Burns

Causes of burns from most to least common are:

• Fire/flame
• Scalding from steam or hot liquids
• Touching hot objects
• Electrical burns
• Chemical burns

Burns can be the result of any of the following:

• House and industrial fires
• Car accidents
• Playing with matches
• Faulty space heaters, furnaces, or industrial equipment
• Unsafe use of firecrackers and other fireworks
• Kitchen accidents, such as a child grabbing a hot iron or touching the stove or oven

You can also burn your airways if you breathe in smoke, steam, superheated air, or chemical fumes in poorly ventilated areas.

There are three levels of burns:

• First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.
• Second-degree burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. They are also called partial thickness burns.
• Third-degree burns affect the deep layers of skin. They are also called full thickness burns. They cause white or blackened, burned skin. The skin may be numb.

Burns fall into two groups.

Minor burns are:

• First degree burns anywhere on the body
• Second degree burns less than 2 to 3 inches (in) or 5.08 to 7.62 centimeters (cm) wide

Major burns include:

• Third-degree burns
• Second-degree burns more than 2 to 3 in (5.08 to 7.62 cm) wide
• Second-degree burns on the hands, feet, face, groin, buttocks, or over a major joint

You can have more than one type of burn at a time.

Major burns need urgent medical care. This can help prevent scarring, disability, and deformity.

Burns on the face, hands, feet, and genitals can be particularly serious.

Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns because their skin tends to be thinner than in other age groups.

Burns commonly occur by direct or indirect contact with heat, electric current, radiation, or chemical agents. Burns can lead to cell death, which can require hospitalization and can be fatal.

To help prevent burns:

• Install smoke alarms in your home. Check and change batteries regularly.
• Teach children about fire safety and the danger of matches and fireworks.
• Keep children from climbing on top of a stove or grabbing hot items such as irons and oven doors.
• Turn pot handles toward the back of the stove so that children can't grab them and they cannot accidentally be knocked over.
• Place fire extinguishers in key locations at home, work, and school.
• Remove electrical cords from floors and keep them out of reach.
• Know about and practice fire escape routes at home, work, and school.
• Set the water heater temperature at 120°F (48.8°C) or less.

Rybarczyk MM, Kivlehan SM. Thermal injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 54.

Voigt CD, Celis M, Voigt DW. Care of outpatient burns. In: Herndon DN, ed. Total Burn Care. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 6.

Wolf SE. Burns. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 20.

Burn symptoms can include:

• Blisters that are either intact (unbroken) or have ruptured and are leaking fluid.
• Pain -- How much pain you have is unrelated to the level of burn. The most serious burns can be painless.
• Peeling skin.
• Shock -- Watch for pale and clammy skin, weakness, blue lips and fingernails, and a decrease in alertness.
• Swelling.
• Red, white, or charred skin.

You may have an airway burn if you have:

• Burns on the head, face, neck, eyebrows, or nose hairs
• Burned lips and mouth
• Coughing
• Difficulty breathing
• Dark, black-stained mucus
• Voice changes
• Wheezing

Call 911 or the local emergency number if:

• The burn is very large, about the size of your palm or larger.
• The burn is severe (third degree).
• You aren't sure how serious it is.
• The burn is caused by chemicals or electricity.
• The person shows signs of shock.
• The person breathed in smoke.
• Physical abuse is the known or suspected cause of the burn.
• There are other symptoms associated with the burn.

For minor burns, contact your health care provider if you still have pain after 48 hours.

Contact your provider right away if signs of infection develop. These signs include:

• Drainage or pus from the burned skin
• Fever
• Increased pain
• Red streaks spreading from the burn
• Swollen lymph nodes

Also contact your provider right away if symptoms of dehydration occur with a burn:

• Decreased urination
• Dizziness
• Dry skin
• Headache
• Lightheadedness
• Nausea (with or without vomiting)
• Thirst

Children, older people, and anyone with a weakened immune system (for example, from HIV) should be seen right away.

Your provider will perform a history and physical examination. Tests and procedures will be done as needed.

These may include:

• Airway and breathing support, including a face mask, tube through the mouth into the trachea, or breathing machine (ventilator) for serious burns or those involving the face or airway
• Blood and urine tests if shock or other complications are present
• Chest x-ray for face or airway burns
• Electrocardiogram (ECG), if shock or other complications are present
• Intravenous fluids (fluids through a vein), if shock or other complications are present
• Medicines for pain relief and to prevent infection
• Ointments or creams applied to the burned areas
• Tetanus immunization, if not up to date

The outcome will depend on the type (degree), extent, and location of the burn. It also depends upon whether internal organs have been affected, and if other trauma has occurred. Burns can leave permanent scars. They can also be more sensitive to temperature and light than normal skin. Sensitive areas, such as the eyes, nose, or ears, may be badly injured and have lost normal function.

With airway burns, the person may have less breathing capacity and permanent lung damage. Severe burns that affect the joints may result in contractures, leaving the joint with decreased movement and a reduction in function.