Burns are a common cause of accidental injury in North America. Millions of individuals are burnt each year and account for a high number of visits to the emergency rooms. Fortunately most of the burns are minor in nature and can be treated as outpatients.
Burns are generally classified by the depth, location and size of burn. This is very important for prognosis and treatment. The three classes of burn classification are:
First-degree burn: First degree burns are superficial and resemble a sun burn effect. Only the most superficial layer of the skin is affected. The skin is usually red and there may be some swelling and pain. Blistering is rare. Pouring a cup of coffee would cause a first degree burn.
Second degree burn: These are similar to first degree burns but the depth is more severe. The second layer of the skin (dermis) is frequently affected in second degree burns. Blisters and skin peeling are commonly seen in 2nd degree burns. The pain is usually moderate to severe and stays for a long time. The surrounding area of the burn is always red and tender to touch. A hot metal placed on the body would produce a second degree burn.
Third degree burns: Third degree burns are the most serious and often the skin is destroyed. The depth of the burn is also significant and all the structures beneath the skin are destroyed, including the nerves. The burnt area appears white and there is no pain (since all the nerves are destroyed). The burn may be severe enough to affect the underlying bone and muscle. Charring is common in 3rd degree burns.
When burns occur, the physician always assesses not only the degree of the burn but also the amount of area burnt. The total skin area affected is important for treatment. Burns are usually described as a percentage of the total body area. Any burn which affects more than 10% of the body surface area (BSA) is considered significant. Individuals with more than 10% BSA burns are usually admitted to the hospital for treatment.
The location of the burn is also important. Burns of the nose, face or mouth may threaten the airways from swelling in the throat area. Life threatening breathing difficulties can occur when hot chemicals are inhaled (such as a house fire). Anytime an individual has burns on the face, the airways are always inspected to ensure that the breathing tube is not affected.
Circumferential burns can cause a tight scar around the organ, such as the leg/arm and may compromise blood flow. This may need urgent surgical excision to relieve the constriction caused by the scar. Burns on the genitals are always serious and most individuals are admitted.
Finally, any burn near or on the eye needs special attention. The eye is fully inspected and an eye specialist is always involved. Missed burn injury around the eye can lead permanent loss of vision and scars.