More than 300,000 people die each year from burn injuries.  Many more are seriously injured, disabled, or disfigured.

There are four general types of burn injuries:

1.    Thermal burns

Caused by flame, heat, or a chemical reaction.  They include:

• Flame burns – Flames cause a direct heat and burn injury to the skin and sometimes deeper tissues.
• Heat burns – In some cases, heat can be so intense that contact with a flame is not necessary to cause injury.
• Contact burns – Coming into contact with a hot object such as a stove.

2.    Chemical burns

These burns occur most often in industrial settings, when victims contact hazardous chemicals.  But they can also result from contact with household cleaners and swimming pool chemicals.

3.    Scald burns

Scalding burns are produced by hot liquids such as boiling water or cooking oil.  These are the most common burns in children.

4.    Electrical burns

In addition to the actual burn, electricity can cause serious internal injuries that are not immediately visible to emergency personnel or other healthcare providers.  These injuries can range from ruptured eardrums, to broken bones, to a heart attack.

Classifying burn injuries

A burn injury involves tissue damage caused by heat, electricity, chemicals, sunlight or nuclear radiation.  The most common burns are those caused by building fires, scalding, and flammable liquids and gases.  The depth of a burn injury is commonly described as first, second, third, or fourth degree:

1.    First-degree burns

Affect only the outer layer (the epidermis) of the skin.  They are red, swollen, and painful.  The burned area whitens (blanches) when lightly touched but does not develop blisters.

2.    Second-degree burns

Also called partial thickness burns.  These burns damage the epidermis and the middle layer of skin beneath it (the dermis).  They are pink or red, swollen, and painful, and they develop blisters that may ooze a clear fluid.  The burned area may blanch when touched.

3.    Third-degree burns

Also called full thickness burns.  These burns involve damage or complete destruction to all layers of skin (dermis, epidermis, and fat layer underneath).  Usually, the sweat glands, hair follicles, and nerve endings are also destroyed.  These burns usually are not painful because the nerves have been destroyed.  The skin becomes leathery and may be white, black, or bright red.  The burned area does not blanch when touched, and hairs can easily be pulled from their roots without pain.

4.    Fourth-degree burns

Extend into the muscle and/or bone below all layers of the skin.

Burn Severity

Burns are classified as minor, moderate, or severe.  These classifications may not correspond to a person’s understanding of those terms.  For example, doctors may classify a burn as minor even though it can cause the person significant pain and interfere with normal activities.  The severity determines how they are predicted to heal and whether complications are likely.  Doctors determine the severity of the burn by its depth and by the percentage of the body surface that has second- or third-degree burns.  Special charts are used to show what percentage of the body surface various body parts comprise.  For example, in an adult, the arm constitutes about 9% of the body.  Separate charts are used for children because their body proportions are different.

Minor burns

All first-degree burns as well as second-degree burns that involve less than 10% of the body surface usually are classified as minor.

Moderate and severe burns

Burns involving the hands, feet, face, or genitals, second-degree burns involving more than 10% of the body surface area, and all third-degree burns involving more than 1% of the body are classified as moderate or, more often, as severe.

Complications of Burn Injuries

Minor burns are usually superficial and do not cause complications. However, deep second-degree and third-degree burns swell and take more time to heal. In addition, deeper burns can cause scar tissue to form. This scar tissue shrinks (contracts) as it heals. If the scarring occurs in a limb or digit, the resulting contracture may restrict movement of nearby joints.

Severe burns and some moderate burns can cause serious complications due to extensive fluid loss and tissue damage.  These complications may take hours or days to develop.  The deeper and more extensive the burn, the more severe are the problems it tends to cause.  Young children and older adults tend to be more seriously affected by complications than other age groups. The following are some complications of some moderate and severe burns:

• Dehydration eventually develops in people with widespread burns, because fluid seeps from the blood to the burned tissues and, if burns are deep and extensive enough, to the whole body.
• Shock develops if dehydration is severe.
• Chemical imbalances can result from extensive burns.
• Destruction of muscle tissue (rhabdomyolysis) sometimes occurs with deep third-degree burns.  The muscle tissue releases myoglobin, one of the muscle’s proteins, into the blood. If present in high concentrations, myoglobin harms the kidneys.
• Infection can complicate burn wounds.  Sometimes the infection can spread throughout the bloodstream and cause severe illness or death.
• Thick, crusty surfaces (eschars) are produced by deep third-degree burns.  Eschars can become too tight, cutting off blood supply to healthy tissues or impairing breathing.

Treatment

Before burns are treated, the burning agent must be stopped from inflicting further damage.  For example, fires are extinguished.  Clothing—especially any that is smoldering (such as melted synthetic shirts), covered with a hot substance (for example, tar), or soaked with chemicals—is immediately removed.

Hospitalization is sometimes necessary for optimal care of burns.  For example, elevating a severely burned arm or leg above the level of the heart to prevent swelling is more easily accommodated in a hospital.  In addition, burns that prevent people from carrying out essential daily functions, such as walking or eating, make hospitalization necessary.  Severe burns, deep second- and third-degree burns, burns occurring in the very young or the very old, and burns involving the hands, feet, face, or genitals are usually best treated at burn centers. Burn centers are hospitals that are specially equipped and staffed to care for burn victims.

