Types of Burns

Several factors are used to determine the severity of a burn injury, including the patient's age, size and depth of burn, and the location of the burn.  A "Rule of Nines" chart is used to determine the total body surface area (TBSA) that has been burned.  The chart divides the body into sections that represent nine percent of the body surface area.  In determining the TBSA of children and infants the Lund-Browder chart is used.  This is required because the surface area of the head and neck of children is larger and the limbs are smaller than adults.

Burns are classified by depth.  However, the terminology of burn depth has changed and is now classified as follows:  superficial, partial-thickness and full-thickness.  These were previously known as first-, second- and third-degree.  You may be more familiar with the previous naming system.  Another class of burns falls under the category of inhalation injuries.

SUPERFICIAL (FIRST-DEGREE) BURNS

A superficial or first-degree burn is a mild burn that produces redness of the skin, but no blistering.  It is considered a minor burn and may usually be treated at home.  It produces only minor symptoms of redness and pain.

PARTIAL THICKNESS (SECOND-DEGREE) BURNS

A partial-thickness or second-degree burn is a burn that blisters the skin and is more severe than a superficial burn.  This burn affects both the outer-layer (epidermis) and the underlying layer of skin (dermis) causing redness, pain, swelling and blisters.  Partial thickness burns may progress and become full thickness burns if left untreated.

FULL THICKNESS (THIRD-DEGREE) Burns

A full thickness burn is a severe burn that results in the destruction of the skin and some of the underlying tissues.  They are referred to as full-thickness burns because all levels of the skin have been damaged.  They are extremely serious injuries that often require prolonged hospitalization, skin grafting surgeries, and result in permanent scarring.  These used to be known as third degree burns.

INHALATION INJURIES

Fires cause burns, and these injuries are obvious, but injuries to the lungs and airways from smoke inhalation are often less apparent and may not present until 24 to 36 hours after exposure.  However, inhalation injuries are common in patients suffering burn injuries.  According to recent literature the leading cause of death in structural fires is not thermal injury, but inhalation of smoke.  Diagnosing and treating inhalation injuries is critical because the medical evidence conclusively establishes that mortality rates from burn victims is dramatically higher when associated with an inhalation injury.  In fact, the presence of an inhalation injury has been repeatedly cited by physicians as having a greater effect on mortality than either patient age or surface area burned.  The three types of inhalation injuries are damage from heat inhalation, damage from systemic toxins and damage from smoke inhalation.

Indications of inhalation injury usually appears within 2-48 hours after the burn occurred.  Indications may include:

The patient faints

Fire or smoke present in a closed area

Evidence of respiratory distress or upper airway obstruction

Soot around the mouth or nose

Nasal hairs, eyebrows, eyelashes have been singed

Burns around the face or neck