Jun 2, 2022, 1:29 PM
Thermal burns result from tissue exposure to an external heat source, and there are three main thermal burn mechanisms. (Walker, & King, 2022). Flash and flame burns occur due to direct or indirect exposure of a patient to a flame source, which resulted from a triad of an ignition source, an oxidizing agent, and a fuel source. (Walker, & King, 2022). Inhalation injuries may occur if patients are exposed to open flames in a closed setting. (Walker, & King, 2022). Scald burns result from exposure of the patient to high-temperature liquids. Grease burns and those due to hot oils are often much deeper than the initial examination suggests. Finally, contact burns occur from direct contact with a high-temperature object. Chemical burns are divided into acid or alkali burns. (Schaefer, & Szymanski, 2021). Alkali burns tend to be more severe causing more penetration deeper into the skin by liquefying the skin (liquefaction necrosis), while acid burns penetrate less because they cause a coagulation injury (coagulation necrosis). (Schaefer, & Szymanski, 2021). Electrical burns can be deceiving with small entry and exit wounds, however, there may be extensive internal organ injury or associated traumatic injuries. (Schaefer, & Szymanski, 2021).
The major factors to consider when evaluating the burned skin are the extent of the burns (usually calculated by the percentage of total body surface area (% TBSA) burned) and the estimated depth of the burns (superficial, partial thickness or full thickness). (Schaefer, & Szymanski, 2021). Rule of Nines – the head represents 9%, each arm is 9%, the anterior chest and abdomen are 18%, the posterior chest and back are 18%, each leg is 18%, and the perineum is 1%. For children, the head is 18%, and the legs are 13.5% each. (Schaefer, & Szymanski, 2021). Lund and Browder Chart is a more accurate method, especially in children, where each arm is 10%, anterior trunk and posterior trunk are each 13% and the percentage calculated for the head and legs varies based on the patient’s age. (Schaefer, & Szymanski, 2021). Palmar Surface – for small burns, the patient’s palm surface (excluding the fingers) represents approximately 0.5% of their body surface area, and the hand surface (including the palm and fingers) represents about 1% of their body surface area. (Schaefer, & Szymanski, 2021).
I remember when I was working at ER, there were 3 kids brought by EMS from their burning house caused by unattended candles. The patients sustained mild superficial burn injuries, however the provider’s more concern was about smoke inhalation. Their chest x-rays did not show any lung damage, and carbon monoxide poisoning was ruled out, but respiratory support still initiated. According to Clardy, Manaker, & Perry (2022), many patients with carbon monoxide inhalation can be managed in the emergency department, as most symptoms resolve with high-flow oxygen. Patients whose symptoms do not resolve, who demonstrate electrocardiogram (ECG) or laboratory evidence of severe poisoning, or who have other medical or social cause for concern should be hospitalized
Clardy, P.F., Manaker, S., & Perry, H. (2022). Carbon monoxide poisoning. Retrieved from https://www.uptodate.com/contents/carbon-monoxide-poisoning?search=smoke%20inhalation%20children&source=search_result&selectedTitle=2~100&usage_type=default&display_rank=2
Schaefer, T.J., & Szymanski, K.D. (2021). Burn evaluation and management. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430741/
Walker, N.J., & King, K.C. (2022). Acute and chronic thermal burn evaluation and management. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430730/