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definitions - Burns

Burns (n.)

1.celebrated Scottish poet (1759-1796)

2.United States comedian and film actor (1896-1996)

3.(MeSH)Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like.

burn (v. trans.)

1.be the source of pain

burn (n.)

1.damage inflicted by fire

2.a place or area that has been burned (especially on a person's body)

3.the act of burning something completely; reducing it to ashes

4.an injury caused by exposure to heat or chemicals or radiation

5.a browning of the skin resulting from exposure to the rays of the sun

6.pain that feels hot as if it were on fire

burn (v.)

1.get a sunburn by overexposure to the sun

2.burn with heat, fire, or radiation"The iron burnt a hole in my dress"

3.burn, sear, or freeze (tissue) using a hot iron or electric current or a caustic agent"The surgeon cauterized the wart"

4.undergo combustion"Maple wood burns well"

5.cause to undergo combustion"burn garbage" "The car burns only Diesel oil"

6.destroy by fire"They burned the house and his diaries"

7.use up (energy)"burn off calories through vigorous exercise"

8.create by duplicating data"cut a disk" "burn a CD"

9.feel strong emotion, especially anger or passion"She was burning with anger" "He was burning to try out his new skies"

10.cause a sharp or stinging pain or discomfort"The sun burned his face"

11.feel hot or painful"My eyes are burning"

12.spend (significant amounts of money)"He has money to burn"

13.burn at the stake"Witches were burned in Salem"

14.cause to burn or combust"The sun burned off the fog" "We combust coal and other fossil fuels"

15.shine intensely, as if with heat"The coals were glowing in the dark" "The candles were burning"

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Merriam Webster

BurnBurn (bûrn), v. t. [imp. & p. p. Burned (bûrnd) or Burnt (bûrnt); p. pr. & vb. n. Burning.] [OE. bernen, brennen, v. t., early confused with beornen, birnen, v. i., AS. bærnan, bernan, v. t., birnan, v. i.; akin to OS. brinnan, OFries. barna, berna, OHG. brinnan, brennan, G. brennen, OD. bernen, D. branden, Dan. brænde, Sw. bränna, brinna, Icel. brenna, Goth. brinnan, brannjan (in comp.), and possibly to E. fervent.]
1. To consume with fire; to reduce to ashes by the action of heat or fire; -- frequently intensified by up: as, to burn up wood. “We'll burn his body in the holy place.” Shak.

2. To injure by fire or heat; to change destructively some property or properties of, by undue exposure to fire or heat; to scorch; to scald; to blister; to singe; to char; to sear; as, to burn steel in forging; to burn one's face in the sun; the sun burns the grass.

3. To perfect or improve by fire or heat; to submit to the action of fire or heat for some economic purpose; to destroy or change some property or properties of, by exposure to fire or heat in due degree for obtaining a desired residuum, product, or effect; to bake; as, to burn clay in making bricks or pottery; to burn wood so as to produce charcoal; to burn limestone for the lime.

4. To make or produce, as an effect or result, by the application of fire or heat; as, to burn a hole; to burn charcoal; to burn letters into a block.

5. To consume, injure, or change the condition of, as if by action of fire or heat; to affect as fire or heat does; as, to burn the mouth with pepper.

This tyrant fever burns me up. Shak.

This dry sorrow burns up all my tears. Dryden.

When the cold north wind bloweth, . . . it devoureth the mountains, and burneth the wilderness, and consumeth the ��ass as fire. Ecclus. xliii. 20, 21.

6. (Surg.) To apply a cautery to; to cauterize.

7. (Chem.) To cause to combine with oxygen or other active agent, with evolution of heat; to consume; to oxidize; as, a man burns a certain amount of carbon at each respiration; to burn iron in oxygen.

To burn, To burn together, as two surfaces of metal (Engin.), to fuse and unite them by pouring over them a quantity of the same metal in a liquid state. -- To burn a bowl (Game of Bowls), to displace it accidentally, the bowl so displaced being said to be burned. -- To burn daylight, to light candles before it is dark; to waste time; to perform superfluous actions. Shak. -- To burn one's fingers, to get one's self into unexpected trouble, as by interfering the concerns of others, speculation, etc. -- To burn out, (a) to destroy or obliterate by burning. “Must you with hot irons burn out mine eyes?” Shak. (b) to force (people) to flee by burning their homes or places of business; as, the rioters burned out the Chinese businessmen. -- To be burned out, to suffer loss by fire, as the burning of one's house, store, or shop, with the contents. -- To burn up, To burn down, to burn entirely.

BurnBurn, v. i.
1. To be of fire; to flame. “The mount burned with fire.” Deut. ix. 15.

2. To suffer from, or be scorched by, an excess of heat.

Your meat doth burn, quoth I. Shak.

3. To have a condition, quality, appearance, sensation, or emotion, as if on fire or excessively heated; to act or rage with destructive violence; to be in a state of lively emotion or strong desire; as, the face burns; to burn with fever.

Did not our heart burn within us, while he talked with us by the way? Luke xxiv. 32.

