Author's details
- Dr. Khashau Eleburuike.
- MBBS, Msc. Global health Karolinska Institute Sweden.
- Residency in family medicine Norrbotten, Sweden
Reviewer's details
- Dr Khadijat Ohunene Aliu
- MBBS, FWACS. Consultant Burns, Plastic and Reconstructive Surgeon
- General Hospital Ikorodu
Burns
Burn is a coagulative necrosis of skin that is usually due to heat, electricity, radiation, and chemical agents. World Health Organisation estimate 250,000 mortalities and 90% reported in low- and middle-income countries with low socio-economic conditions. Females are more at risk for having injuries due to exposure to open flame, steam and wearing loose clothes while cooking. Children < 5 years are exposed to morbidities due to burns because of improper safety measures.
Symptoms
History of burns, eyewitness, duration, type of burns
Superficial burns are characterized by blisters and pain sensation.
Deep burns usually have mottling and charring of deep dermal skin. Loss of sensation.
Clinical findings
Burn surface area (BSA) estimate is usually used with Wallace rule of nine for patients between 10-80kg where the palm is equal to 1%, The head 9%, trunk; front18% and back 18%, each upper limb 9%, each lower limb 18% and perineal region 1%. The rule of five for obese overweight and obese patients whereby 5% for each arm, 5 x 4 (20%) for each lower limb, 2% is for the head, 5x10 (50%) for the trunk. For children <10 kg the rule of 8 applies; 8 % for each arm, 2x8% for each lower limb, 8 x 4% for the trunk and 20% for the head.
Rough estimate of body surface area of burn patient depending on body weight | |||
Rule of 8 <10kg | Rule of nine(10-80kg) | Rule of 5 for >80kg | |
Head (%) | 20 | 9 | 2 |
Trunk (%) | 32 | 36 | 50 (40-52) |
Each upper limb (%) | 8 | 9 | 5 (5-7.5) |
Each lower limb (%) | 16 | 18 | 20 (15-20) |
Perineal region (%) | 1 |
Depending on the type of burns and the depth the symptoms could be grouped into;
Partial thickness burns.
Superficial partial thickness: part of the epidermis and dermis could be burnt. Partial loss of the epidermis presents with painful erythema formerly called first degree burns while the loss of epidermis and part of the dermis takes 3 weeks for re-epithelization if there is no secondary infection.
Deep Partial Thickness (Deep dermal) burn affect the dermis, hair follicles and sebaceous gland. The sweat glands are usually not affected. Healing occurs with scars, a thin layer of epidermis. Scars may become hypertrophic.
Full Thickness burns: The whole of the skin are lost and even deeper structures like fat, fascia, muscle, and bone may be affected.
Differential diagnoses
- Fixed drug eruption: history of consumption of drugs like Ibuprofen
- Stevens-Johnson syndrome: history of infection like respiratory tract infection and consumption of medication. Affects <10% of the body surface area.
- Toxic epidermal necrolysis (TEN) history of influenza-like infection, medications like non-steroidal anti-inflammatory drugs (NSAID), antibiotics, antiviral, antiepileptic. Symptoms usually manifest within 1-3 weeks of intake of medications. Affects >30% of the body surface area.
- Staphylococcal scalded skin syndrome mostly in children where there is evidence of staphylococcal infection.
Investigations
Full blood count where there may be anaemia, low platelet, electrolytes like sodium and potassium.
Management
- Burns should be treated as a trauma case. It is important to be systematic ATLS pathway and ensure a secure airway, breathing and circulation. Do a primary and secondary survey before intensive fluid resuscitation start.
- Parkland formular in estimation of fluid therapy: Crystalloid solution in form Lactated Ringer’s acetate 4ml/kg x total body surface area burned.
- Skin care
- Prophylactic antibiotics
- Operation: referral to plastic surgeons for skin graft
Complications of Burn
- Infections which delay healing
- Hypertrophic scar
- Economic effect: Loss of the quality adjusted life in millions annually.
