Burns

A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight or
radiation. Scalds from hot liquids and steam, building fires and flammable liquids and gases are
the most common causes of burns.

There are three types of burns:

• First-degree burns damage only the outer layer of skin

• Second-degree burns damage the outer layer and the layer underneath
• Third-degree burns damage or destroy the deepest layer of skin and tissues underneath

Burns can cause swelling, blistering, scarring and, in serious cases, shock and even death. They
also can lead to infections because they damage your skin's protective barrier. Antibiotic creams
can prevent or treat infections. After a third-degree burn, you need skin or synthetic grafts to
cover exposed tissue and encourage new skin to grow. First- and second-degree burns usually
heal without grafts.

First Aid: Burns

What causes burns?

You can get burned by heat, fire, radiation, sunlight, electricity or chemicals. There are 3 degrees
of burns:

• First-degree burns are red and painful. They swell a little. They turn white when you
press on the skin. The skin over the burn may peel off after 1 or 2 days.
• Second-degree burns are thicker burns, are very painful and typically produce blisters
on the skin. The skin is very red or splotchy, and may be very swollen.
• Third-degree burns cause damage to all layers of the skin. The burned skin looks white
or charred. These burns may cause little or no pain because the nerves and tissue in the
skin are damaged.

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How long does it take for burns to heal?

• First-degree burns usually heal in 3 to 6 days.

• Second-degree burns usually heal in 2 to 3 weeks.
• Third-degree burns usually take a very long time to heal.

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How are burns treated?

The treatment depends on what kind of burn you have.

See a doctor if:

• A first- or second-degree burn covers an area larger than 2 to 3 inches in diameter.

• The burn is on your face, over a major joint (such as the knee or shoulder), on the hands,
feet or genitals.
• The burn is a third-degree burn, which requires immediate medical attention.

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First-degree burn

Soak the burn in cool water for at least 5 minutes. The cool water helps reduce swelling by
pulling heat away from the burned skin.

Treat the burn with a skin care product that protects and heals skin, such as aloe vera cream or an
antibiotic ointment. You can wrap a dry gauze bandage loosely around the burn. This will protect
the area and keep the air off of it.

Take an over-the-counter pain reliever, such as acetaminophen (one brand name: Tylenol),
ibuprofen (some brand names: Advil, Motrin) or naproxen (brand name: Aleve), to help with the
pain. Ibuprofen and naproxen will also help with swelling.

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Second-degree burn

Soak the burn in cool water for 15 minutes. If the burned area is small, put cool, clean, wet cloths
on the burn for a few minutes every day. Then put on an antibiotic cream, or other creams or
ointments prescribed by your doctor. Cover the burn with a dry nonstick dressing (for example,
Telfa) held in place with gauze or tape. Check with your doctor's office to make sure you are up-
to-date on tetanus shots.

Change the dressing every day. First, wash your hands with soap and water. Then gently wash
the burn and put antibiotic ointment on it. If the burn area is small, a dressing may not be needed
during the day. Check the burn every day for signs of infection, such as increased pain, redness,
swelling or pus. If you see any of these signs, see your doctor right away. To prevent infection,
avoid breaking any blisters that form.

Burned skin itches as it heals. Keep your fingernails cut short and don't scratch the burned skin.
The burned area will be sensitive to sunlight for up to one year, so you should apply sunscreen to
the area when you're outside.

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Third-degree burn

For third-degree burns, go to the hospital right away. Don't take off any clothing that is stuck to
the burn. Don't soak the burn in water or apply any ointment. If possible, raise the burned area
above the level of the heart. You can cover the burn with a cool, wet sterile bandage or clean
cloth until you receive medical assistance.

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Is there anything I shouldn't do when treating a burn?

Do not put butter or oil on burns. Do not put ice or ice water directly on second- or third-degree
burns. If blisters form over the burn, do not break them. These things can cause more damage to
the skin.

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What do I need to know about electrical and chemical burns?

A person who has an electrical burn (for example, from a power line) should go to the hospital
right away. Electrical burns often cause serious injury to organs inside the body. This injury may
not show on the skin.

A chemical burn should be flushed with large amounts of cool water. Take off any clothing or
jewelry that has the chemical on it. Don't put anything on the burned area, such as antibiotic
ointment. This might start a chemical reaction that could make the burn worse. You can wrap the
burn with dry, sterile gauze or a clean cloth. If you don't know what to do, call 911 or your local
poison control center, or see your doctor right away.