The barge she sat in, like a burnished throne,
Burned on the water.
Shak.

Burning with high hope. Byron.

The groan still deepens, and the combat burns. Pope.

The parching air
Burns frore, and cold performs the effect of fire.
Milton.

4. (Chem.) To combine energetically, with evolution of heat; as, copper burns in chlorine.

5. In certain games, to approach near to a concealed object which is sought. [Colloq.]

To burn up, To burn down, to be entirely consumed.

BurnBurn, n.
1. A hurt, injury, or effect caused by fire or excessive or intense heat.

2. The operation or result of burning or baking, as in brickmaking; as, they have a good burn.

3. A disease in vegetables. See Brand, n., 6.

BurnBurn, n. [See 1st Bourn.] A small stream. [Scot.]

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definition (more)

definition of Wikipedia

synonyms - Burns

see also - Burns

phrases

-Burns and corrosions • Burns and corrosions confined to eye and internal organs • Burns and corrosions of external body surface, specified by site • Burns and corrosions of multiple and unspecified body regions • Burns and corrosions of multiple body regions • Burns classified according to extent of body surface involved • Burns involving 10-19% of body surface • Burns involving 20-29% of body surface • Burns involving 30-39% of body surface • Burns involving 40-49% of body surface • Burns involving 50-59% of body surface • Burns involving 60-69% of body surface • Burns involving 70-79% of body surface • Burns involving 80-89% of body surface • Burns involving 90% or more of body surface • Burns involving less than 10% of body surface • Burns of multiple regions, at least one burn of third degree mentioned • Burns of multiple regions, no more than first-degree burns mentioned • Burns of multiple regions, no more than second-degree burns mentioned • Burns of multiple regions, unspecified degree • Burns originating from fire caused directly by a fire-producing device or indirectly by any conventional weapon • Burns, Chemical • Burns, Electric • Burns, Inhalation • Chemical Burns • Electric Burns • Eye Burns • George Burns • Inhalation Burns • Multiple burns NOS • Robert Burns • Robert Burns Woodward • Sequelae of burns, corrosions and frostbite • burns (electric) • burns (thermal) from electrical heating appliances • burns (thermal) from flame • burns (thermal) from friction • burns (thermal) from hot air and hot gases • burns (thermal) from hot objects • burns (thermal) from lightning • burns (thermal) from radiation • burns (thermal) fromelctricity • burns and corrosions • burns and corrosions classifiable to more than one of the categories (T20-T25), (T26-T28) • burns and corrosions from local applications and irradiation • burns and corrosions of first degree [erythema] • burns and corrosions of second degree [blisters][epidermal loss] • burns and corrosions of third degree [deep necrosis of underlying tissue][full-thickness skin loss] • burns from localized fire or explosion on board ship • burns or other injuries from electric current NOS • chemical burns [corrosion] (external)(internal)

-Burn Centers • Burn NOS • Burn Units • Burn and corrosion confined to eye and adnexa • Burn and corrosion of ankle and foot • Burn and corrosion of head and neck • Burn and corrosion of hip and lower limb, except ankle and foot • Burn and corrosion of other internal organs • Burn and corrosion of respiratory tract • Burn and corrosion of shoulder and upper limb, except wrist and hand • Burn and corrosion of trunk • Burn and corrosion of wrist and hand • Burn and corrosion, body region unspecified • Burn involving larynx and trachea with lung • Burn of cornea and conjunctival sac • Burn of eye and adnexa, part unspecified • Burn of eyelid and periocular area • Burn of first degree of ankle and foot • Burn of first degree of head and neck • Burn of first degree of hip and lower limb, except ankle and foot • Burn of first degree of shoulder and upper limb, except wrist and hand • Burn of first degree of trunk • Burn of first degree of wrist and hand • Burn of first degree, body region unspecified • Burn of internal genitourinary organs • Burn of larynx and trachea • Burn of mouth and pharynx • Burn of oesophagus • Burn of other and unspecified internal organs • Burn of other parts of alimentary tract • Burn of other parts of eye and adnexa • Burn of other parts of respiratory tract • Burn of respiratory tract, part unspecified • Burn of second degree of ankle and foot • Burn of second degree of head and neck • Burn of second degree of hip and lower limb, except ankle and foot • Burn of second degree of shoulder and upper limb, except wrist and hand • Burn of second degree of trunk • Burn of second degree of wrist and hand • Burn of second degree, body region unspecified • Burn of third degree of ankle and foot • Burn of third degree of head and neck • Burn of third degree of hip and lower limb, except ankle and foot • Burn of third degree of shoulder and upper limb, except wrist and hand • Burn of third degree of trunk • Burn of third degree of wrist and hand • Burn of third degree, body region unspecified • Burn of unspecified body region, unspecified degree • Burn of unspecified degree of ankle and foot • Burn of unspecified degree of head and neck • Burn of unspecified degree of hip and lower limb, except ankle and foot • Burn of unspecified degree of shoulder and upper limb, except wrist and hand • Burn of unspecified degree of trunk • Burn of unspecified degree of wrist and hand • Burn with resulting rupture and destruction of eyeball • Burn-in • Burn-out • First-degree burn NOS • Second-degree burn NOS • Sequelae of burn and corrosion classifiable only according to extent of body surface involved • Sequelae of burn, corrosion and frostbite of head and neck • Sequelae of burn, corrosion and frostbite of lower limb • Sequelae of burn, corrosion and frostbite of trunk • Sequelae of burn, corrosion and frostbite of upper limb • Sequelae of unspecified burn, corrosion and frostbite • Third-degree burn NOS • burn and corrosion (of) confined to eye and adnexa • burn and corrosion (of) mouth and pharynx • burn and corrosion of ankle and foot alone • burn and corrosion of axilla • burn and corrosion of interscapular region • burn and corrosion of scapular region • burn and corrosion of wrist and hand alone • burn and corrosion with statement of the extent of body surface involved • burn away • burn bag • burn black • burn center • burn down • burn mark • burn off • burn one's candle at both ends • burn one's fingers • burn out • burn plant • burn to ashes • burn to the ground • burn up • burn up fraction • burn with • burn-clearing • burn-in • burn-out • cigarette burn • electric burn • first-degree burn • freezer burn • have money to burn • rope burn • second-degree burn • specific burn up • start to burn • tertiary burn • third-degree burn

