Burns

Overview: What are burns?

Burns are injuries that damage tissue by excessive direct exposure to heat. Heat damage caused by hot liquids or hot steam is referred to as scalding.

Burns – frequency and age

According to the Swiss Council for Accident Prevention, around 17,000 accidents are caused by fire in Switzerland every year, a third of which are due to negligence. Injured are mainly children between 0 and 16 years. Children are affected in six out of ten burns and scalds.

Burns: Causes and risk factors

There are several possible causes of a burn or scald. These include for example

• open fire and flames (candle, burning clothing, other fires)
• hot water, steam, oil and other hot liquids
• Explosions caused by gas or explosives
• hot metals (e.g. irons, ovens, machines)
• Electricity (e.g. on high-voltage lines, live vehicles or machines).

Cells can be damaged at temperatures as low as 45 degrees Celsius when heat is applied to the skin or tissue. Whether and to what extent the skin or the tissue is damaged depends on the respective temperature, but also on how long one was exposed to it.

Symptoms: Burns

The signs of a burn or scald do not always show up immediately. Some symptoms do not become apparent until several hours after the injury. The nature and extent of symptoms depend primarily on the severity of the burn or scald.

Important to know: The severity may increase within three days of the injury if the burn or scald continues to progress in the tissue. In this case, one also speaks of “afterburning”.

• 1st degree burn: In a first degree burn, the top layer of skin is damaged. A painful reddening of the skin develops. In addition, the skin in the affected area may swell. It is also typical that the redness temporarily disappears when we gently press down the affected skin area with a sterile glass spatula.
• Second-degree burn: In addition to redness, swelling and pain, second-degree burns sometimes include blisters. This is because heat exposure also damages blood vessel walls. As a result, fluid leaks builds up and collects under the top layer of skin, becoming visible as a blister.

Depending on the duration and intensity of heat exposure, experts distinguish between grade 2a and 2b burns in 2nd degree burns:

• Burn grade 2a: Here, closed burn blisters often appear. If these tear, an oozing wound bed becomes visible, which is reddened and sensitive to pain. The wound surface is moist and shiny. Grade 2a burns usually heal without scarring.
• Burn grade 2b: In this case, the burn blisters are ruptured. Characteristic features are a whitish background, slightly rough wound edges and a redness that hardly fades on pressure. The wound surface is less shiny and the pain intensity is lower. Grade 2b burns usually leave scars.
• 3rd degree burn: In a third degree burn, epidermis and dermis are completely destroyed. As a result, the skin is dry, thickened like leather and may be whitish to brownish in color. The pain sensors in the skin are also destroyed, which means that touch is not perceived as painful. Because third-degree burns are relatively inconspicuous, they are often difficult to detect.
• 4th degree burn: At the highest level of severity, not only the deep layers of the skin are damaged, but also underlying muscles, tendons, bones and joints. The skin is charred and discolored black. Sufferers with fourth-degree burns also feel no pain because the nerve fibers in the skin have been destroyed.

Burns: Diagnosis with us

In the case of a burn or scald, we will first assess the burn wound to gauge the extent and severity of the injury.

To find out what type of burn you have, we will ask you about how the injury occurred. Important clues for the diagnosis are provided by your condition as well as your level of consciousness, breathing and cardiovascular function.

Burns: Rule of nine

We estimate the extent of the burn based on the size of the affected area. This value is expressed as a percentage of the total body surface area. For a quick estimation of the extent of combustion, the so-called rule of nine has proven its worth. Here, the body is divided into areas, each of which accounts for about nine percent (or a multiple thereof) of the total body surface.

• Head and neck: 9 percent
• Poor: 9 percent
• Leg: 18 percent
• Chest and abdomen: 18 percent
• Back: 18 percent
• Genital region: 1 percent

We estimate a burn in children using a different formula. In them, the head is larger in relation to the body than in adults, but the arms and legs are relatively short.

Imaging techniques for inhalation trauma

Depending on the nature of the burn or scald, further investigation may be required. If there is a suspicion that the affected person has inhaled hot steam or smoke, we take an X-ray of the lungs to determine a so-called inhalation trauma. Bronchoscopy may also be necessary in this case. We use an endoscope to examine the patient’s airways for possible damage. For burns to the face, an ophthalmologist or ear, nose and throat specialist is often consulted.

Burns: Prevention, early detection, prognosis

You can avoid burns or scalds in many cases by being prudent and proactive.

Be attentive with young children. This is especially true when they are learning to walk and are holding onto other things or exploring things out of curiosity. In doing so, the child can easily knock over hot drinks or knock down cooking pots. Also beware of hot oven doors. You can reduce the risk of scalds and burns by eliminating possible sources of danger or shielding them with protective grids.

Among adolescents and adults, burns from barbecue accidents are common, in addition to scalds from hot liquids or burns from cooking or baking in the oven. Therefore, make sure to handle grills properly and avoid liquid fire accelerants such as methylated spirits.

Older people, on the other hand, are more likely to suffer burns in home fires. Therefore, be careful with possible sources of fire such as candles or cigarettes. An underestimated source of danger for scalding is too hot water in the bathtub, if you cannot get out of the tub quickly enough. Therefore, before taking a bath, you should always check the temperature.

Course and prognosis of burns

The course of a burn or scald depends on how badly the tissue is damaged and how much skin is affected. The age and any previous illnesses of the person concerned also play a role. For example, diabetes mellitus can make wound healing more difficult.

Mild burns often heal without complications. In contrast, a severe burn can severely affect the quality of life. This is especially true if visible scars develop, mobility is limited, or there is permanent pain. Therefore, in the case of severe burns, not only medical treatment of the burns and possibly physiotherapy are important for the prognosis, but also psychological care.

A burn of grade 2 or higher, with more than 20 percent burned skin in adults or more than ten percent in children, can be life-threatening. Accordingly, the prognosis is worse here. Similarly, if affected individuals suffer inhalation trauma. This means that the heat enters the respiratory tract through inhalation and causes burns.

Burns: Treatment depending on extent and severity

The treatment of a burn or scald depends on whether it has just happened or happened some time ago. Thus, in the case of an acute burn or scald, fast and proper first aid is important.

Secondly, the extent and severity of the burn play an important role. More severe burns may require hospitalization and prolonged follow-up.