Thermal Burns (Heat or Fire)

Facts on Thermal Burns

  • From simple sunburn on vacation to touching a hot pot on a stove, many of us have experienced minor burns at one time or another.
  • Thermal burn injuries are very common. Children are particularly at risk due to accidental burns.
  • The type of burn and the severity of the burn depend on the number of layers of skin affected.
  • Most burns are mild, but some may be severe.
  • Most importantly, a majority of burns are estimated to be preventable.

What Causes Thermal Burns?

You may get burned from any hot or heated source or from chemical reactions that release heat.

  • Thermal burns
    • Flame
    • Scald (from steam, hot or molten liquid)
    • Contact (from a hot object, such as a hot cooking pan)
    • Electrical burns
    • Radiation burns (sunburn, medical radiation treatment for cancers, welding exposures)
    • Chemical burns

What Are the Symptoms of Thermal Burns?

All thermal burns (from fire or flame) cause an injury to the different layers of the skin. The type of burn and the severity of the burn depends on the number of layers of skin affected.

Traditionally burns were described using the word degrees (first, second, and third). Now most doctors describe burns as to their thickness (superficial, partial, and full).

The skin is made up of three important layers:

  1. the epidermis (or the outer layer),
  2. the dermis, and
  3. the subcutaneous tissues.

Each corresponds roughly to the types of burns. (It is important to note that many burn injuries may include all three types of burns at the same time.)

  • Superficial burn or first degree burn: This burn involves only the epidermis, the outermost layer of the skin. Most people are familiar with this burn in the form of sunburn.
  • Symptoms and signs - Painful, red, area turns white when touched, no blisters, moist
  • Partial thickness burn or second degree burn: This burn involves the epidermis and some portion of the dermis, the second layer of the skin. This type of burn may be further categorized as superficial or deep, depending on how much of the dermis is involved.
  • Superficial symptoms and signs - Painful, red, area turns white to touch, mottling, blisters, moist, hairs still present
  • Deep symptoms and signs - May or may not be painful (it may be so deep that nerve endings may be destroyed), may be moist or dry (so deep that sweat glands are destroyed), may or may not turn white when area is touched, hair is usually gone
  • Full thickness burn or third degree burn: This is the most severe burn. The burn involves all of the epidermis and dermis—the first two layers of the skin. Nerve endings, tiny blood vessels, hair follicles, and tiny sweat glands are all destroyed. If very severe, the burn may involve bone and muscle.
  • Symptoms and signs - Painless, no sensation to touch, pearly white or charred, dry, may appear leathery

When Should I Call the Doctor About Thermal Burns?

Seek emergency medical care if you have any partial or full thickness burn that involves the genitals, eyes, ears, hands, or feet, or burns over major joints regardless of size. Also seek immediate medical care for the following burns:

  • Any full thickness burn, for example, that looks dry, is painless, or looks charred
  • Any partial thickness burn that is more than the size of your palm
  • If pain is uncontrollable

Call 911 for emergency medical transport in these cases

:
  • If there are extensive partial thickness or full thickness burns to the body
  • For any problems breathing with burns to the face
  • With a large amount of smoke exposure in a closed room
  • If a person is unconscious after he or she has sustained a burn
  • If you need to update your tetanus shot, your doctor can check your medical records or if you have any questions about burn care, call your doctor.

What Are the Exams and Tests to Diagnose Thermal Burns?

At the hospital, the doctor will take a history and perform a physical examination to determine the extent and severity of the burn.

  • In determining the extent of the burn, the doctor may use a tool called the "Rule of Nines." This tool is a formula that divides the surface area of the body into sections, each roughly 9%. Determining the amount of surface area burned helps the doctor decide on treatment of the burn.
  • No special diagnostic tests are needed.
  • The doctor will determine whether the burn or burns are superficial, partial thickness, or full thickness and begin treatment appropriately.

What Are the Home Remedies for Thermal Burns?

The most important first step is to stop the burning process.

  • Put out any fire or flames (the common advice is to 'stop, drop, and roll' to put out flames on your clothing). Remove hot or burned clothing, if possible, or stop contact with the hot steam, liquid, or a hot object.
  • Cool the injured area with water (not ice) within 30 seconds. This may limit the extent and severity of the burn. Run your burned hand or finger, for example, immediately under cool tap water for several minutes.

Control the pain.

  • Apply a cool wet compress for pain relief. Do not use ice. This may worsen the injury to the skin.
  • Other common remedies, such as butter or mayonnaise have not been proven to work; and may increase the chance of infection.
  • You may also use acetaminophen (Tylenol) or ibuprofen (Advil) for pain as directed on the bottle.

Begin the healing process.

  • For small burns and burns that are superficial in nature, you may use a triple antibiotic ointment. This will aid in healing and limit the chance of infection.
  • Do not remove blisters at home, especially those on the palms of the hands or on the soles of the feet.

What Is the Medical Treatment for Thermal Burns?