-'Farmer' Burns • A Hunka Hunka Burns in Love • A Star Is Burns • Allan Burns • Anthony Burns • Anthony Burns (politician) • August Burns Red • BMO Nesbitt Burns • Barry Burns • Billings-Burns • Black Light Burns • Bob Burns • Bob Burns (comedian) • Bob Burns (drummer) • Bob Burns (golfer) • Brent Burns • Burnie Burns • Burns Arena • Burns Beach • Burns Beach, Western Australia • Burns Court Historic District • Burns Flat, Oklahoma • Burns Fugitive Slave Case • Burns Harbor, Indiana • Burns Howff • Burns Lake Airport • Burns Lake Park • Burns Lake Site • Burns London • Burns Park (Detroit, Michigan) • Burns Philp • Burns Realty Company-Karl Bickel House • Burns Township, Michigan • Burns Tri-Sonic • Burns and Allen • Burns stanza • Burns supper • Burns' Heir • Burns' bog • Burns, Baby Burns • Burns, Kansas • Burns, Michael • Burns, New York • Burns, Oregon • Burns, Tennessee • Burns, Wisconsin • Burns, Wyoming • C. B. Burns • Carol Burns • Catherine Burns • Charles Burns • Charles Burns (cartoonist) • Chris Burns (footballer) • Chris Burns (radio host) • Christian Burns • Clarence H. Burns • Cockburn-Burns • Conrad Burns • Curry Burns • David Burns (actor) • David D. Burns • Diann Burns • Dick Burns • Ed Burns • Eddie Burns • Eric Burns • Eric Burns (blogger) • Evers Burns • Everything Burns • Farmer Burns • Farmer Burns (baseball) • Francis Burns • Gary Burns (Canada) • George Burns • George Burns (first baseman) • George Burns (golfer) • George Burns (outfielder) • George Burns Comedy Week • Greg Burns • Greg Burns (coach) • Harry Burns (activist) • Heather Burns • Hock burns • Jack Burns (football coach) • Jack Burns (golfer) • Jackson Burns • Jacob Burns • Jacob Burns (attorney) • Jacob Burns (footballer) • Jacob Burns Film Center • Jake Burns and the Big Wheel • James Burns (businessman) • James Burns (shipowner) • James D. Burns • James MacGregor Burns • Jamie Burns • Jean Burns • Jere Burns • Jim Burns • John Burns • John Burns (comics) • John Burns (disambiguation) • John Burns (radio) • John Burns Hynd • John Carpenter's Cigarette Burns • John L. Burns • John M. Burns • Karen Ramey Burns • Karl Burns • Kay Burns • Keith Burns • Keith Burns (coach) • Keith Burns (disambiguation) • Ken Burns • Ken Burns Effect • Kennedy Francis Burns • Kenneth Burns • Kenneth C. Burns • Kenny Burns • Kevin Burns • Larry Burns • Larry Burns (The Simpsons) • Laura J. Burns • Liam Burns • Life Burns! • Major Frank Burns • Marilyn Burns (politician) • Martha Burns • Martin Burns • Mary Burns • Max Burns • Megan Burns • Michael Burns • Michael Burns (actor) • Michael Burns (historian) • Michael Burns (producer) • Mike Burns (baseball) • Montgomery Burns • My Flame Burns Blue • Nathan Burns • Nicholas Burns (British actor) • Nicholas Burns (actor) • Nicholas Burns (musician) • Olive Ann Burns • Oyster Burns • Panther Burns • Pat Burns (broadcaster) • Patrick Burns • Patrick Burns (businessman) • Patrick Burns (paranormal investigator) • Paul Burns • Pete Burns • Powder Burns • R. Nicholas Burns • Ralph Burns • Regan Burns • Ric Burns • Richard Burns • Richard Burns Rally • Robert Andrew Burns • Robert Burns Woodward • Robert Elliott Burns • Robert L. Burns • Ronnie Burns • Ronnie Burns (actor) • Ronnie Burns (footballer) • Ronnie Burns (singer) • Roy Burns • Sarah Burns • Scott Burns • Scott Burns (voice actor) • Simon Burns • Sings the Songs of Robert Burns • Sir George Burns, 1st Baronet • Stephen W. Burns • Steve Burns • Steve Burns (architect) • Tam o' Shanter (Burns poem) • The Burns and Allen Show • The Panther Burns • Thomas Burns (New Zealand) • Timothy Burns • Todd Burns • Tom Burns (baseball) • Tom Burns (sociologist) • Tommy Burns (boxer) • United States v. Burns • Ursula Burns • Vincent Burns • What Burns Never Returns • When Eden Burns • William Burns • William Chalmers Burns • William J. Burns House • William Joseph Burns • William Wallace Burns McInnes • Woodward, Robert Burns • World Burns to Death • Éamonn Burns