- Physical inability
- Psychiatric complications such as depression, anxiety disorders.
Follow up.
This will depend on the complications that arise. A multidisciplinary team should be involved in the patient care.
Prevention and control
Legislative policies to ensure safety in homes and workplaces.
Strengthening of systems because burn is common in low socioeconomic class.
Education of health workers, parents, guardians, and children about the danger of exposing self to open fire
Inspections of homes by community health workers to identify risk of burn occurring at homes and workplaces.
Safety measures when homes are built to reduce exposure to naked electrical cables that could cause electrical burn.
Caustic substances should not be publicly available.
A 28-year-old male sustained second-degree burns covering 20% of his body, including his arm, chest, and face, following a gas explosion in an urban kitchen. He was brought to the hospital within an hour, presenting with blistering burns and breathing difficulties, raising concern for possible airway injury. Immediate care included airway monitoring, fluid resuscitation, pain management, and wound care. He will require further monitoring for respiratory issues and potential skin grafting, with plans for admission to a burn unit for advanced treatment.
- E.A Badoe, E.Q Archampong, J.T da Rocha-Afodu. Principles and Practice of Surgery including Pathology in the Tropics. Third ed. Accra Ghana: Assemblies of God Literature Centre Ltd. P. O. Box AN 7644, Accra; 2000.
- Quinn L, Ahmed T, Falk H, Miranda Altamirano A, Muganza A, Nakarmi K, Nawar A, Peck M, Man Rai S, Sartori J, Philipe Molina Vana L, Wabwire B, Moiemen N, Lilford R. Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey. J Burn Care Res. 2023 Mar 2;44(2):320-328. doi: 10.1093/jbcr/irac096. PMID: 35802351; PMCID: PMC9981866.
- Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, Huss F, Kamolz LP. Recent trends in burn epidemiology worldwide: A systematic review. Burns. 2017 Mar;43(2):249-257. doi: 10.1016/j.burns.2016.08.013. Epub 2016 Sep 3. PMID: 27600982; PMCID: PMC5616188.
- Mock C, Peck M, Krug E, Haberal M. Confronting the global burden of burns: a WHO plan and a challenge. Burns. 2009 Aug;35(5):615-7. doi: 10.1016/j.burns.2008.08.016. Epub 2009 May 6. PMID: 19423230.
- Borhani-Khomani K, Partoft S, Holmgaard R. Assessment of burn size in obese adults; a literature review. J Plast Surg Hand Surg. 2017 Dec;51(6):375-380. doi: 10.1080/2000656X.2017.1310732. Epub 2017 Apr 18. PMID: 28417654.
- Mehta M, Tudor GJ. Parkland Formula. [Updated 2023 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537190/
- Livingston EH, Lee S. Percentage of burned body surface area determination in obese and nonobese patients. J Surg Res. 2000 Jun 15;91(2):106-10. doi: 10.1006/jsre.2000.5909. PMID: 10839957.
Author's details
Reviewer's details
Burns
- Background
- Symptoms
- Clinical findings
- Differential diagnosis
- Investigations
- Treatment
- Follow-up
- Prevention and control
- Further readings
Burn is a coagulative necrosis of skin that is usually due to heat, electricity, radiation, and chemical agents. World Health Organisation estimate 250,000 mortalities and 90% reported in low- and middle-income countries with low socio-economic conditions. Females are more at risk for having injuries due to exposure to open flame, steam and wearing loose clothes while cooking. Children < 5 years are exposed to morbidities due to burns because of improper safety measures.
- E.A Badoe, E.Q Archampong, J.T da Rocha-Afodu. Principles and Practice of Surgery including Pathology in the Tropics. Third ed. Accra Ghana: Assemblies of God Literature Centre Ltd. P. O. Box AN 7644, Accra; 2000.