Superficial Minor Burns

Superficial minor burns are immersed immediately in cool water if possible.  The burn is carefully cleaned to prevent infection.  If dirt is deeply embedded, doctors can give analgesics or numb the area by injecting a local anesthetic and then scrub the burn with a brush.

Often, the only treatment required is application of an antibiotic cream, such as silver sulfadiazine.  The cream prevents infection and forms a seal to prevent further bacteria from entering the wound.  A sterile bandage is then applied to protect the burned area from dirt and further injury.  A tetanus vaccination is given if needed.

Care at home includes keeping the burn clean to prevent infection.  In addition, many people are given analgesics, often opioids for at least a few days.  The burn can be covered with a nonstick bandage or with sterile gauze.  The gauze can be removed without sticking by first being soaked in water.

Deep Minor Burns

As with more superficial burns, deep minor burns are treated with antibiotic cream.  Any dead skin and broken blisters should be removed by a health care practitioner before the antibiotic cream is applied.  In addition, keeping a deeply burned arm or leg elevated above the heart for the first few days reduces swelling and pain.  The burn may require admission to a hospital or frequent re-examination at a hospital or doctor’s office, possibly as often as daily for the first few days.

A skin graft may be needed.  Some skin grafts replace burned skin that will not heal.  Other skin grafts help by temporarily covering and protecting the skin as it heals on its own.  In a skin grafting procedure, a piece of healthy skin is taken from an unburned area of the person’s body (autograft), or a dead person (allograft) or an animal (xenograft).  After any dead tissue is removed and the wound is clean, a surgeon sews the skin graft over the burned area.  Artificial skin can also be used.  Autografts are permanent.  Allografts and xenografts, however, are rejected after 10 to 14 days by the person’s immune system and artificial skin is removed.  These skin covers help by temporarily covering and protecting the skin as it begins to heal on its own.  However, an autograft eventually must be placed.  Burned skin can be replaced anytime within several days of the burn.

Physical and occupational therapy usually are needed to prevent immobility caused by scarring around the joints and to help people function if joint motion is limited.  Stretching exercises are started within the first few days after the burn.  Splints are applied to ensure that joints that are likely to be immobile rest in positions that are least likely to lead to contractures.  The splints are left in place except when the joints are moved.  If a skin graft has been used, however, therapy is not started for 3 to 5 days after the grafts are attached so that the healing graft is not disturbed.  Bulky dressings that put pressure on the burn can prevent large scars from developing.

Severe Burns

Severe, life-threatening burns require immediate care.  People who have gone into shock as a result of dehydration are given oxygen through a face mask.

Large amounts of intravenous fluids are given, beginning immediately, for people who have dehydration or shock or burns that cover a large area of the body. Fluids are also given to people who develop destruction of muscle tissue.. The fluids dilute the myoglobin in the blood, preventing extensive damage to the kidneys. Sometimes a chemical, sodium bicarbonate, is given intravenously to help dissolve myoglobin and thus also prevent further damage to the kidneys.

A surgical procedure to cut open eschars that cut off blood supply to a limb or that impair breathing may be needed. This procedure is called escharotomy. Escharotomy usually causes some bleeding, but because the burn causing the eschar has destroyed the nerve endings in the skin, there is little pain.

Skin care is extremely important. Keeping the burned area clean is essential, because the damaged skin is easily infected. Cleaning may be accomplished by gently running water over the burns periodically. Wounds are cleaned and bandages changed 1 to 3 times per day. Skin grafts are needed to cover burns that will not heal.

A proper diet that includes adequate amounts of calories, protein, and nutrients is important for healing. People who cannot consume enough calories may drink nutritional supplements or receive them by way of a tube inserted through the nose into the stomach (a nasogastric tube), or less often nutrition may be given intravenously. Additional vitamins and minerals are usually given.

Physical and occupational therapy are needed.

Depression is treated. Because severe burns take a long time to heal and can cause disfigurement, people can become depressed. Depression often can be relieved with drugs or psychotherapy or both.

Prognosis

First- and some second-degree burns heal in days to weeks without scarring. Deep second-degree and small third-degree burns take weeks to heal and usually cause scarring. Most require skin grafting. Burns that involve more than 90% of the body surface, or more than 60% in an older person, are often fatal.

What to do if you or a loved one receive an electrical injury

After administering first aid, there are several steps you should take if you or a loved one receive an electrical injury:

1.   First and foremost – seek immediate medical attention.
2.   Take photographs of the injuries, evidence, and scene.
3.   Preserve all evidence – i.e. the product, source, and scene.
4.   Contact the proper authorities.
5.   Record the names and phone numbers of all witnesses.
6.   Keep detailed records of all lost wages and other expenses.
7.   Contact a qualified burn injury lawyer.

Experienced Burn Injury Attorneys – Simon & Luke

The burn injury lawyers at Simon & Luke have handled numerous burn injury cases, recovering hundreds of millions of dollars for our clients.

We have a team of experienced burn experts, engineers, investigators, and photographers standing by to immediately investigate the cause of your injuries, photograph and preserve the evidence, question witnesses, and protect all of your legal rights.

Call the lawyers at Simon & Luke toll free at 1-888-335-4901 for a free consultation on your legal rights.