analogical dictionary

poète. (fr)[ClasseParExt.]

Burns (n.)





 

MESH root[Thème]

burn [MeSH]











physics[Domaine]

Combustion[Domaine]

burn (v.)














burn (v. intr.)


 

(burn)[Thème]

burn (v. intr.)


 

(burn)[Thème]

burn (v. intr.)





Wikipedia

Burns

                   

Burns may refer to:

Places:

Ships:

Buildings:

  See also


   
               

Burn

                   
Burn
Classification and external resources

Second-degree burn of the hand
ICD-10 T20-T31
ICD-9 940-949
MeSH D002056

A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction.[1][2][3] Most burns affect only the skin (epidermal tissue and dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an out-of-hospital setting, or may require more specialized treatment such as those available at specialized burn centers.

Managing burn injuries properly is important because they are common, painful and can result in disfiguring and disabling scarring, amputation of affected parts or death in severe cases. Complications such as shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress may occur. The treatment of burns may include the removal of dead tissue (debridement), applying dressings to the wound, fluid resuscitation, administering antibiotics, and skin grafting.

While large burns can be fatal, modern treatments developed in the last 60 years have significantly improved the prognosis of such burns, especially in children and young adults.[4][5] In the United States, approximately 1 out of every 25 people to suffer burns will die from their injuries. The majority of these fatalities occur either at the scene or on the way to hospital.[6]

  Sign and symptoms

Burns can be classified by mechanism of injury, depth, extent and associated injuries and comorbidities.

  By depth

Currently, burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third, and fourth degrees. This system was devised by the French barber-surgeon Ambroise Pare and remains in use today.[7]

It is often difficult to accurately determine the depth of a burn. This is especially so in the case of second degree burns, which can continue to evolve over time. As such, a second-degree partial-thickness burn can progress to a third-degree burn over time even after initial treatment. Distinguishing between the superficial-thickness burn and the partial-thickness burn is important, as the former may heal spontaneously, whereas the latter often requires surgical excision and skin grafting.

The following tables describe degrees of burn injury under this system as well as provide pictorial examples.

Names Layers involved Appearance Texture Sensation Time to healing Complications Example
First degree Epidermis Redness (erythema) Dry Painful 1wk or less Increased risk to develop skin cancer later in life A sunburn is a typical first degree burn.
Second degree (superficial partial thickness) Extends into superficial (papillary) dermis Red with clear blister. Blanches with pressure Moist Painful 2-3wks Local infection/cellulitis

Second degree burn of the thumb

Second degree (deep partial thickness) Extends into deep (reticular) dermis Red-and-white with bloody blisters. Less blanching. Moist Painful Weeks - may progress to third degree Scarring, contractures (may require excision and skin grafting) Second-degree burn caused by contact with boiling water
Third degree (full thickness) Extends through entire dermis Stiff and white/brown Dry, leathery Painless Requires excision Scarring, contractures, amputation Eight day old third-degree burn caused by motorcycle muffler.
Fourth degree Extends through skin, subcutaneous tissue and into underlying muscle and bone Black; charred with eschar Dry Painless Requires excision Amputation, significant functional impairment, possible gangrene, and in some cases death. 4th degree burn

  Cause

Burns are caused by a wide variety of substances and external sources such as exposure to chemicals, friction, electricity, radiation, and heat.

  Chemical

Most chemicals that cause chemical burns are strong acids or bases.[8] Chemical burns can be caused by caustic chemical compounds such as sodium hydroxide or silver nitrate, and acids such as sulfuric acid.[9] Hydrofluoric acid can cause damage down to the bone and its burns are sometimes not immediately evident.[10] Chemical burns can be either first, second, or third degree burns, depending on duration of contact, strength of the substance, and other factors.

  Electrical

Electrical burns are caused by either an electric shock or an uncontrolled short circuit (a burn from a hot, electrified heating element is not considered an electrical burn). Common occurrences of electrical burns include workplace injuries, taser wounds, or being defibrillated or cardioverted without a conductive gel. Lightning is also a rare cause of electrical burns.

Since normal physiology involves a vast number of applications of electrical forces, ranging from neuromuscular signaling to coordination of wound healing, biological systems are very vulnerable to application of supraphysiologic electric fields. Some electrocutions produce no external burns at all, as very little current is required to cause fibrillation of the heart muscle. Therefore, even when the injury does not involve any visible tissue damage, electrical shock survivors may experience significant internal injury.[11] The internal injuries sustained may be disproportionate to the size of the burns seen (if any), and the extent of the damage is not always obvious. Such injuries may lead to cardiac arrhythmias, cardiac arrest, and unexpected falls with resultant fractures or dislocations.[12]

The true incidence of electrical burn injury is unknown. In one study of 220 deaths due to electrical injury, 40% of those associated with low-voltage (<500 AC volts) injury demonstrated no skin burns or marks whatsoever. This is sufficient to cause cardiac arrest and ventricular fibrillation but generates relatively low heat energy deposit into skin, thus producing few or no burn marks at all.[13] High voltage electricity, on the other hand, is a common cause of third and fourth degree burns due to the extreme heat yielded by high temperature arcs and flashover associated with voltages over 1000v.

  Radiation

Radiation burns are caused by protracted exposure to UV light (as from the sun), tanning booths, radiation therapy (in people undergoing cancer therapy), sunlamps, radioactive fallout, and X-rays. By far the most common burn associated with radiation is sun exposure, specifically two wavelengths of light UVA, and UVB, the latter being more dangerous. Tanning booths also emit these wavelengths and may cause similar damage to the skin such as irritation, redness, swelling, and inflammation. More severe cases of sun burn result in what is known as sun poisoning or "heatstroke". Microwave burns are caused by the thermal effects of microwave radiation.

  Scalding

Scalding (from the Latin word calidus, meaning hot[14]) is caused by hot liquids (water or oil) or gases (steam), most commonly occurring from exposure to high temperature tap water in baths or showers or spilled hot drinks.[15] A so called immersion scald is created when an extremity is held under the surface of hot water, and is a common form of burn seen in child abuse.[16] A blister is a "bubble" in the skin filled with serous fluid as part of the body's reaction to the heat and the subsequent inflammatory reaction. The blister "roof" is dead and the blister fluid contains toxic inflammatory mediators. Scald burns are more common in children, especially "spill scalds" from hot drinks and bath water scalds.

Generally scald burns are first or second degree burns, but third degree burns can result, especially with prolonged contact.

  Pathophysiology

Burn injury results in a local inflammatory response. In larger burns there is a systemic inflammatory response. The lungs may be doubly compromised by smoke inhalation and the venous affluent returning from circulation through the burned skin. Following a major burn injury, heart rate and peripheral vascular resistance increase. This is due to the release of catecholamines from injured tissues, and the relative hypovolemia that occurs from fluid volume shifts. Initially cardiac output decreases. At approximately 24 hours after burn injuries, cardiac output returns to normal if adequate fluid resuscitation has been given. Following this, cardiac output increases to meet the hypermetabolic needs of the body.

The effects of high temperature on tissue include speeding chemical reactions and unfolding (denaturing) proteins. [17]

Heat stimulates pain fibers and alters protein structure in the burn area. Stimulated pain fibers release neuropeptides. Altered proteins activate complements. Complements in turn coat these altered proteins and degranulate mast cells. Complement-coated proteins attract neutrophils which also degranulate to release free radicals and proteases causing further damage. Mast cells upon degranulation release tumor necrosis factor – α (TNF – α, primary cytokine). TNF – α is chemotactic to other inflammatory cells (TNF – α acts as a chemokine in this way) which release secondary cytokines.[18] These secondary cytokines increase permeability of blood vessels in the burn area. This causes exudation of proteins and fluid into the adjacent interstitial tissue. Red cells are not extravasated. This results in increase in the oncotic pressure in the interstitium. The volume of fluid loss is directly proportional to the burn area. If burn area is 10% to 15% of the total body surface area (TBSA), then the consequent fluid loss may cause circulatory shock. If it is more than 25% of TBSA, then inflammation occurs even in the blood vessels remote to the burn, causing greater fluid loss.[18]

  Diagnosis

  Three degrees of burns

  By severity

In order to determine the need for referral to a specialised burn unit, the American Burn Association devised a classification system to aid in the decision-making process. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area (TBSA) burnt, the involvement of specific anatomical zones, age of the person and associated injuries.[6]

  Major

Major burns are defined as:

  • Age 10-50yrs: partial thickness burns >25% of total body surface area
  • Age <10 or >50: partial thickness burns >20% of total body surface area
  • Full thickness burns >10%
  • Burns involving the hands, face, feet or perineum[19]
  • Burns that cross major joints
  • Circumferential burns to any extremity
  • Any burn associated with inhalational injury
  • Electrical burns
  • Burns associated with fractures or other trauma
  • Burns in infants and the elderly
  • Burns in persons at high-risk of developing complications

These burns typically require referral to a specialised burn treatment center.