- Quinn L, Ahmed T, Falk H, Miranda Altamirano A, Muganza A, Nakarmi K, Nawar A, Peck M, Man Rai S, Sartori J, Philipe Molina Vana L, Wabwire B, Moiemen N, Lilford R. Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey. J Burn Care Res. 2023 Mar 2;44(2):320-328. doi: 10.1093/jbcr/irac096. PMID: 35802351; PMCID: PMC9981866.
- Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, Huss F, Kamolz LP. Recent trends in burn epidemiology worldwide: A systematic review. Burns. 2017 Mar;43(2):249-257. doi: 10.1016/j.burns.2016.08.013. Epub 2016 Sep 3. PMID: 27600982; PMCID: PMC5616188.
- Mock C, Peck M, Krug E, Haberal M. Confronting the global burden of burns: a WHO plan and a challenge. Burns. 2009 Aug;35(5):615-7. doi: 10.1016/j.burns.2008.08.016. Epub 2009 May 6. PMID: 19423230.
- Borhani-Khomani K, Partoft S, Holmgaard R. Assessment of burn size in obese adults; a literature review. J Plast Surg Hand Surg. 2017 Dec;51(6):375-380. doi: 10.1080/2000656X.2017.1310732. Epub 2017 Apr 18. PMID: 28417654.
- Mehta M, Tudor GJ. Parkland Formula. [Updated 2023 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537190/
- Livingston EH, Lee S. Percentage of burned body surface area determination in obese and nonobese patients. J Surg Res. 2000 Jun 15;91(2):106-10. doi: 10.1006/jsre.2000.5909. PMID: 10839957.
Content
Author's details
Reviewer's details
Burns
Background
Burn is a coagulative necrosis of skin that is usually due to heat, electricity, radiation, and chemical agents. World Health Organisation estimate 250,000 mortalities and 90% reported in low- and middle-income countries with low socio-economic conditions. Females are more at risk for having injuries due to exposure to open flame, steam and wearing loose clothes while cooking. Children < 5 years are exposed to morbidities due to burns because of improper safety measures.
Further readings
- E.A Badoe, E.Q Archampong, J.T da Rocha-Afodu. Principles and Practice of Surgery including Pathology in the Tropics. Third ed. Accra Ghana: Assemblies of God Literature Centre Ltd. P. O. Box AN 7644, Accra; 2000.
- Quinn L, Ahmed T, Falk H, Miranda Altamirano A, Muganza A, Nakarmi K, Nawar A, Peck M, Man Rai S, Sartori J, Philipe Molina Vana L, Wabwire B, Moiemen N, Lilford R. Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey. J Burn Care Res. 2023 Mar 2;44(2):320-328. doi: 10.1093/jbcr/irac096. PMID: 35802351; PMCID: PMC9981866.
- Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, Huss F, Kamolz LP. Recent trends in burn epidemiology worldwide: A systematic review. Burns. 2017 Mar;43(2):249-257. doi: 10.1016/j.burns.2016.08.013. Epub 2016 Sep 3. PMID: 27600982; PMCID: PMC5616188.
- Mock C, Peck M, Krug E, Haberal M. Confronting the global burden of burns: a WHO plan and a challenge. Burns. 2009 Aug;35(5):615-7. doi: 10.1016/j.burns.2008.08.016. Epub 2009 May 6. PMID: 19423230.
- Borhani-Khomani K, Partoft S, Holmgaard R. Assessment of burn size in obese adults; a literature review. J Plast Surg Hand Surg. 2017 Dec;51(6):375-380. doi: 10.1080/2000656X.2017.1310732. Epub 2017 Apr 18. PMID: 28417654.
- Mehta M, Tudor GJ. Parkland Formula. [Updated 2023 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537190/
- Livingston EH, Lee S. Percentage of burned body surface area determination in obese and nonobese patients. J Surg Res. 2000 Jun 15;91(2):106-10. doi: 10.1006/jsre.2000.5909. PMID: 10839957.