Burns

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: A burn is a condition in which cells of the skin and soft tissue are destroyed by heat (flames, hot liquids or steam), electricity, chemicals, or contact, causing necrosis or functional impairment. Depending on the depth of injury, burns are classified from first-degree burns, which involve only the epidermis, to fourth-degree burns, which extend to the muscles and bones. The depth of injury and total body surface area (TBSA) determine systemic responses (such as fluid loss, inflammatory reactions, and infection risk) and prognosis.
• Main causes: Flames (fires, gas explosions), scalds (boiling water, oil, or steam), electricity (low or high voltage), chemicals (acids, alkalis, organic solvents), and contact (hot metal, irons, etc.). Burns occur frequently in the home (provided data: 70–80%), and particular caution is needed in children.
• Symptoms
  • Local: Pain, redness, blisters, changes in skin color (redness, waxy appearance, blackening), loss of sensation (severe third-degree burns or higher), and swelling
  • Systemic/severe signs: Altered consciousness, difficulty breathing (suspected inhalation injury), shock (low blood pressure and tachycardia), jaundice-like symptoms or symptoms of inhalation of carbonized products
  • Special findings: Electrical burns may cause heart, muscle, and nerve damage even when the skin surface injury is small; chemical burns may progressively worsen at the contact site

(Reference: Classification — first-degree: epidermis only, second-degree: part of the dermis (blisters), third-degree: full-thickness skin damage, fourth-degree: muscle, tendon, and bone damage)

Treatment Methods

• First aid (at the scene/initially)
  • Remove the source (extinguish flames, disconnect the power, and remove contaminants in chemical burns)
  • Cooling: Cool with running water (lukewarm to cold water; approximately 15–20°C recommended) for at least 10–20 minutes. Never apply ice directly.
  • Remove clothing and jewelry (if possible) — before swelling develops
  • Cover with a clean cloth (such as sterile gauze or a plastic bag) — to prevent infection and heat loss
  • Immediately transfer to the emergency room if there is an airway risk (inhalation injury), extensive burns, severe pain, or impaired consciousness
  • Prohibited: Do not use home remedies such as butter, oil, or ointments
• Emergency room/inpatient treatment
  • Airway management: Secure the airway early when inhalation injury is suspected (consider endotracheal intubation)
  • Fluid replacement: For severe systemic burns (extensive partial-thickness burns), intravenous fluid therapy (e.g., Parkland formula: 4 ml × body weight (kg) × %TBSA — 1/2 administered within the first 8 hours and the remainder over the next 16 hours) — however, adjustment according to age and condition is necessary
  • Pain management: IV analgesics (e.g., opioids) and a stepwise analgesia plan
  • Wound care: Removal of dead tissue (debridement), selective use of topical antimicrobial dressings (silver-containing dressings, silver sulfadiazine, etc.), and frequent dressing changes to prevent infection
  • Antibiotics: Systemic antibiotics are used when infection is clear (prophylactic broad-spectrum antibiotics are not recommended)
  • Surgical treatment: Skin grafting (such as split-thickness grafting) for deep third-degree burns or higher, or when healing is delayed; escharotomy or fasciotomy when necessary
  • Electrical burns: Electrocardiogram monitoring (monitoring for arrhythmias), testing for muscle breakdown (rhabdomyolysis) (CK, urine color, and urine myoglobin tests), and urinary tract perfusion management when necessary
  • Chemical burns: Thoroughly wash away contaminants (prolonged irrigation with water). Neutralization may be used for certain substances, but expert instructions are required
  • Vaccination: Check tetanus status and administer vaccination/immunoglobulin when necessary
• Rehabilitation and follow-up treatment
  • Early physical therapy (maintaining range of motion) and compression therapy or silicone sheets to prevent scars and contractures
  • Regular scar management (invasive and noninvasive) and plastic reconstructive surgery when necessary
  • Psychosocial support (counseling for trauma, depression, anxiety, and changes in appearance)
• Complications and precautions
  • Acute complications: Inhalation injury, shock, infection (sepsis), rhabdomyolysis, and acute kidney injury
  • Chronic complications: Abnormal scars, contractures, pigment abnormalities, growth impairment (in children), and psychological trauma
  • Precautions for self-care: Prevent the wound from becoming dry or contaminated, comply with regular dressing changes and physical therapy, and continue scar management (compression therapy and silicone)

Checklist Before an Outpatient Visit (Including Suggested Items to Bring and Example Questions)

• Items to bring (recommended)
  • A list of all medications currently being taken (including doses and administration times)
  • History of allergies (medications, latex, and food)
  • Recent emergency room or hospitalization records (if possible, medical opinion letters and surgical records)
  • Wound photographs (chronological photographs before and after treatment), and dressing-change records (frequency and condition)
  • Pain records (pain intensity, type, and relieving factors), and records of systemic symptoms such as urination and fever
  • Whether tetanus vaccination has been received
• Things for patients to check themselves before an outpatient visit
  • Whether there is pus, an unpleasant odor, or fever from the wound
  • Worsening pain or changes in color caused by the dressing
  • Reduced sensation or movement in the limbs, or tingling or numbness around the wound
• Information to show the doctor during the outpatient visit (examples)
  • The location and size of the wound (photographs if possible), the date and time it first occurred, and its progression
  • Treatments received in the emergency room (fluids, intubation, skin grafting, etc.)

Examples of General Questions to Ask the Doctor

• "How severe is my burn, and what is the prognosis?"
• "What side effects may occur with my current pain management method (medication and dosage)?"
• "What dressings and hygiene practices do you recommend to prevent wound infection?"
• "What rehabilitation (physical therapy, medications, or assistive devices) is needed to reduce scarring and contractures?"

Examples of Condition-Specific Questions

• Suspected inhalation injury: "An inhalation injury is suspected. Do I need intubation or additional tests?"
• In cases of electrical burns or suspected muscle breakdown: "Do I need additional tests such as an electrocardiogram or blood tests (CK and electrolytes)? Are there measures to protect my kidneys?"
• When skin grafting is being considered: "Do I need a skin graft, and what type of graft (split-thickness or full-thickness) is recommended? What are the recovery period and possible complications?"

(Reference: Example TBSA divisions from the provided data: Adults — face 18%, back 18%, one arm 9%, one leg 18%, genitals 1%; children — one leg 13.5%, etc. Calculating the surface area by age and body region is important when determining severity and systemic treatment.)

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Caution: If emergency symptoms (difficulty breathing, impaired consciousness, extensive burns, rapidly progressing swelling, severe bleeding, or systemic shock) are present, go to the emergency room immediately.