  Moderate

Moderate burns are defined as:

  • Age 10-50yrs: partial thickness burns involving 15-25% of total body surface area
  • Age <10 or >50: partial thickness burns involving 10-20% of total body surface area
  • Full thickness burns involving 2-10% of total body surface area

Persons suffering these burns often need to be hospitalised for burn care.

  Minor

Minor burns are:

  • Age 10-50yrs: partial thickness burns <15% of total body surface area
  • Age <10 or >50: partial thickness burns involving <10% of total body surface area
  • Full thickness burns <2% of total body surface area, without associated injuries

These burns usually do not require hospitalization.

  By surface area

Burns can also be assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns. First degree (erythema only, no blisters) burns are not included in this estimation. The rule of nines is used as a quick and useful way to estimate the affected TBSA. More accurate estimation can be made using Lund & Browder charts, which take into account the different proportions of body parts in adults and children.[20] The size of a person's hand print (palm and fingers) is approximately 0.8% of their TBSA, but for quick estimates, medical personnel round this to 1%, slightly overestimating the size of the affected area.[21]

Burns of 10% in children or 15% in adults (or greater) are potentially life threatening injuries (because of the risk of hypovolaemic shock) and should have formal fluid resuscitation and monitoring in a burns unit. Burns units will use surface area to predict severity and mortality, using a methodology such as the Baux score.

  Management

The resuscitation and stabilization phase begins with the reassessment of the injured person's airway, breathing and circulatory state. Appropriate interventions should be initiated to stabilize these. This may involve targeted (using specific resuscitation formula to guide fluid administration) fluid resuscitation and, if inhalation injury is suspected, intubation and ventilation. Once the injured person is stabilized, attention is turned to the care of the burn wound itself. Until then, it is advisable to cover the burn wound with a clean and dry sheet or dressing (such as cling film).

Early cooling reduces burn depth and pain, but care must be taken as uncontrolled cooling can result in hypothermia.[22]

  Intravenous fluids

Children with >10% total body surface area burns, and adults with >15% total body surface area burns need formal fluid resuscitation and monitoring (blood pressure, pulse rate, temperature and urine output).[23] Once the burning process has been stopped, the injured person should be volume resuscitated according to the Parkland formula. This formula calculates the amount of Ringer's lactate required to be administered over the first 24 hours post-burn.

Parkland formula: 4mL x (percentage of total body-surface-area sustaining non-superficial burns) x (person's weight in kgs).

Half of this total volume should be administered over the first eight hours, with the remainder given over the following 16 hours. It is important to note that this time frame is calculated from the time at which the burn is sustained, and not the time at which fluid resuscitation is begun. Children also require the addition of maintenance fluid volume. Such injuries can disturb a person's osmotic balance.[24] Inhalation injuries in conjunction with thermal burns initially require up to 40–50% more fluid.

The formula is a guide only and infusions must be tailored to the urine output and central venous pressure. Inadequate fluid resuscitation may cause renal failure and death, but over-resuscitation also causes morbidity.

  Wound care

  Second degree heat burn, approx 1cm across centre, 6 days after burn.

Debridement cleaning and then dressings are important aspects of wound care. The wound should then be regularly re-evaluated until it is healed.[3] In the management of first and second degree burns little quality evidence exists to determine which type of dressing should be used.[25] Silver sulfadiazine (Flamazine) is not recommended as it potentially prolongs healing time[25] while biosynthetic dressings may speed healing.[26]

  Antibiotics

Intravenous antibiotics may improve survival in those with large and severe burns. However due to the poor quality of the evidence, routine use is not currently recommended.[27]

  Analgesics

A number of different options are used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and narcotics. A local anesthetic may help in managing pain of minor first-degree and second-degree burns.[28]

  Surgery

Wounds requiring surgical closure with skin grafts or flaps should be dealt with as early as possible.[3] Circumferential burns of digits, limbs or the chest may need urgent surgical release of the burnt skin (escharotomy) to prevent problems with distal circulation or ventilation.[3]

  Alternative treatments

Hyperbaric oxygenation may be useful in adjunct to traditional treatments to speed up healing time; however, more research is needed to confirm or deny this.[29] Honey has been used since ancient times to aid wound healing and may be beneficial in first and second degree burns, but may cause infection.[30]

There are a number of methods to reduce procedural pain and anxiety for people with burns include the use of virtual reality therapy, relaxation techniques, sensory focusing, distraction, and education.[31]

  Complications

Infection is a major complication of burns. Infection is linked to impaired resistance from disruption of the skin's mechanical integrity and generalized immune suppression. The skin barrier is replaced by eschar. This moist, protein rich avascular environment encourages microbial growth. Migration of immune cells is hampered, and there is a release of intermediaries that impede the immune response. Eschar also restricts distribution of systemically administered antibiotics because of its avascularity.