Background

Burn injuries account for an estimated 700,000 annual ED visits per year. Of these, 45,000
require hospitalization. Approximately half of these patients are hospitalized at one of the 125
specialized burn treatment centers in the United States.
Most burns are not life threatening, but each burn causes a significant amount of pain for the
patient and often some degree of psychological trauma. At temperatures greater than 120 º F, a
child's skin is burned severely enough to require surgery in 3 seconds. Rapid evaluation by the
emergency physician (EP) is essential to address pain management, provide initial wound care,
evaluate appropriate disposition, mitigate the psychological impact of the burn, and identify
intentional burns. Follow-up for even superficial thickness burns is imperative, particularly when
involving the hands, feet, face, genital area, or other particularly sensitive areas.

To effectively evaluate, treat, and prevent potential future burns, understanding the different
methods of categorizing burns is helpful. The general categories include life-threatening versus
non–life-threatening, accidental versus intentional, recreational versus occupational, and
domestic (home or residence) versus industrial.

Identifying the type of burn is essential because interventions must be appropriately tailored to
the underlying cause. Type of burns include thermal burns, chemical burns, and radiation burns.
Thermal burns can be further classified according to skin depth and percentage of total body area
burned. Additional descriptions for thermal burns include contact, flame, heat, and scalding.
Accurate documentation of the burn location (such as ophthalmic, hand, face, inhalation, soles,
or perineum) and measurement of involved surface area are essential for follow-up and specialist
referral/consultation.

Pathophysiology

The skin is the largest organ of the body. Although not very active metabolically, the skin serves
multiple functions essential to the survival of the organism, which may be compromised by the
presence of a burn, including the following:

• Thermal regulation and prevention of fluid loss by evaporation

• Hermetic barrier against infection
• Sensory receptors that provide information about environment

The skin is divided into 3 layers, as follows:

• Epidermis: This is the outermost layer of skin composed of cornified epithelial

cells. Outer surface cells die and are sloughed off as newer cells divide at the
stratum germinativum.
• Dermis: This is the middle layer of skin composed of primarily connective
tissue. It contains capillaries that nourish the skin, nerve endings, and hair
follicles.
• Hypodermis: This is a layer of adipose and connective tissue between the
skin and underlying tissues.

The most common type of burns are thermal burns. Soft tissue is burned when it is exposed to
temperatures above 115ºF (46°C). The extent of damage depends on surface temperature and
contact duration. A thermal burn causes coagulation of soft tissue. As the marginally perfused
areas become reperfused, it is thought that there is a release of vasoactive substances causing
formation of reactive oxygen species, which leads to increases in capillary permeability. This
causes fluid loss as well as increasing plasma viscosity with resultant microthrombi formation.1

This third spacing of fluid "seals" at 18-24 hours, which is why the guidelines for fluid
resuscitation are based on a 24-hour time scale. After the initial 24 hours, the fluid requirements
abruptly drop as the capillary permeability returns to normal. Underresuscitation in this initial
24-hour time period leads to significant morbidity from hypovolemia and shock.

Burns may cause a hypermetabolic state manifested by fever, increased metabolic rate, increased
minute ventilation, increased cardiac output, decreased afterload, increased gluconeogenesis
resistant to glucose infusion, and increased skeletal and visceral muscle catabolism. Patients need
support in this state, which continues until wound closure is complete.1 To a large degree, how
the individual responds to the increased energy demands determine recovery.

Frequency

United States

Nearly one million Americans seek ED treatment of burns each year. According to data provided
by the American Burn Association, the incidence of burn injuries in the United States has
declined from 2 million annual injuries estimated from 1957-1961.

According to 2007 data from the US Fire Administration, in 2006, 3,245 Americans lost their
lives, and another 16,400 were injured as the result of fire. Notably, although the number of fires
and deaths due to fires has decreased from 1997 to 2006, the direct dollar loss in millions has
significantly increased from $8,525 to $11,307. Not included in these data are the deaths or the
monetary value attributed to fires caused by the terrorist attacks of September 11, 2001. In 2002-
2004, the United States had one of the highest fire death rates reported in the industrialized world
at 12.4 deaths per million population, a slight decrease from 12.9 deaths per million population
last reported in 2003.2 Most of these fatalities (79.5%) occurred in the home.

