What is Thermal Burns?
Thermal burns are injuries to the skin that happen due to extreme heat. This can happen if you come into contact with hot surfaces, hot liquids, steam, or flames. Most of these burns are not severe and can usually be treated at a local hospital or healthcare facility. However, about 6.5% of all patients who have been burned need to be treated in specialized burn centers. The decision about whether or not a patient needs to be moved to a burn center depends on how much of the body was burned, how deep the burns are, and other factors like the patient’s age, if there are any other injuries, and if the patient has any pre-existing medical conditions.
About 25% of all serious burns happen at home.
What Causes Thermal Burns?
Thermal burns, or burns from hot sources, are the most common type of burn injury and account for about 86% of cases seen at burn centers. These injuries often happen from hot liquids, steam, fire, electrical items, and certain types of gases.
Some people are more likely to get burns. This includes:
- Children, because they often end up touching hot liquids by accident,
- Men, especially those who have jobs where they’re more likely get injured. During the summer, many people get burned from fire when they use gas products for fun or for farming. For adults, drinking alcohol can also increase the risk of getting a burn, and
- People who live in homes without smoke detectors.
Lastly, it’s important to note that when a child has what’s known as immersion scald burns—burns that happen when the skin is put directly into hot liquid—abuse by a parent or caregiver may be the cause.
Risk Factors and Frequency for Thermal Burns
Every year, around 450,000 people receive treatment for burns, and of these, around 30,000 need to be admitted to specialized burn centers. Different types of burns make up this figure: approximately 86% are caused by heat (such as fire or flame, scalds, or hot objects), 4% are electrical burns, 3% are chemical burns and the remaining 7% encompass other types of burns.
Unfortunately, each year about 3,400 people die as a result of burns or complications like smoke inhalation, carbon monoxide or cyanide poisoning, organ failure, or infection. A significant 72% of these death cases happen due to home fires. Burns are the fourth primary cause of trauma-based deaths and the second leading cause of accidental deaths in young children ages one to four.
However, there is a ray of hope as roughly 97% of burns patients survive, and the mortality rate from burns has dropped significantly, by about 75%, since the 1960s.
- 450,000 people are treated for burns yearly, with 30,000 needing specialized care.
- Most burns (86%) are caused by heat. Other types include electrical burns (4%), chemical burns (3%) and other types (7%).
- Each year, around 3,400 people die from burns or related complications.
- About 72% of these deaths occur from residential fires.
- Burn injuries are the fourth leading cause of trauma deaths and the second leading cause of accidental deaths in children ages one to four.
- The overall survival rate for burn patients is about 97%.
- The death rate from burns has decreased by about 75% since the 1960s.
foot, with a total body surface area of less than 1%.
Signs and Symptoms of Thermal Burns
Most burn injuries are minor and usually cause pain as the main symptom. These injuries primarily require wound care for the burn site and medication to control pain. However, in cases of extensive and deep burns, these are classified as severe burns, requiring a similar emergency response to other trauma cases. If the burns aren’t severe, regular medical procedures for assessing a patient’s health can be carried out. During these checks, critical information includes the type of burn (like from heat, electricity, corrosive chemicals, or radiation), the possibility of injuries from inhaling hot gases, or other injuries (like from an explosion or a fall while trying to escape a fire).
In the physical examination, medical professionals should pay particular attention to the patient’s airways and respiration. They’ll look for indications of facial burns or burns inside the mouth, signs of soot in the mouth or nose, and symptoms of breathing difficulties such as coughing, wheezing or laborious breaths. Beyond burns, they also check for other injuries. Then, of course, they focus on examining the burns. Key elements they look for are the extent of the burns – expressed as the percentage of the total body’s surface area (% TBSA) that got burned – and the depth of the burns, which can be categorized as superficial (or first-degree), partial-thickness (or second-degree), or full-thickness (or third-degree).
In the case of a burn injury involving only the outer layer of skin, the burn is classified as a superficial or first-degree burn, and it doesn’t significantly affect the skin’s standard function. Burns that reach the deeper, second layer of the skin are known as partial-thickness or second-degree burns. They may affect important skin functions like safeguarding against infections, regulating body temperature, preventing fluid loss, and providing sensation. Burns that affect both skin layers are classified as full-thickness or third-degree burns, causing a complete loss of normal skin functions.
- Superficial (or first-degree) burns feel warm, are painful, red, soft, usually without blisters, and change color (blanch) when touched. A common example is a sunburn.
- Partial-thickness (or second-degree) burns are usually very painful, red, blistered, moist, soft, and also blanch when touched. They are typically caused by hot surfaces, hot fluids, or flames.
- Full-thickness (or third-degree) burns can be painless or minimally painful but may appear white, brown, or charred, feel firm and leathery when touched and do not blanch. These are usually caused by flames, hot oils, or superheated steam.
Testing for Thermal Burns
The American Burn Association has created guidelines to classify burns as minor, moderate, or severe. This classification is based on several factors including the extent and depth of the burn, the patient’s age (especially those younger than 10 or older than 50 years), related medical conditions, additional injuries such as smoke inhalation or trauma, and burns on specific body areas like hands, feet, face, ears, nose, genitals.
