2019. https://www.rch.org.au/clinicalguide/guideline_index/Burns/
5. “Burns: first aid”. Mayo Clinic. Accessed on 30 August 2019. https://www.mayoclinic.org/first-aid/first-aid-burns/basics/art-20056649