Slightly different findings were released by the World Fire Statistics in 2007.3 They reported that
the fire-related death rate in the United States was 1.39 deaths per 100,000 (18.6 per million) in
the years 2002-2004. For comparison, fire-related death rates per 100,000 were higher in Finland
and Hungary at 2.08 and 2.10, respectively.

States with the highest death rates in 2004 were the District of Columbia (36.1 per million),
Mississippi (32.1 per million), and Alabama (25.6 per million). The states with the lowest rates
were Colorado (4.3 per million), Vermont (3.2 per million), and Wyoming (2 per million).2
Interestingly, in 2006, fire killed more Americans than all natural disasters combined.2

From 1990-2006, an estimated 2,054,563 patients aged 20 years or younger were treated in US
EDs for burn-related injuries, with an average of 120,856 cases per year.4
International

The incidence of burn injuries varies from country to country, typically peaking during the
country's holiday period.

In 2007, the World Fire Statistics Centre released fire-related death data by country (from lowest
to highest number of deaths per 100,000 person) from 2002-2004.3 The countries with the lowest
incidences include Singapore (0.08) and Switzerland (0.51). Those with the highest include
Finland (2.08) and Hungary (2.10).3

In the United Kingdom, more than 47 fire-related injuries occur every day.

In Greece, the estimated annual incidence of childhood firework injuries treated in EDs is 7
injuries per 100,000 children per year. Seventy percent of injuries occur in children aged 10-14
years. Boys sustain self-inflicted accidental injuries; girls are typically injured as bystanders. A
sharp peak of firework injuries occurs in the spring when the Greek Orthodox Easter is
celebrated.5

Interesting data from Northern Ireland allows a comparison of burn incidence before and after
the enactment of firework legislation. In the prelegislation series, the mean number of patients
admitted annually was 0.38 per 100,000, whereas in the postlegislation series, the mean was 0.43
per 100,000. The authors concluded that legislation did not significantly affect the incidence of
burns. Also in Northern Ireland, blast injuries to the hand account for more than 50% of injuries
in this series.6

Mortality/Morbidity

Although fire-related deaths still rank fifth in the leading causes of unintentional injury-related
deaths,7 the number of deaths from fires and burns has declined since the 1960s. Improvements in
burn care (ie, quality burn centers, recognition, and effective management of burn shock) have
reduced the number of deaths in the early postburn period. Improved wound management and
antibiotics have decreased deaths from burn wound infection as well. The legislature has passed
acts aimed at the prevention of injury due to fires. In 1971, the Flammable Fabrics Act was
passed in an attempt to regulate the sale of flammable children’s clothing, especially that of
sleepwear in infants, as it was noted to be a major cause of morbidity and mortality. Over time,
this decreased the number of fire-related deaths and injuries in children.8

However, the greatest factors in the reduction of burn-related deaths is the use of smoke
detectors and regulations on hot water heater temperature. In the United States, most people
killed in house fires die from smoke inhalation rather than from burns (see Smoke Inhalation and
Toxicity, Carbon Monoxide).

Race

Native American and black children are more than 2 times and 3 times as likely to die in a fire
than white children, respectively.7 Black children and adolescents had the highest rates of burn
and fire-related deaths. This is attributed to the decreased likelihood of minorities to engage in
safe practices (fireplace guards, smoke alarm use, and adjusting water heater temperature).7

Age

Minor burns are more common in younger adults, often as a result of cooking or occupational
exposures. Teenaged males are at increased risk of injury from fireworks; scald injuries are more
common in young children. Most scald injuries in young children result from improper setting of
domestic hot water heaters and spillage of cooking pots or beverages. Both types of injuries are
easily prevented.

Most children aged 4 years and younger who are hospitalized for burn-related injuries suffer
from scald burns (65%) or contact burns (20%). Most scald burns to children, especially small
children aged 6 months to 2 years, are caused by hot foods or liquids spilled in the kitchen or
other areas where food is prepared and served.

Water heater temperature must be set lower than 120°F. Within 3 seconds, a child's skin can be
burned severely enough to require surgery when they are scalded with water temperature greater
than 120°F.

