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Burn Evaluation

What is a burn evaluation?

A burn is a type of injury to the skin and/or other tissues. The skin is the largest organ in your body. It is essential for protecting the body against injury and infection. It also helps control body temperature. When skin is injured or damaged by a burn, it can be very painful. Other health problems from a burn may include severe dehydration (the loss of too much fluid from your body), breathing troubles, and life-threatening infections. Burns can also cause permanent disfigurement and disability.

A burn evaluation looks at how deep in the skin a burn has gone (degree of burns) and how much of the body's surface area has been burned.

Burns are most often caused by:

  • Heat, such as fire or hot liquids. These are known as thermal burns.
  • Chemicals, such as acids or detergents. They can cause burns if they touch your skin or eyes.
  • Electricity. You can get burned when an electrical current passes through your body.
  • Sunlight. You can get a sunburn if you spend too much time in the sun, especially if you don't wear sunscreen.
  • Radiation. These types of burns can be caused by certain cancer treatments.
  • Friction. When skin rubs against a surface too roughly, it can cause an abrasion (scrape) known as a friction burn. Friction burns often happen in a bicycle or motorcycle accident when skin rubs against the pavement. Other causes include sliding down a rope too quickly and falling off a treadmill.

Other names: burn assessment

What are the different types of burns?

The types of burns are based on the depth of the injury, known as the degree of burns. There are three main types.

  • First-degree burns. This is the least serious type of burn. It only affects the outermost layer of the skin, known as the epidermis. First-degree burns may cause pain and redness, but no blisters or open sores. A sunburn is a common type of first-degree burn. First-degree burns usually go away within a week or so. At-home treatments may include soaking the area in cool water and dressing it with a sterile bandage. Over-the-counter pain medicines can also relieve minor burn pain.
  • Second-degree burns, also called partial thickness burns. These burns are more serious than first-degree burns. Second-degree burns affect the outer and the middle layer of the skin, known as the dermis. They can cause pain, redness, and blisters. Some second-degree burns can be treated with antibiotic creams and sterile bandages. More serious second-degree burns may need a procedure known as a skin graft. A skin graft uses natural or artificial skin to cover and protect the injured area while it heals. Second-degree burns can cause scarring.
  • Third-degree burns, also called full thickness burns. This is a very serious type of burn. It affects the outer, middle, and innermost layers of the skin. The innermost layer is known as the fat layer. Third-degree burns often damage hair follicles, sweat glands, nerve endings, and other tissues in the skin. These burns can be severely painful. But if pain-sensing nerve cells have been damaged, there may be little or no pain at first. These burns can cause severe scarring and usually need to be treated with skin grafts.

In addition to the type of degree, burns are also categorized as minor, moderate, or severe. Nearly all first-degree burns and some second-degree burns are considered minor. While they can be very painful, they rarely cause complications. Some second-degree burns and all third-degree burns are considered moderate or severe. Moderate and severe burns cause serious and sometimes fatal health problems.

How is a burn evaluation used?

Burn evaluations are used to examine moderate to severe burn injuries. During a burn evaluation, your health care provider will carefully look at the wound. He or she will also figure out an estimated percentage of total body surface area (TBSA) that has been burned. Your provider may use a method known as the "rule of nines" to get this estimate. The rule of nines divides the body into sections of 9% or 18% (2 times 9). The sections are divided as follows:

  • Head and neck: 9% of TBSA
  • Each arm: 9% TBSA
  • Each leg: 18% TBSA
  • Anterior trunk (front of the body) 18% TBSA
  • Posterior trunk (back of the body) 18% TBSA

Rule of nines estimates are not used for children. Their bodies have different proportions than adults. If your child has a burn that covers a medium to large area, your provider may use a chart, called a Lund-Browder chart, to make an estimate. This gives more accurate estimates based on a child's age and body size.

If you or your child has a burn that covers a small area, your provider may use an estimate based on the size of the palm, which is about 1% of TBSA.

What else happens during a burn evaluation?

If you have a serious burn injury, you may also need an emergency evaluation known as an ABCDE assessment. ABCDE assessments are used to check key body systems and functions. They often take place in ambulances, emergency rooms, and hospitals. They are used for different types of traumatic emergencies, including severe burns. "ABCDE" stands for the following checks:

  • Airway. A health care provider will check for any blockages in your airway.
  • Breathing. A provider will check for signs of trouble breathing, including coughing, rasping, or wheezing. The provider may use a stethoscope to monitor your breath sounds.
  • Circulation. A provider will use devices to check your heart and blood pressure. He or she may insert a thin tube called a catheter into your vein. A catheter is a thin tube that carries fluids into your body. Burns can often cause serious fluid loss.
  • Disability. A provider will check for signs of brain damage. This includes checking to see how you respond to different verbal and physical stimulation.
  • Exposure. A provider will remove any chemicals or burn-causing substances from the skin by flushing the injured area with water. He or she may bandage the area with a sterile dressing. The provider will also check your temperature, and warm you with a blanket and warm fluids if necessary.