Understanding the size of a burn is crucial when deciding the appropriate treatment and whether hospital admission is necessary. A widely used standard for this is the “rule of nines”. It breaks down the adult body into sections, each representing a percentage of the total body surface area (TBSA):
– 9% for the head and neck
– 9% for each arm
– 18% for the chest and back
– 18% for each leg
– 1% for the genital area
Also, an individual’s palm is roughly equivalent to 1% of the total body. The burn injury can be further broken down into partial and full-thickness injuries, which relates to the burn’s depth.
The associations defines a major burn injury as:
– Involving more than 25% of the total body surface in adults or 20% in children
– A full-thickness burn affecting more than 10% of the body
– A burn on the face, genitals, or limbs
– Resulting in serious cosmetic impairment
– Patients with such injuries are typically referred to a specialist burn center
A moderate burn injury refers to:
– A partial-thickness burn affecting between 15 to 20% TBSA in adults, or 10 to 15% in children, or a full-thickness burn affecting 2 to 10% TBSA
– Minimal impact on the face and genital area
– A low risk of severe cosmetic damage
– These patients require hospital admission but don’t always need a referral to a burn center
Finally, a minor burn injury includes:
– Burns that cover less than 15% of the total body area in adults and less than 10% in children
– No expected changes in function or cosmetics
– No impact on the face and genital area
– These kinds of burns usually can be managed with outpatient treatment.
Treatment Options for Thermal Burns
If someone gets burnt, treatment should begin right away at the site of the injury. Emergency services should check for any smoke inhalation injuries by looking for scorched nose hairs, burns around the nose and mouth, signs of struggle in breathing, and soot-colored mucus. If the person is having a hard time breathing, always consider to insert a breathing tube immediately. Also, an intravenous line for fluids is essential, especially for adults. For kids, this might be difficult in a dark environment, and should be performed during transport. To help with pain, cool the area of burn immediately.
The first thing to do is to stop the burn from getting worse. This can be done by removing any objects that are still hot or burning from contact with the skin. Small burn areas can be cooled with tap water or salt water. But, if the burn covers a large area, be careful not to cool too much as it could lead to a drastic decrease in body temperature. Treatment for minor burns usually doesn’t need more than over-the-counter painkillers, local pain-relief creams, or aloe vera. More severe burns should be cleaned and treated with antibiotic creams or bandages, painkillers, and a tetanus booster if necessary. Patients with very severe burns will need fluid replacement, oxygen, heart monitoring, a stomach tube, a urinary catheter, strong painkillers given through an IV, and a tetanus booster. They will likely need to be transferred to a specialist burn treatment center.
If a patient goes to the emergency department, it’s important to make sure they haven’t breathed in smoke. This can cause their airways to swell up within 12 to 24 hours. If there’s any doubt about this, they should be intubated. A small telescope can be used to check for breathing problems. For burns around the chest that could limit chest expansion, a cut may be made to prevent this. Sometimes, additional cuts are needed.
For burns that go all the way around and are full-thickness, the burn area will need to be cut into to prevent too much pressure building up (compartment syndrome).
It’s also important to check the levels of carbon monoxide and cyanide in the body, and to give patients oxygen. If there’s bad metabolic acidosis (too much acid in the body), normal arterial oxygen, and low carboxyhemoglobin (a type of hemoglobin), it might mean that there’s cyanide poisoning.
All burns that cover more than 20% of the total body surface area will need fluid to be given based on the Parkland formula. Saline solutions are usually the best choice. Excess fluid should be avoided to prevent lung complications. A urinary catheter should be inserted for accurate monitoring of fluid balance.
There’s ongoing debate on the best way to treat blisters from burns. It’s generally agreed that large or tense blisters, and ones that go over joints should be cut open, while small blisters or those on the palms and soles are left alone.
One way to treat partial-thickness burns is to cover them with antibiotic creams, like bacitracin or triple-antibiotic ointment, and then apply a simple bandage. The cream can be spread on the bandage and then placed on the burn. The dressing is then changed once or twice a day, and healing may take 1 to 2 weeks. A burn dressing can also be applied and left in place for a week.
After the patient is stabilized, the dead skin may need to be surgically removed and a skin graft may be needed.
Nutrition is critical in burn patients because their energy needs are very high. Eating should be started as early as possible to prevent bacteria from getting into the body from the gut. Calorie needs can be estimated with the Curreri formula.
Another common problem after a burn is changes in skin color, which can cause a lot of distress. Skin grafts are an option to resolve this, though they can be time-consuming and expensive.
Lastly, it should be kept in mind that burns can get worse after the initial injury, making them hard to assess accurately at first. Therefore, anyone with burns should be checked again a few days later to reevaluate the extent and severity of the burns.
What else can Thermal Burns be?
There are different types of burns including:
- Chemical burns
- Electric burns
- Heat or fire burns
What to expect with Thermal Burns
The outcome after experiencing a burn injury depends on several factors. First-degree burns usually have a good outcome; however, more serious second and third-degree burns can lead to complicated recovery or even death. Other factors can affect recovery, such as the age of the patient, other existing medical conditions, the level of experience of the medical facility, and whether or not the person inhaled smoke or toxic gases during the incident.
