Burn Emergencies

Electricity, chemicals, steam, very hot water, and fire can all cause serious burns. The care you receive for burns will depend on the type and severity of your injury. Many burns can be treated in an outpatient setting. If a burn needs inpatient treatment, it should be done in a burn center. Very severe burns need treatment in a burn center. 

Types of burns

You may be most familiar with the traditional burn classification of first, second, and third-degree burns.

• First-degree burns are usually mild. They affect only the outer layer of skin (epidermis). The skin is likely to be red, and there may be some pain and swelling. Most sunburns are first-degree burns.

• Second-degree burns injure the second layer (dermis) of skin. The skin will be intensely red and may develop blisters. These burns are often very painful.

• Third-degree burns involve all the layers of skin. Fat, nerves, muscles, and even bone may be burned. The skin may be charred black or appear very white. Pain is likely to be severe. If nerves are damaged, no pain may be felt at all.  

A newer classification uses designations based on the depth of the burn and the need for surgical intervention.

• Superficial burns involve the outer layer of skin (epidermis). They are painful and red, but do not blister

• Superficial partial-thickness involves the outer layer and second layer (dermis) of skin. These burns usually blister within 24 hours that are painful, red and weeping.

• Deep partial-thickness burns extend into the deeper dermis and damage hair follicles and glandular tissue. The burn is painful on pressure and the blister is wet or waxy and mottled or patchy in color.

• Full-thickness burns extend through all layers of the skin and often to the underlying tissue. Blisters do not develop but skin can vary from waxy white to gray to charred and black.

• Fourth degree burns are deep and can be life threatening, extending through skin into underlying tissues, muscle or bone.

When to go to the emergency department

For a second- or third-degree burn, burns all the way around an arm or leg, burns caused by electricity or chemicals, burns involving the eyes, mouth, or airway, or any burn that covers large parts of the body, go to the emergency department or call 911 right away.

What to expect in the emergency department

Some activities that will happen include:

• Medicine will be given to relieve pain.

• The burn is cooled with moist cloths.

• A chemical burn will be flushed with water and may be injected with medicine.

• The burn is washed and any damaged tissue is removed. An antibiotic ointment may be applied and the burn covered with a dressing.

• Fluids are given through a vein by intravenous access (IV) in the arm or other extremity not affected by burns.

• If smoke was inhaled, the airways may be burned. If so, a tube may be placed in the windpipe (trachea) and connected to a ventilator to help breathing. A chest X-ray may be done to look for damage to the lungs from inhaling smoke. Blood and urine tests may be done to check the body’s levels of oxygen and carbon dioxide.

Follow-up

Some burns can be cared for at home. Burns easily become infected, so careful cleaning and dressing changes are important. Very deep burns often require long-term medical treatment. For these burns, treatment is done in a burn center. Depending on the severity of the burn, skin grafts may be needed to replace damaged tissue.