Burns: Symptoms, Causes & Treatment

Burns represent one of the most devastating traumatic injuries, affecting approximately 11 million people annually and causing over 180,000 deaths worldwide. Most burns occur in domestic settings, with children and the elderly at highest risk. Burns are classified by depth: superficial (first-degree), partial-thickness superficial and deep (second-degree), full-thickness (third-degree), and deep tissue burns extending to muscle or bone (fourth-degree). The total body surface area (TBSA) burned — estimated by the Rule of Nines or Lund-Browder chart — drives initial resuscitation decisions and determines whether transfer to a burn center is indicated.

Large burns trigger massive systemic inflammation with cytokine release, capillary leak, and distributive shock. Immediate intravenous fluid resuscitation using the Parkland formula (4 mL/kg/% TBSA in the first 24 hours, half in the first 8 hours) is the cornerstone of early management. Loss of the skin barrier creates profound vulnerability to bacterial invasion; Pseudomonas aeruginosa, Staphylococcus aureus, and fungal organisms are common wound pathogens. Inhalation injury (from smoke, hot gases, or combustion products) dramatically worsens prognosis and should be suspected in enclosed-space burns.

Comprehensive burn care encompasses primary survey (airway-breathing-circulation, with early intubation for inhalation injury), wound cooling (15–20 minutes of running cool water within 3 hours of injury), sterile dressings, early surgical excision and skin grafting for full-thickness burns, nutritional support, and multidisciplinary rehabilitation. Burn center referral criteria include burns >10% TBSA, full-thickness burns, face/hands/feet/genitalia burns, and electrical or chemical burns.

• First-degree (superficial): erythema, pain, mild swelling — no blistering; intact epidermis (sunburn)
• Second-degree (partial thickness): blistering, intense pain, moist pink or red wound bed — painful to air and touch
• Third-degree (full thickness): white, waxy, or charred; leathery; painless (nerve destruction) — requires grafting
• Systemic signs in major burns: hypotension, tachycardia, tachypnea, altered consciousness
• Inhalation injury: hoarseness, stridor, singed nasal hairs, sooty sputum, progressive dyspnea

• Thermal burns: flame, scalds (most common in children), steam, hot surfaces (contact burns)
• Chemical burns: alkalis (liquefaction necrosis) and concentrated acids — penetrate deeply and continue burning until neutralized
• Electrical burns: household current, industrial voltage, lightning strikes — entry/exit wound pattern with internal path injury
• Radiation burns: ultraviolet (sunburn), ionizing radiation (therapeutic or accidental)
• Friction burns: skin abrasion against rough surfaces in road traffic accidents

Assessment is clinical: burn depth classification (appearance, pain, blister presence) and TBSA estimation (Rule of Nines for adults, Lund-Browder for children). Laboratory evaluation for major burns includes CBC, BMP, ABG, lactate, and coagulation studies. Chest X-ray for inhalation injury assessment. Bronchoscopy confirms inhalation injury and guides airway management decisions. Urine myoglobin in electrical burns.

First aid: cool running water 15–20 minutes (within 3 hours) — do NOT use ice, butter, or toothpaste. Remove clothing and jewelry from burned area. Minor burns: cleanse, debride blisters, apply topical antimicrobials (silver sulfadiazine, silver-containing dressings), non-adherent sterile dressings; update tetanus. Major burns (burn center): IV fluid resuscitation per Parkland formula, early intubation for inhalation injury, nutritional support (enteral feeding within 6 hours), early surgical excision and autografting of full-thickness burns (within 48–72 hours reduces mortality), wound infection surveillance, physiotherapy.

• Sepsis and wound infection (Pseudomonas, MRSA, Candida) — leading cause of burn mortality after the acute phase
• Hypertrophic scarring and contractures causing functional impairment at joints
• Multi-organ dysfunction (renal, pulmonary, hepatic) from systemic inflammatory response
• PTSD, depression, body image disorders, and social reintegration challenges
• Heterotopic ossification and peripheral neuropathy in large or electrical burns

• Install and maintain smoke detectors and fire extinguishers in every home
• Set water heater thermostats to ≤49°C (120°F) to prevent scald burns in children
• Chemical and electrical safety training in occupational settings
• Broad-spectrum sunscreen and limiting sun exposure during peak UV hours
• Store flammable liquids and ignition sources out of children's reach