Depending on the nature and severity of the burned area, these treatments may be given.

  • Gentle cleansing may be performed of the burned area.
  • Blisters will be cared for. Some doctors may debride blisters (cut away dead tissue). Others may leave them intact. There is no right or wrong approach. Blisters on the soles of the feet or palms of the hands will usually be left intact.
  • Depending on the extent of the burn, the doctor may order fluids to be taken by mouth or to be administered by IV.

Also, depending on the severity and extent of the burn, the doctor may advise or request that care be continued at a special Burn Center. Specific criteria exist for such cases and have been established by the American Burn Association. Criteria may include any full thickness burn greater than 5%; partial thickness burn greater than 20% in people between ages 10-50; any partial thickness burn greater than 10% in children younger than 10 years and older than 50 years of age; any significant burns to the ears, eyes, hands, feet, or genitals.

What Are the Medications to Treat Thermal Burns?

  • Topical antibiotic ointment may be applied. This may be a triple antibiotic ointment, such as Neosporin, Bacitracin, or Silvadene (a topical antibiotic commonly used for burn care).
  • Pain medication - The doctor may tell you to use ibuprofen or acetaminophen if the burn is minor and the pain is mild. If pain is severe, the doctor may prescribe a narcotic pain reliever, such as Tylenol with codeine or hydrocodone.
  • Tetanus update

What Is the Follow-up for Thermal Burns?

After receiving care in a hospital's emergency department for a burn, it is always wise to follow up with your doctor to have the burn reexamined.

How Can I Prevent Thermal Burns?

Burns are easy injuries to prevent, use common sense.

  • Do not allow young children to play with matches or materials that can cause a fire.
  • Do not smoke cigarettes, cigars, or any other tobacco products in bed.
  • Set the water temperature in your home's hot water heater to 120-125°F. Also, turn the hot water off before the cold water when taking a bath or shower. This will prevent scald-type burns.
  • Turn pot-handles to the inside on the stove so that toddlers and young children cannot reach up and pull them down. If stove controls are on the front of the stove or if the stove top is accessible to a toddler or young child, erect a barrier to prevent touching of hot surfaces.
  • Do not carry a child and hot liquids at the same time. Also, do not leave cups, mugs, or bowls containing hot liquids at the edge of a table where a toddler or young child can reach up and pull them down onto themselves.
  • Teach children to respect fire and not to play with fire or burning objects. Instruct them in the techniques of 'stop, drop, and roll' to put out flames on their clothing.
  • As a family, put together a fire escape plan and practice it.
  • Install smoke detectors in the house and check them regularly.

What Is the Outlook for Thermal Burns?

Most minor burns can be treated at home and will heal fine without scarring. Extensive burns, severe burns in critical areas, such as the face, genitals, hands, or feet, and burns in infants or the elderly may require hospitalization and care by a specialist in burns.

Besides scarring, another complication of burns is infection. This is uncommon with good wound care as directed by the doctor and use of a topical antibiotic ointment. Nevertheless, if infection does occur, a doctor should be consulted so that he or she may start an oral antibiotic and follow the burn closely with frequent follow-ups.

Signs of infection include redness, increased pain in the area, drainage of pus, swelling, and fever.

Pictures of Thermal Burns

Superficial burn. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin.
Superficial burn. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin.
Superficial partial-thickness burn without blisters. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin.
Superficial partial-thickness burn without blisters. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin. Click to view larger image.

Superficial partial-thickness burn. This image demonstrates associated blister formation. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin.
Superficial partial-thickness burn. This image demonstrates associated blister formation. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin. Click to view larger image.

Deep partial-thickness burn. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin.
Deep partial-thickness burn. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin. Click to view larger image.

Partial-thickness and full-thickness burns from structure fire. Note facial involvement. Image courtesy of Roy Alson, MD, PhD.
Partial-thickness and full-thickness burns from structure fire. Note facial involvement. Image courtesy of Roy Alson, MD, PhD. Click to view larger image.

Full-thickness burn. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin.
Full-thickness burn. Image courtesy of Nicholas A. Meyer, MD, Assistant Professor of Surgery, Division of General Surgery, University of Wisconsin. Click to view larger image.

Rule of Nines for calculating burn area. Image courtesy of Roy Alson, MD, PhD.
Rule of Nines for calculating burn area. Image courtesy of Roy Alson, MD, PhD. Click to view larger image.

Child with burns from a scald. Hot soup was spilled when the child grabbed the handle of a pot. Note full-thickness burn to left upper chest. Swelling of lips and blisters on face and nose indicate second-degree burns of face. Image courtesy of Roy Alson, MD, PhD.
Child with burns from a scald. Hot soup was spilled when the child grabbed the handle of a pot. Note full-thickness burn to left upper chest. Swelling of lips and blisters on face and nose indicate second-degree burns of face. Image courtesy of Roy Alson, MD, PhD. Click to view larger image.

Reviewed on 11/21/2017
Sources: References

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