The EP must consider intentional injury when burn patterns, such as absence of splash marks,
stocking glove distribution, sharply defined wound margins, soles, palms, and pinpoint "cigarette
ash" burns, are identified. Children aged 4 years and younger and children with disabilities are at
the greatest risk of burn-related death and injury, especially scald and contact burns.

The leading cause of residential fire-related death and injury among children aged 9 years and
younger is due to carelessness. Fires kill more than 600 children aged 14 years and younger each
year and injure approximately 47,000 other children. Approximately 88,000 children aged 14
years and younger were treated at hospital EDs for burn-related injuries; 62,500 were thermal
burns and 25,500 were scald burns. The most common causes of product-related thermal burn
injuries among children aged 14 years and younger are hair curlers, curling irons, room heaters,
ovens and ranges, irons, gasoline, and fireworks.

Elderly persons are also at increased risk not only for having a burn-related injury but for having
increased morbidity due to their thinner skin and decreased healing abilities.

Clinical

History

The EP must consider the type of burn (thermal, chemical, radiation) and the location during
early burn management. Once it has been determined that the burn is a thermal burn, the EP can
add to the description: contact (with source name), scald (with fluid or gas type), heat, and flame.
Systemic injury, duration, intentional versus accidental, and location of the burn must all be
considered during the critical early burn period.
Other important points to determine include the patient's tetanus immunization status as well as
the components of the history including past medical history, medications, and allergies.

Ascertain the history early because often the paramedics may be the only source of information
about the event.

History should also include the following:

• Medical personnel must consider abuse as a cause of burns in all children. As

many as 10% of abuse cases involve burns (see Pediatrics, Child Abuse).
• Components of the history that should raise suspicion of abuse include the
o Multiple/conflicting stories of how injury was sustained
o Injury attributed to a sibling
o Injury claimed to be unwitnessed
o Injury incompatible with developmental level of the child
o Presence of adult male who is not child's father (such as mother's
boyfriend) living in household
• Characteristics of the burn that should raise suspicion of abuse include the
following:
o Pattern burns that suggest contact with an object
o Cigarette burns
o Stocking, glove, or circumferential burns
o Burns to genitalia or perineum
• All health care personnel are obligated to contact appropriate law
enforcement and protective services if they suspect the burn was intentional.
• Medical personnel must be aware that burns resulting from abuse or neglect
may also be seen in the geriatric population.

Physical

• Burn depth is described as superficial, partial thickness, or full thickness

(corresponding to first, second, or third degree). (See Causes for more
information.)
• Superficial (first-degree) burns involve only the epidermis.
o Tissue blanches with pressure.
o Tissue is erythematous.
o Tissue damage is minimal.
o Edema may be present; generally blisters do not form.
o Sunburn is a classic example of this type of burn (see Sunburn for
more details and management).
o These wounds are red, dry, painful, and generally heal in 3-6 days
without scarring.9
• Partial-thickness burns (second-degree) are often further delineated into
superficial and deep types.;
o Epidermis and portions of the dermis are involved.
o Blisters usually form either very quickly or within 24 hours.
o Superficial and deep partial-thickness can be difficult to differentiate at
the bedside. The difference lies in the depth of penetrance into the
 dermis with the transition occurring at about half of dermal
depth. Superficial partial-thickness burns usually blanch and do not
result in scarring. Deep partial-thickness burns often do not blanch and
do scar. The deeper the injury, the longer the healing time, which may
vary from 7-21 days in the more superficial dermis burns to greater
than 21 days in the deep dermis burns.
o Adnexal structures (eg, sweat glands, hair follicles) are often involved,
but enough of these structures are preserved for function, and the
epithelium lining them can proliferate and allow for regrowth of skin.
o If deep second-degree burns are not cared for properly, edema, which
accompanies the injury, and decreased blood flow in the tissue can
result in conversion to full-thickness burn.
o These wounds are red, wet, and painful (with decreasing pain, color,
and moisture with increasing depth into the dermis).9
• Full-thickness (third-degree) burns extend completely through the skin to
subcutaneous tissue. They may involve underlying structures including
tendon, nerves, muscle, or bone (sometimes previously referred to as fourth-
degree burn). Full-thickness and partial thickness burns are shown in the
image below.
•

Partial- and full-thickness burns from a structure fire. Note facial

involvement.

