A burn is damage to the skin and deeper tissue from heat, chemicals, electricity or radiation, classified by depth as superficial, partial thickness or full thickness. Size is measured as a percent of total body surface area, which guides fluids, referral and outcome.
Key symptoms
- Superficial: red, dry, painful skin without blisters, like a sunburn
- Superficial partial thickness: blisters, moist pink skin and severe pain
- Deep partial thickness: patchy white or red skin that is less painful
- Full thickness: leathery white, brown or charred skin with little pain
What you find on exam
- Primary survey first: airway, breathing and circulation, especially after smoke exposure
- Look for airway burns: singed nose hair, soot in the mouth, hoarse voice, stridor
- Estimate burned area with the rule of nines or the palm method (about 1 percent); do not count superficial burns
- Check blanching and capillary refill to judge depth, and look for circumferential burns
- Check for other injuries, and for abuse in children with patterned or immersion burns
Tests
- Most small burns need no tests
- Major burns: blood count, electrolytes, kidney function and blood gas
- Carboxyhemoglobin after smoke exposure, and lactate if cyanide poisoning is a concern
- ECG after electrical burns; creatine kinase and urinalysis for muscle injury
Treatment basics
- Stop the burning and cool with cool running water for 20 minutes; keep the patient warm
- Large burns (about 20 percent or more in adults): IV lactated Ringer's guided by a burn formula (2 to 4 mL per kg per percent burned) and urine output
- Pain control, tetanus update and clean dressings such as petrolatum gauze or silver dressings
- Early intubation if airway burns are suspected
- Burn center referral: large or deep burns, face, hands, feet, genitals, joints, electrical, chemical or inhalation injury
Red flags
- Hoarse voice, stridor, facial burns or soot in the airway
- Circumferential burn of the chest or a limb (may need escharotomy)
- Electrical injury, carbon monoxide exposure, or a burn in a child that does not fit the story
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.