Burn Care in Emergency Medicine

Introduction:

Burn injuries or burns result from accidental tissue damage caused by heat, hot liquids, flames, steam, chemicals, radiation, or electricity. Burns vary in severity depending on the cause and intensity of exposure. The emergency care for the burns depends on the severity of the burn injury. Minor burns that do not require hospital care (such as burns due to hot soups) and heal well with first aid at home. Minor burns can also lead to severe infections and complications that require emergency care if neglected. Major burns require prompt emergency medical care by a multidisciplinary team at a proper facility (hospital burn centers).

What Are the Types of Burns?

The burns can be classified based on the severity of the injury. The cause, size, depth, time, and extent, and the body part injured determine the severity of the burn. Treatment and emergency care of burns depend on the severity. The types of burns include:

1. Minor Burns: These are mild burns that can be treated at home or as an outpatient by the doctor. Minor burns are generally those superficial burns that are smaller than the patient’s hand size.

2. Moderate Burns: These include superficial to deep burns that require hospital admission. Burns that are larger, involving the joints, or burns involving functional body parts like the groin, eyes, feet, face, and ears require immediate medical attention and emergency care. If ignored, they may cause serious complications like loss of function or disfigurement.

3. Severe Burns: These include large and deep burns that require emergency medical care at a specialized center or a burn care center.

Burns are also classified based on their depth. These include:

1. First-Degree Burns: These are superficial burns limited to the outer layer of the skin, such as sunburns. When this type of burn occurs, the skin remains intact and appears red or pink in color. These burns are painful and may cause mild blisters and swelling on the skin.

2. Second-Degree Burns: These are painful partial-thickness burns that go deeper into the skin (involve the deeper layer of skin called the dermis). The burnt area is moist or wet with blisters, swelling, or loss of skin on the wound. Even a small burn can become infectious, so it is important to seek immediate medical care.

3. Third and Fourth-Degree Burns: These are called full-thickness burns involving all the layers of the skin and the deeper tissues such as muscles, nerves, bones, or organs. The burnt area appears charred, leathery, and dry. They are extremely painful. Loss of sensation or feeling occurs in cases where nerve damage has occurred. These severe burns require immediate evaluation and treatment by a healthcare provider regardless of the size of the burn or the body part affected.

When Should One Call for Emergency Care for a Burn Injury?

Immediate emergency care is required in cases of major burns. One must call for emergency medical care in case of the following:

• Major deep burns involving all layers of skin.

• Burn damage in the deeper tissues such as muscles, nerves, bones, and joints.

• The wound appears charred or has dry, leathery skin.

• Burns that are larger than three inches in diameter.

• Burns, along with smoke inhalation.

• Burns begins to swell up.

• Electrical burns.

• Burns caused by lightning.

• Major chemical burns.

• Burns in functional body parts such as those covering the hands, feet, ears, eyes, mouth, and genitals.

• Burns in babies and older adults.

• Minor burns that cause persistent pain or fever.

How to Care for Minor Burns?

Minor burns are painful, and they have the potential to become infected, leading to complications. First aid must be initiated immediately. The steps to be followed in case of minor burns include:

1. The burn should be cooled with running cool water (not cold) for five to ten minutes. This will help stop the progress of the burning process.

2. Rings, jewelry, watches, and clothing near the burn must be removed.

3. Over-the-counter pain relievers should be administered to control pain.

4. Soothing products can be applied to the burn.

5. In case of blisters, antibiotic ointment should be applied.

6. The burnt area must be covered with a band-aid or loosely covered with a cotton cloth or sterile gauze.

7. Ice should not be applied to the burn as it worsens the damage.

8. Home remedies such as butter should not be applied to the burn as they trap the heat and worsen the damage.

9. Blisters on the burns must not be touched or broken.

10. The patient must drink plenty of water and remain hydrated.

11. One must call for emergency care in case of the following:

    • Persistent fever or chills after a minor burn injury that is not relieved by medication.

    • Redness extends beyond the burn area.

    • Persistent or worsening pain that is not relieved by over-the-counter pain medication such as Acetaminophen or Ibuprofen.

What Should One Do in Case of Major Burns?

In case of major burns, call for emergency care immediately. Until the emergency team arrives, the following standard of care must be provided:

• The burned person must be kept away from further harm or contact with the source of the burn.

• Ensure that the power source is switched off before handling electrical burn patients.

• Clothing stuck to the burns must not be removed.

• The injured person’s breathing should be checked. If possible, rescue breathing must be initiated (if trained).

• Tight items around the burn area, such as belts or jewelry, should be removed.

• The burn should be covered loosely with a clean cloth or sterile gauze.

• If possible, the burnt area must be raised above the heart level.

• The caregiver should be alert for various signs and symptoms such as cold, clammy skin, shallow breathing, and irregular or weak pulse. These could be signs of life-threatening conditions such as shock.

How Are Major Burns Managed by Emergency Medical Personnel?

There is a significant risk of death and deformity in case of major burns. Prompt management with appropriate treatment during the initial resuscitation reduces such risk. The burn care guidelines for emergency stabilization of burned patients include the following:

1. Measures to stop the burning process are initiated.

2. The patient’s airway is kept open to ensure oxygen delivery to the body. Airway management includes oxygen supply and oral intubation procedures.

3. Breathing assistance is provided whenever necessary.

4. Circulation or blood flow through the body is assessed and managed. Medical interventions are initiated to ensure oxygen delivery to all parts of the body.

5. Intravenous line access is obtained.

6. A physical examination of the burned patient is performed, and the patient is checked for any other associated injuries. Any other injuries found, such as inhalation injuries, are appropriately managed.

7. For babies and children, the glucose level is monitored.

8. Cardiac monitors are used for electrical burn patients.

9. Fluid resuscitation procedures are initiated.

10. The burns are covered with dry dressings. The patient is kept warm by using blankets and warming up the emergency medical service vehicles to prevent complications due to loss of body temperature (hypothermia).

11. Pain medications are administered as per protocol.

12. The patient is assessed and transported to a nearby hospital with burn capabilities or a burn care center for definitive treatment.

Conclusion:

Burn injuries are common worldwide. Severe burns cause loss of life or deformities. The severity of the burn injury determines the emergency care to be provided. Minor burns heal well with first aid at home. Some minor burns may lead to severe infections and complications if neglected. Severe burns require prompt assessment and treatment initiation by emergency medical services. Quick initial resuscitation, wound care, and prompt transfer to a hospital or burn care center can help save lives.