[ CLOSE WINDOW ]
 Partial- and full-thickness burns from a structure fire. Note facial
involvement.

o These burns are characterized by charring of skin or a translucent

white color, with coagulated vessels visible below.
o The area is insensate, but the patient complains of pain, which is
usually a result of surrounding second-degree burn.
o As all of the skin tissue and structures are destroyed, healing is very
slow. Full-thickness burns are often associated with extensive scarring
because epithelial cells from the skin appendages are not present to
repopulate the area.
o These wounds vary from waxy white, to charred and black often with a
leathery texture, they are dry and usually painless to touch. These
wounds generally do not heal on their own.9
• Burn extent
o The more body surface area (BSA) involved in a burn, the greater the
morbidity and mortality rates and the difficulty in management.
 Emergency medical services (EMS) personnel tend to overestimate the
extent of the burn, whereas ED personnel tend to underestimate it.
o An individual's palmar surface classically represents 1% of the BSA,
but, in actuality, it represents about 0.4%, whereas the entire hand
represents about 0.8%.10,11 A simple method to estimate burn extent is
to use the patient's palmar surface including fingers to measure the
burned area. Burn extent is calculated only on individuals with partial-
thickness or full-thickness burn.
o Another quick method is to use the Rule of Nines to estimate the
extent of burn injury (as is shown in the image below).
o

Rule of nines for calculating burn area.

[ CLOSE WINDOW ]
 Rule of nines for calculating burn area.

o The head represents a greater portion of body mass in children than it

does in adults. Lund and Browder first described a method for
 compensating for the differences, and the Lund and Browder Chart is
used to calculate BSA in children (as is shown in the image below).
o

Lund and Browder chart illustrating the method for calculating

the percentage of body surface area affected by burns in
children.

[ CLOSE WINDOW ]
 Lund and Browder chart illustrating the method for calculating
the percentage of body surface area affected by burns in
children.

o If the chart is unavailable, estimate BSA by the Rule of Nines and

adjust for age as follows:
 In children younger than 1 year, the head and neck are 18% of
BSA and each leg is 15% of BSA. The torso and arms represent
the same percentages as in adults (10% and 16%, respectively).
 For each year older than 1 year, add 0.5% to each leg and
decrease percentage for the head by 1% until adult values are
reached.
• On the basis of burn extent and depth, EPs can determine the severity of
burn injury and whether the patient requires transfer to a burn center. The
American Burn Association has developed criteria for burn center admission,
as follows:
o Full-thickness (third-degree) burns over 5% BSA
o Partial-thickness (second-degree) burns over 10% BSA
 o Any full-thickness or partial-thickness burn involving critical areas (eg,
face, hands, feet, genitals, perineum, skin over any major joint), as
these have significant risk for functional and cosmetic problems
o Circumferential burns of the thorax or extremities
o Significant chemical injury, electrical burns, lightning injury, coexisting
major trauma, or presence of significant preexisting medical conditions
o Presence of inhalation injury
o Greater than 15% BSA in adults
o Greater than 10% BSA in children
o Hand and foot burns can lead to significant morbidity if not properly
treated; therefore, most are treated with aggressive therapy. However,
with careful follow-up, the patient may be monitored on an outpatient
basis.

Causes

• Flame burns
o Contact with open flame causes direct injury to tissue.
o Flame may ignite clothing. Although natural fibers tend to burn,
synthetic fibers may melt or ignite, adding a contact burn component
to the injury.
o If the burn occurs in an enclosed area, the patient is also at risk for CO
poisoning and cyanide poisoning as well as inhalational injury from the
smoke and heat.
• Contact burns
o Contact burns result from direct contact with a hot object.
o Burn injury is confined to the point of contact.
o Examples are burns from cigarettes and tools (eg, soldering irons,
cooking appliances, curling irons).
• Scalds
o Scalds result from contact with hot liquids (as is shown in the image
below).
o
 Child with burns from a scald. Hot soup was spilled when the
child grabbed the handle of a pot. Note the full-thickness burn
to left upper part of the chest. Edema of the lips and blisters
on the face and nose indicate second-degree burns of the face.