Risk factors of burn wound infection include:

  • Burn > 30% TBSA
  • Full-thickness burn
  • Extremes in age (very young, very old)
  • Preexisting disease e.g. diabetes
  • Virulence and antibiotic resistance of colonizing organism
  • Failed skin graft
  • Improper initial burn wound care
  • Prolonged open burn wound

Burn wounds are prone to tetanus. A tetanus booster shot is required if individual has not been immunized within the last 5 years.

Circumferential burns of extremities may compromise circulation. Elevation of limb may help to prevent dependent edema. An Escharotomy may be required.

Acute Tubular Necrosis of the kidneys can be caused by myoglobin and hemoglobin released from damaged muscles and red blood cells. This is common in electrical burns or crush injuries where adequate fluid resuscitation has not been achieved.

  Prognosis

The outcome of any injury or disease depends on three things: the nature of the injury, the nature of the injured or ill person and the treatment available. In terms of injury factors in burns, the prognosis depends primarily on total body surface area percentage burn and the age of the person. The presence of smoke inhalation injury, other significant injuries such as long bone fractures, and serious co-morbidities (heart disease, diabetes, psychiatric illness, suicidal intent etc.) will also adversely influence prognosis. Advances in resuscitation, surgical management, intensive care, control of infection, control of the hyper-metabolic response and rehabilitation have resulted in dramatic improvements in burn mortality and morbidity in the last 60 years. The modified Baux score determines the futility point for major burn injury. The Baux score is determined by adding the size of the burn (% TBSA) to the age of the patient. In most burn units a score of 140 or greater is a non-survivable injury, and comfort care should be offered. In children all burn injuries less than 100% TBSA should be considered a survivable injury.

Following a burn injury children can suffer significant psychological trauma in both the short- and long-term. A major concern of a survivor of any traumatic injury is post-traumatic stress disorder (PTSD). Another significant concern for children is coping with a disturbance in body image.[32]

  Epidemiology

  Disability-adjusted life years for fires per 100,000 inhabitants in 2004.[33]
  no data
  < 50
  50-100
  100-150
  150-200
  200-250
  250-300
  300-350
  350-400
  400-450
  450-500
  500-600
  > 600

As of 2004, 11 million burn requiring medical care occurred worldwide.[34] About 90% of burns occur in the developing world and 70% of these are in children. Survival of injuries greater than 40% total body surface area is rare in the developing world.[35]

  United States

An estimated 500,000 burn injuries receive medical treatment yearly in the United States.[7] The 2009 National Burn Repository reports the most common cause of burns as direct fire/flame (43%) followed by scalds (30%). Scald injuries were the predominant cause in children under the age of 5. Burns sustained at home accounted for 65.5% of all burn injuries in the United States that year, and had a mortality rate of 4% overall. This mortality rate was directly associated with advancing age, burn size, the presence of inhalational injury and the female sex.[6] It is estimated that approximately 75% of deaths from burns and fires in the United States occur either at the scene of the incident or enroute to medical facilities. Demographically, people sustaining burns in the United States tended to be male (70%) and to have suffered their injuries in a residential setting (43%).[6] The highest incidence of burns occurs in the 18-35yr old age group, while the highest incidence of scalds occurs in children 1-5yrs old and adults over 65.

  Other

In India about 700,000 people a year are admitted to hospital, though very few are looked after in specialist burn units.[36]

