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Injury from contact with flame, hot liquids, or hot object.

Categorized as;

Flame burns (Direct contact)

Scald burns (Contact with liquid/steam)

Contact burns (Contact with hot object)

(Wound Care; Sussman Pg. 401)

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Injury to skin by direct contact with either acidic or basic caustic agents, varying extent of injury based on duration of contact, strength/concentration and nature of agent.

Acids denature proteins that produce coagulative effects on skin and underlying tissue.

Bases tend to denature proteins and cause saponification of fats.

Chemicals like elemental metals, phosphorus and hydrocarbons can also injure skin

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Exposure to ionizing radiation such as UV rays, radioactive isotopes, and some radiology tests (rare).

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Friction caused by skin rubbing against another surface creating heat and abrasions to the skin tissue. Examples such as "carpet burns" or "court burns" in athletes.

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Complex injuries created by an electric current that contacts a persons skin and travels through them (if strong enough).

Injury at the site of contact is referred to as the "entrance wound", depending on the path the current takes, one or more "exit wounds" can be created.

Flame or Flash burns can also occur as a result of the flash/heat or sparks from ignited clothing or other material on the person or nearby.

(Wound Care; Sussman, Pg. 403)

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Superficial:

Pink, red, erythematous; dry surface; no blisters

Superficial partial-thickness:

Blisters; moist, bright red surface; blanches with normal capillary refill

Deep partial-thickness:

May have broken blisters;

red, pale or white; moist;

blanching with delayed

capillary refill

Full-thickness:

Dry, firm, leathery eschar;

white or pale yellow to

a dark red or black; no

blanch or refill

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Historically, burns have been classified by the degree of burn, first to fourth degree.

However, now they are commonly classified by describing the thickness affected by the burn, such as Superficial (1st), Partial (2nd), Full (3rd), or Sub-dermal (4th).

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This type of burn affects the epidermis and some of the dermis layer, characterized by presence of blisters that are red, moist and painful.

Burns to this depth could have some edema but can be seen to blanch and refill with pressure. These wounds typically heal in 7 to 14 days however wounds with increased depth of injury to the dermis can take up to 21 days. Upon healing the wound should have minimal to no scarring.

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This type of wound destroys the epidermis and the papillary layer of the dermis, and damage the reticular layer of the dermis. These burns may have broken blisters; red, pale or white; moist; blanching with delayed capillary refill.

Burns to this depth could have moderate to marked tissue edema, and they are sensitive to touch and pressure.

These wounds typically heal in 21 to 35 days. Upon healing the wound presents scarring.

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This type of wound affects the entirety of the epidermis and dermis, may damage the subcutaneous fat but do not damage muscle fascia. Full-thickness burn appear dry, firm, leathery eschar; white or pale yellow to a dark red or black; no blanch or refill.

Burn to this depth are insensate to touch and the pain is associated with inflammation of viable tissue in the area. There is marked tissue edema with these wounds and it may require weeks and a skin grafting for these wounds to heal. Scarring is also present in full-thickness burns.

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These types of burns penetrate through the fascial layer of muscle and destroys deep tissues, which may result in damage to muscle, nerve, bone, and related structures like capsules and bursae.

Their appearance is relevant to the depth of tissue damage. The damaged tissue is generally insensate, and is pain associated with inflammation of viable tissue.

Burns to this depth present with moderate to marked tissue edema.

They require weeks and surgical intervention to heal. Scarring is present as well as potential for tissue defects.

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Superficial thickness burns affect the epidermal layer of skin and have a pink/red, erythematous appearance with a dry surface. Typically have minimal tissue edema, no blisters and no scarring with healing.

The area of the burn will elicit pain to touch with resting inflammatory pain however these types of burns usually heal within 2 to 5 days with no scaring and minimal medical interventions. (Pg. 405)

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Burn wounds includes three zones of injury: zone of coagulation, zone of stasis, and zone of hyperemia. The region of coagulation represents tissue that was destroyed at the time of injury. This is surrounded by a zone of stasis, with inflammation and low levels of perfusion. Outside the zone of stasis is a zone of hyperemia, where microvascular perfusion is not impaired. (Nielson CB et al.)

In some cases the area of stasis will progress and become necrotic within the first 48 hours following thermal injury. As a result, the initial burn expands in area and depth.

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Superficial:

Resting inflammatory pain and tender to touch

Superficial partial-thickness:

Very painful, sensitive to touch, pressure, temperature change

Deep partial-thickness:

Painful; sensitive to touch and pressure

Full-thickness:

Insensate to touch, pain associated with inflammation of associate viable tissue

Subdermal:

Damaged tissue is generally insensate; inflammatory pain of associated viable tissue

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Superficial:

Super-Fish

Sunburn

Superficial partial-thickness:

Super-Fish

Blister

Blanching (Bleach)

Deep partial-thickness:

Partial Deep-Diver

Little or none Blanching

(little nun-bleach)

Full-thickness:

Full Glass

Waxy white, yellow or black

(waxy candle)