[ CLOSE WINDOW ]

Child with burns from a scald. Hot soup was spilled when the
child grabbed the handle of a pot. Note the full-thickness burn
to left upper part of the chest. Edema of the lips and blisters
on the face and nose indicate second-degree burns of the face.

o The more viscous the liquid and the longer the contact with the skin,
the greater the damage.
o Accidental scalds often show a pattern of splashing, with burns
separated by patches of uninjured skin.
o In contrast, intentional scalds often involve the entire extremity,
appearing in a circumferential pattern with a line that marks the liquid
surface.
• Steam burns
o Steam burns most often occur in industrial accidents or result from
automobile radiator accidents.
o These burns produce extensive injury from the high heat-carrying
capacity of steam and the dispersion of pressurized steam and liquid.
 o Steam inhalation can actually cause thermal injury to the distal
airways of the lung.
• Gas burns
o Inhalation of hot gas normally does not injure distal airways, as the
heat-exchange capacity of the upper airway is excellent.
o In this situation, the upper airway is at risk for thermal injury and
subsequent occlusion due to edema.
o Distal airway injury is more likely to be due to the direct effects of the
products of combustion on the mucosa and alveoli.
• Electrical burns, including lightning12
o Electrical burns produce heat injury by passing through tissue.
o Most problems from these burns present in patients exposed to more
than 1000V.
o Children can have significant injury after exposure to 200-1000V.
o Ignition of clothing may produce some flame burn, but most of the
injury is deep in the skin (see Electrical Injuries).
o Cardiac injury is prominent, and patients must be monitored for 4-72
hours depending on the strength of the voltage and the age of the
patient.
o The EP must consider visceral injuries, long bone and spine fractures,
myoglobinuria, and compartment syndromes.
• Flash burns
o Flash burns are a subset of flame burns and are a result of rapid
ignition of a flammable gas or liquid.
o The body parts involved are those exposed to the agent when it
ignites.
o Areas covered by clothing are usually spared.
o The face may be involved, but if this type of injury takes place outside,
then the risk for inhalation injury is low. A careful examination of the
airway is indicated.
o A classic example of this type of injury occurs when a person pours
gasoline on a trash or leaf fire to increase the flame and is burned by
the subsequent fireball.
• Tar burns (see Emergency Department Care)
• Chemical burns12
o Alkaline substances and acid substances can burn the skin and can be
associated with systemic toxicity.
o Alkaline burns produce liquefactive necrosis and are considered higher
risk burns due to their likelihood to penetrate deeper.
o Acid burns are the result of coagulation necrosis, limiting the depth
and penetration of the burn.
o The upper GI tract and oropharynx may also be at risk if the chemicals
were ingested; therefore, the EP should be aware that the airway may
occlude due to edema.
o Circumoral burns may be present if the agent was ingested.

http://emedicine.medscape.com/article/769193-overview
Burns

MedlinePlus Topics
Burns

Images

Burns

Burn, blister - close-up

Burn, thermal - close-up

Airway burn

Skin

First degree burn

Second degree burn

Third degree burn

Minor burn - first aid - series

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 (partial thickness) burns affect both the outer and
underlying layer of skin. They cause pain, redness, swelling, and blistering.
• Third-degree (full thickness) burns extend into deeper tissues. They cause
white or blackened, charred skin that may be numb.
Considerations

Before giving first aid, evaluate how extensively burned the person is and try to determine the
depth of the most serious part of the burn. Then treat the entire burn accordingly. If in doubt,
treat it as a severe burn.

By giving immediate first aid before professional medical help arrives, you can help lessen the
severity of the burn. Prompt medical attention to serious burns 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.

In case of a fire, you and the others there are at risk for carbon monoxide poisoning. Anyone
with symptoms of headache, numbness, weakness, or chest pain should be tested.

Causes

Burns can be caused by dry heat (like fire), wet heat (such as steam or hot liquids), radiation,
friction, heated objects, the sun, electricity, or chemicals.

Thermal burns are the most common type. Thermal burns occur when hot metals, scalding
liquids, steam, or flames come in contact with your skin. These are frequently the result of fires,
automobile accidents, playing with matches, improperly stored gasoline, space heaters, and
electrical malfunctions. Other causes include unsafe handling of firecrackers and kitchen
accidents (such as a child climbing on top of a stove or grabbing a hot iron).

Burns to your airways can be caused by inhaling smoke, steam, superheated air, or toxic fumes,
often in a poorly ventilated space.

Burns in children are sometimes traced to parental abuse.