  References

  1. ^ MedlinePlus. "Burns". http://www.nlm.nih.gov/medlineplus/burns.html. Retrieved 2010-09-22. 
  2. ^ WebMD (January 7, 2009). "Burns-Topic Overview". firstaid&emergencies. http://firstaid.webmd.com/tc/burns-topic-overview. Retrieved 2010-09-22. 
  3. ^ a b c d Total Burn Care, 3rd Edition, Edited by David Herndon, Saunders, 2007.
  4. ^ Total Burn Care 3rd Edition. Editied David Herndon. Chapter 1 [1] Accessed January 8, 2010
  5. ^ Sevitt S (May 1979). "A review of the complications of burns, their origin and importance for illness and death". J Trauma 19 (5): 358–69. DOI:10.1097/00005373-197905000-00010. PMID 448773. 
  6. ^ a b c d "American Burn Association". http://www.ameriburn.org/resources_factsheet.php. 
  7. ^ a b Ron Walls MD; John J. Ratey MD; Robert I. Simon MD (2009). Rosen's Emergency Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print (Rosen's Emergency Medicine: Concepts & Clinical Practice (2v.)). St. Louis: Mosby. ISBN 0-323-05472-2. 
  8. ^ Chemical Burn Causes emedicine Health Accessed February 24, 2008
  9. ^ Chemical Burn Causes eMedicine Accessed February 24, 2008
  10. ^ Hydrofluoric Acid Burns emedicine Accessed February 24, 2008
  11. ^ Mechanism of Electrical Injury Chicago Electrical Trauma Research Institute Accessed April 27, 2010
  12. ^ Electrical Burns: First Aid Mayo Clinic Accessed February 24, 2008
  13. ^ Wright RK, Davis JH: The investigation of electrical deaths: A report of 220 fatalities. J Forensic Sci 25:514, 1980
  14. ^ Mosby’s Medical, Nursing and Allied Health Dictionary, Fourth Edition, Mosby-Year Book Inc., 1994, p. 1395
  15. ^ Scald and Burn Care, Public Education City of Rochester Hills Accessed February 24, 2008
  16. ^ Allasio D, Fischer H (May 2005). "Immersion scald burns and the ability of young children to climb into a bathtub". Pediatrics 115 (5): 1419–21. DOI:10.1542/peds.2004-1550. PMID 15867058. 
  17. ^ Ashley G. Smart: "Kinetic Experiments Shed Light on Protein-folding Thermodynamics", Physics Today August 2011
  18. ^ a b Bailey and Love's Short Practice of Surgery. United Kingdom: Hodder Arnold. 2008. ISBN 978-0-340-93932-1. 
  19. ^ http://www.burnsurgery.com/Modules/BurnWound%201/sect_IV.htm SECTION IV: INITIAL WOUND MANAGEMENT
  20. ^ Ames WA (1999). "Management of the Major Burn". Update in Anaesthesia (Nuffield Department of Anaesthesia, Oxford, UK) (10). http://www.nda.ox.ac.uk/wfsa/html/u10/u1010_01.htm. Retrieved 2010-01-22. 
  21. ^ Perry RJ, Moore CA, Morgan BD, Plummer DL (May 1996). "Determining the approximate area of a burn: an inconsistency investigated and re-evaluated". BMJ 312 (7042): 1338. PMC 2350999. PMID 8646048. http://www.bmj.com/content/312/7042/1338.full. 
  22. ^ Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. ISBN 0-07-148480-9. 
  23. ^ Herndon, David N. (2007). "Chapter 9 Total Burn Care". Total Burn Care. Philadelphia: Saunders. pp. 880. ISBN 1-4160-3274-6. 
  24. ^ Lee JA (December 1981). "Sydney Ringer (1834-1910) and Alexis Hartmann (1898-1964)" (PDF). Anaesthesia 36 (12): 1115–21. DOI:10.1111/j.1365-2044.1981.tb08698.x. PMID 7034584. http://www.dr-green.co.uk/PDFs/Ringer%20and%20Hartmann.pdf. 
  25. ^ a b Wasiak J, Cleland H, Campbell F (2008). Wasiak, Jason. ed. "Dressings for superficial and partial thickness burns". Cochrane Database Syst Rev (4): CD002106. DOI:10.1002/14651858.CD002106.pub3. PMID 18843629. 
  26. ^ Hubley P (July 2009). "Review: evidence on dressings for superficial burns is of poor quality". Evid Based Nurs 12 (3): 78. DOI:10.1136/ebn.12.3.78. PMID 19553415. 
  27. ^ Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M (2010). "Prophylactic antibiotics for burns patients: systematic review and meta-analysis". BMJ 340: c241. DOI:10.1136/bmj.c241. PMC 2822136. PMID 20156911. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2822136. 
  28. ^ Minor Burns quickcare.org Accessed February 25, 2008
  29. ^ Villanueva E, Bennett MH, Wasiak J, Lehm JP (2004). Wasiak, Jason. ed. "Hyperbaric oxygen therapy for thermal burns". Cochrane Database Syst Rev (3): CD004727. DOI:10.1002/14651858.CD004727.pub2. PMID 15266540. 
  30. ^ Jull AB, Rodgers A, Walker N (2008). "Honey as a topical treatment for wounds". Cochrane Database Syst Rev (4): CD005083. DOI:10.1002/14651858.CD005083.pub2. PMID 18843679. 
  31. ^ Blount, R.L., Zempsky, W.T., Jaaniste, T., Evans, S., Cohen, L.L., Devine, K.A., & Zeltzer, L.K. (2011). Management of pediatric pain and distress due to medical procedures. In Roberts, M.C. & Steele, R.G. (Eds.) Handbook of Pediatric Psychology (171-184). New York, NY: Guilford Press.
  32. ^ Tarnowski, K.J. & Brown, R.T. (2011). Pediatric burns. In Roberts, M.C. & Steele, R.G. (Eds.) Handbook of Pediatric Psychology (114-129). New York, NY: Guilford Press.
  33. ^ "WHO Disease and injury country estimates". World Health Organization. 2009. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html. Retrieved Nov. 11, 2009. 
  34. ^ Peck, MD (2011 Nov). "Epidemiology of burns throughout the world. Part I: Distribution and risk factors.". Burns : journal of the International Society for Burn Injuries 37 (7): 1087–100. PMID 21802856. 
  35. ^ Potokar T, Chamania S, Ali S. International network for training, education and research in burns. Indian J Plast Surg 2007;40:107
  36. ^ Bhattacharya S. Principles and Practice of Burn Care. Indian J Plast Surg 2009;42:282-3

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