Is there anything else I should know about a burn evaluation?

Burns and fires are the fourth most common cause of accidental death in children and adults in the U.S. Young children, older adults, and people with disabilities are at a higher risk of burn injury and death. The vast majority of burn accidents can be prevented with some simple safety precautions. These include:

  • Set your water heater to 120°F.
  • Test the water temperature before you or your child gets into the tub or shower.
  • Turn handles of pots and pans toward the back of the stove, or use back burners.
  • Use smoke alarms in your home and check batteries every six months.
  • Check electrical cords every few months. Throw out any that are frayed or damaged.
  • Put covers on electrical outlets that are within a child's reach.
  • If you smoke, never smoke in bed. Fires caused by cigarettes, pipes, and cigars are the leading cause of deaths in house fires.
  • Be very careful when using space heaters. Keep them away from blankets, clothes, and other flammable materials. Never leave them unattended.

To learn more about burn treatment or prevention, talk to your health care provider or your child's provider.

References

  1. Agrawal A, Raibagkar SC, Vora HJ. Friction Burns: Epidemiology and Prevention. Ann Burns Fire Disasters [Internet]. 2008 Mar 31 [cited 2019 May 19]; 21(1): 3-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188131
  2. Children's Hospital of Wisconsin [Internet]. Milwaukee: Children's Hospital of Wisconsin; c2019. Facts about burn injury [cited 2019 May 8]; [about 4 screens]. Available from: https://www.chw.org/medical-care/burn-program/burns/facts-about-burn-injury
  3. Familydoctor.org [Internet]. Leawood (KS): American Academy of Family Physicians; c2019. Burns: Preventing Burns in Your Home [updated 2017 Mar 23; cited 2019 May 8]; [about 4 screens]. Available from: https://familydoctor.org/burns-preventing-burns-in-your-home
  4. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co., Inc.; c2019. Burns [cited 2019 May 8]; [about 2 screens]. Available from: https://www.merckmanuals.com/home/injuries-and-poisoning/burns/burns?query=burn%20evaluation
  5. National Institute of General Medical Sciences [Internet]. Bethesda (MD): Burns [updated 2018 Jan; cited 2019 May 8]; [about 2 screens]. Available from: https://www.nigms.nih.gov/education/pages/Factsheet_Burns.aspx
  6. Olgers TJ, Dijkstra RS, Drost-de-Klerck AM, Ter Maaten JC. The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study. Neth J Med [Internet]. 2017 Apr [cited 2019 May 8]; 75(3):106–111. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28469050
  7. Strauss S, Gillespie GL. Initial assessment and management of burn patients. Am Nurse Today [Internet]. 2018 Jun [cited 2019 May 8]; 13(6):16–19. Available from: https://www.americannursetoday.com/initial-assessment-mgmt-burn-patients
  8. TETAF: Texas EMS Trauma and Acute Care Foundation [Internet]. Austin (TX): Texas EMS Trauma and Acute Care Foundation; c2000–2019. Burn Clinical Practice Guideline [cited 2019 May 8]; [about 4 screens]. Available from: http://tetaf.org/wp-content/uploads/2016/01/Burn-Practice-Guideline.pdf
  9. Thim T, Vinther Karup NH, Grove EL, Rohde CV, Lofgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med [Internet]. 2012 Jan 31 [cited 2019 May 8]; 2012(5):117–121. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273374
  10. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Burns Overview [cited 2019 May 8]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01737
  11. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Burn Center: Burn Center Frequently Asked Questions [updated 2019 Feb 11; cited 2019 May 8]; [about 3 screens]. Available from: https://www.uwhealth.org/burn-center/burn-center-frequently-asked-questions/29616
  12. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Emergency Medicine: Assessing Burns and Planning Resuscitation: The Rule of Nines [updated 2017 Jul 24; cited 2019 May 8]; [about 3 screens]. Available from: https://www.uwhealth.org/emergency-room/assessing-burns-and-planning-resuscitation-the-rule-of-nines/12698
  13. World Health Organization [Internet]. Geneva (SUI): World Health Organization; c2019. Management of Burns; 2003 [cited 2019 May 8]; [about 4 screens]. Available from: https://www.who.int/surgery/publications/Burns_management.pdf

The medical information provided is for informational purposes only, and is not to be used as a substitute for professional medical advice, diagnosis or treatment. Please contact your health care provider with questions you may have regarding medical conditions or the interpretation of test results.

In the event of a medical emergency, call 911 immediately.