Symptoms

• Blisters
• Pain (the degree of pain is not related to the severity of the burn -- the most serious burns
can be painless)
• Peeling skin
• Red skin
• Shock (watch for pale and clammy skin, weakness, bluish lips and fingernails, and a drop
in alertness)
• Swelling
• White or charred skin

Symptoms of an airways burn:

 • Charred mouth; burned lips
• Burns on the head, face, or neck
• Wheezing
• Change in voice
• Difficulty breathing; coughing
• Singed nose hairs or eyebrows
• Dark, carbon-stained mucus

First Aid

FOR MINOR BURNS

1. If the skin is unbroken, run cool water over the area of the burn or soak it in a cool water
bath (not ice water). Keep the area submerged for at least 5 minutes. A clean, cold, wet
towel will also help reduce pain.
2. Calm and reassure the person.
3. After flushing or soaking, cover the burn with a dry, sterile bandage or clean dressing.
4. Protect the burn from pressure and friction.
5. Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling. Do
NOT give children under 12 aspirin. Once the skin has cooled, moisturizing lotion also
can help.
6. Minor burns will usually heal without further treatment. However, if a second-degree
burn covers an area more than 2 to 3 inches in diameter, or if it is located on the hands,
feet, face, groin, buttocks, or a major joint, treat the burn as a major burn.
7. Make sure the person is up to date on tetanus immunization.

FOR MAJOR BURNS

1. If someone is on fire, tell the person to stop, drop, and roll. Wrap the person in thick
material to smother the flames (a wool or cotton coat, rug, or blanket). Douse the person
with water.
2. Call 911.
3. Make sure that the person is no longer in contact with smoldering materials. However, do
NOT remove burned clothing that is stuck to the skin.
4. Make sure the person is breathing. If breathing has stopped, or if the person's airways are
blocked, open the airways. If necessary, begin rescue breathing and CPR.
5. Cover the burn area with a dry sterile bandage (if available) or clean cloth. A sheet will
do if the burned area is large. Do NOT apply any ointments. Avoid breaking burn
blisters.
6. If fingers or toes have been burned, separate them with dry, sterile, nonadhesive
dressings.
7. Elevate the body part that is burned above the level of the heart. Protect the burn area
from pressure and friction.
8. Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches, and
cover the person with a coat or blanket. However, do NOT place the person in this shock
 position if a head, neck, back, or leg injury is suspected or if it makes the person
uncomfortable.
9. Continue to monitor the person's vital signs until medical help arrives. This means pulse,
rate of breathing, and blood pressure.

DO NOT

• Do NOT apply ointment, butter, ice, medications, cream, oil spray, or any household
remedy to a severe burn.
• Do NOT breathe, blow, or cough on the burn.
• Do NOT disturb blistered or dead skin.
• Do NOT remove clothing that is stuck to the skin.
• Do NOT give the person anything by mouth, if there is a severe burn.
• Do NOT immerse a severe burn in cold water. This can cause shock.
• Do NOT place a pillow under the person's head if there is an airways burn. This can close
the airways.

When to Contact a Medical Professional

Call 911 if:

• The burn is extensive (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 inhaled smoke.
• Physical abuse is the known or suspected cause of the burn.

Call a doctor if your pain is still present after 48 hours.

Call immediately if signs of infection develop. These signs include increased pain, redness,
swelling, drainage or pus from the burn, swollen lymph nodes, red streaks spreading from the
burn, or fever.

Also call immediately if there are signs of dehydration: thirst, dry skin, dizziness,
lightheadedness, or decreased urination. Children, elderly, and anyone with a weakened immune
system (for example, HIV) should be seen right away.

Prevention

o help prevent burns:

• Install smoke alarms in your home. Check and change batteries regularly.
• Teach children about fire safety and the hazards of matches and fireworks.
 • Keep children from climbing on top of a stove or grabbing hot items like irons and oven
doors.
• Turn pot handles toward the back of the stove so that children can't grab them and they
can't be accidentally 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 temperature of water heater at 120 degrees or less.

Swollen lymph nodes

• Lymph nodes are found throughout your body. They are an important part of your
immune system. Lymph nodes help your body recognize and fight germs, infections, and
other foreign substances.
• The term "swollen glands" refers to enlargement of one or more lymph nodes.
• In a child, a node is considered enlarged if it is more than 1 centimeter (0.4 inch) in
diameter