CuraRN

Burns

Student study notes from paramedic coursework (2023 to 2024), not medical advice. Verify clinical values against current references and your local protocols.

EMS etiologies Setting: ER

Burns result from exposure to heat, chemicals, electricity, or radiation. Patients with extensive, deep, or complex burns are typically referred to specialized burn centers for comprehensive care, including surgical intervention, critical care, and long-term rehabilitation.

Clinical Presentation:

Burns are classified by their depth and severity, which influence their clinical presentation:

  1. Superficial (First-Degree Burns):
    • Affects only the outer layer of the skin (epidermis).
    • Symptoms: Redness, minor swelling, pain, and dry skin. There are no blisters.
    • Appearance: The burn area is usually red and painful to touch, similar to sunburn. It heals within 5-7 days without scarring.
  2. Partial-Thickness (Second-Degree Burns):
    • Involves the epidermis and part of the dermis.
    • Symptoms: Intense pain, swelling, redness, and blistering.
    • Appearance: The skin appears moist or wet with blisters. These burns can take 10-21 days to heal, and deeper partial-thickness burns may cause scarring.
  3. Full-Thickness (Third-Degree Burns):
    • Extends through the entire dermis, potentially affecting underlying tissue, nerves, and blood vessels.
    • Symptoms: Burned areas may appear white, charred, or leathery. There is usually no pain in the affected area because the nerve endings are destroyed.
    • Appearance: The skin may appear dry and stiff. Healing is slow, and significant scarring and contractures can develop.
  4. Fourth-Degree Burns:
    • Involves damage to the underlying bones, muscles, and tendons.
    • Symptoms: The burn area is typically painless because nerve endings are destroyed. Muscle and bone may be exposed.
    • Appearance: The area is usually charred and blackened. Skin grafting, amputation, or reconstructive surgery may be required.

Treatment Modalities:

The treatment of burns depends on the depth and extent of the injury. Basic burn care includes stopping the burning process, cleaning the wound, and providing pain relief. However, more extensive or severe burns may require specialized care. Below are the treatment approaches:

  1. First-Degree Burns (Superficial):
    • Immediate care: Cool the burn with running cool (not cold) water for 10-20 minutes to reduce pain and swelling.
    • Topical treatments: Apply soothing lotions or aloe vera to help with pain and prevent dryness. Over-the-counter pain relievers like ibuprofen or acetaminophen can be used.
    • Hydration and wound care: Keep the area moisturized with non-perfumed creams, and cover with a sterile dressing if needed.
  2. Second-Degree Burns (Partial-Thickness):
    • Wound cleaning: Clean the burn with mild soap and water. Remove debris or dead tissue.
    • Blister care: Blisters should not be popped. However, if they rupture, the area should be cleaned and covered with a sterile dressing.
    • Topical agents: Use antibiotic ointments (e.g., silver sulfadiazine) to prevent infection and promote healing.
    • Dressing: Use non-stick dressings that are changed regularly.
    • Pain management: Pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) or stronger analgesics if necessary.
    • Referral: If the burn covers a large area or is located on the face, hands, feet, or groin, seek medical attention.
  3. Third-Degree Burns (Full-Thickness):
    • Emergency care: These burns require immediate medical treatment. Call emergency services for transport to a burn center.
    • Fluid resuscitation: Large burns often cause fluid loss and can lead to shock. IV fluids are given to maintain blood pressure and hydration.
    • Wound care: The dead tissue (eschar) may need to be removed (debridement). Burned areas are cleaned and covered with specialized dressings.
    • Antibiotics: To prevent infection, topical antibiotics like silver sulfadiazine or systemic antibiotics may be prescribed.
    • Skin grafts: Full-thickness burns do not heal on their own and often require skin grafting or reconstructive surgery.
    • Pain management: Strong pain medications are administered, often opioids for severe burns.
    • Rehabilitation: Physical therapy is often needed to maintain range of motion and prevent contractures.
  4. Fourth-Degree Burns:
    • Surgical intervention: These burns are life-threatening and typically require surgical intervention, including amputation or reconstructive surgery to repair damaged areas.
    • Intensive care: Patients may require intensive care management, including respiratory support if the airway is compromised.

Additional Treatment Considerations: