Emergency Medicine


Introduction to Burns

Burns can occur as a result of exposure of the skin to heat, electricity, abrasive chemicals or radiation. Burns are thus classified into four classes  corresponding to the degree of the injury:

- First degree burns- this type of burn affect only the epidermis, the first or the outer layer of one’s skin, which result in pain and redness. 

- Second degree burns- affects the second layer of skin called the dermis which brings about redness, pain and swelling.

- Third degree burns- penetrates through the first two layers and may be injurious to the bones, muscles and tendons. Pain may not be felt as the underlying nerves may be damaged.

- Fourth degree burns- this type of burn penetrate through the skin and subcutaneous fat layer which affects the bones and muscles.


  • Signs and Symptoms
  • Causes of Burns
  • Risk Factors
  • Preventative Care
  • Diagnosis
  • Treatment
  • Complications associated with Burns
  • Conclusion




Each year,1-2 million of the population in the United States obtain medical care  for burns out of which 50,000-70,000 are hospitalised.   This type of injury most of the time take place at home, work or by traffic accidents. Extremely hot liquids are the cause of burns in children usually. Even minor burns have the tendency to do considerable harm if it is not treated.


Signs and Symptoms

Signs and Symptoms that pertain to burns generally depends on the severity of the burn itself. Thus, a medical doctor will first assess the burn to find out the amount of area which has been affected. Furthermore, he will determine complications like infections, dehydration as well as related defects.


Infections tend to occur in the cases of burns as skin the skin is the natural barrier against infections and other destructive particles. Once the barrier is damaged, infections are inclined to happen. It’s quite difficult to find out if a minor burn is infected or not as the area around the burn may be red and warm which are signs of infections. Other signs of infection include:-

  • Colour change in encircling skin of the burn
  • Exudation of pus
  • Purplish colour present especially when there is swelling.
  • Fever
  • The burn may suddenly  extend deeper into the skin due to infections.


Dehydration may result in burns as significant amount of fluids are lost through the damaged skin. In some cases dehydration could be very severe leading to shock. This condition is generally treated with intravenous or IV fluids. Signs of dehydration include:

  • Thirstiness
  • Dizziness, giddiness or feeling faint when standing up.
  • Feebleness
  • Drying of skin
  • Infrequent urination than normal

Patterns of Burns

Two types of patterns are said to prevail- typical and atypical. The difference between the two is that typical patterns arise from accidental burns whereas atypical may result due to physical abuse. Therefore, typical or accidental burns often occurs in areas of exposed or unprotected skin like arms, neck, face. Atypical burns may materialise in unexposed parts of the skin.

Causes of Burns

Burns generally occur due to the skin being exposed to electricity, radiation, thermal heat or corrosive chemicals. As the name suggest, electric burns are caused due to contact with electric currents, chemical burn due to contact with corrosive chemicals and thermal burns due to contact with hot substances. Radiation is also said to cause burns, long-term exposure to ultraviolet or UV light can cause significant harm. Other sources of radiation like tanning booths and beds which emits UV light. Major burns are usually caused by fire or extremely hot liquids and surfaces. Electricity and certain chemicals can also cause major damage.

 Risk Factors

  • Unprotected sources of heating and power cords.
  • Incautious smoking
  • Child abuse.
  • Prolonged exposure to the sun
  • Heated surfaces
  • Water heater’s temperature too high
  • Careless storage of injurious chemicals

Preventative Care

Preventative care measures will protect you from being exposed to burns:

  • Smoke detector installation 
  • Designing emergency exits
  • Practicing fire drill and emergency evacuation procedures.
  • Quit smoking and excessive alcohol consumption
  • Familiarising and educating kids about fire safety and burn prevention.

Measures to reduce risk of burn:

  • Immediate first aid
  • Immediate medical care
  • If the burn victim is hospitalised make sure medical care professionals are attending to the patient.


A medical doctor will examine the extent of damage or harm caused by the burn, the intensity of pain, the swelling and will look into the signs and symptoms that would indicate infection to make an accurate diagnosis. Thus, health care professionals grade the injury depending on the complexity of the burn. Urgent medical care is required for patients who have undergone severe burn injuries like when a significant part of the body is burnt, burns caused due to inhalation of smoke, electric burns, physical abuse burns, etc. In an ER (emergency room) the burns are quickly covered with sterilised cloth and patients may be given oxygen and liquids. The injury will be evaluated for causative agents as well as tests will be conducted to assess for infections.

Video of Burns


It is important to note that minor burns can be treated at home but other severe burns need immediate medical care due to the occurrences of infection, dehydration and other intricacies. Medical doctors would generally concentrate on keeping the burned area clean to avoid infection as well as he/she will remove dead tissue. Medications are prescribed for pain and infection. A tetanus vaccine can be given to the patient in the case of not receiving one in the last five years.  Massage therapy, hypnosis, therapeutic touch, acupuncture, homeopathy, nutritional advise are all different kinds of support mechanisms which are available to the patient for a speedy recovery.

First-Aid Treatments

First degree burns-  

  • Cover the injured area with a cold compress or run cold water
  • Do not apply ice, butter or oil
  • For pain relief and swelling take ibuprofen or acetaminophen
  • Immediate medical care is required for ocular burns
  • Do not apply any ointment or other burn care products for at least a period of 24 hours.

Second degree burns-

  • Blisters should not be ruptured or broken
  • Removal of clothing that is fixed or stuck to the skin should be avoided.
  • Cover the area with a cold compress or run cold water for 5-10 minutes. Now, remove clothing which is not stuck to the skin.
  • Ibuprofen or acetaminophen can be used for pain relief and swelling.
  •  If the burn area is in close proximity to the nose, eye or mouth immediate medical attention is required.

Third Degree burns-

  • Call an emergency hotline immediately
  • If the person has caught fire follow the emergency protocol:- STOP, DROP, ROll the victim.
  • Inspect breathing and circulatory functions.
  • Clothing which are stuck to the skin should not be removed.
  • Run cold water on the injured area.
  • Do not apply any products (ointments, burn care products). Cover the injured area with sterilised bandages or sheets.


  • Antimicrobial ointments or creams can be used to prevent infection. These ointments can be either silver sulfadiazine, mafenide, silver nitrate or povidone-iodine. 
  • Bacitracin ointments can be applied for first degree burns.
  • Antibiotics are administered to treat infection arising from bacteria. Examples of antibiotics are:oxacillin, mezlocillin, and gentamicin.
  • Pain medications (acetaminophen with codeine, morphine, or meperidine) may be prescribed to manage severe burns.
  • Anabolic steroids can also be administered to treat severe burns.


Debridement and skin grafting procedures may be carried out in the case of severe burns. Debridement is the medical removal of damaged, infected or dead tissue. Skin grafting, on the other hand, involves transplanting skin; it is a surgical procedure involving replacing the damaged tissue with new tissue. The skin obtained can be from another part of the victim’s body (permanent fixation), a donor, from an animal or artificial skin. Plastic or cosmetic surgery is sometimes performed to upgrade the function and appearance of the injured area.

Nutrition and other Supplements

Minor or first degree burns are usually treated at home where natural products could be used to increase healing whereas severe or major burns require emergency medical care. On an important note, victims of severe burn injuries must be given healthy food containing the necessary nutrients for prompt recovery.  In hospitals, these patients are usually given food containing high protein and calories. The following pointers will make better one’s healing and health in general:-

  • Antioxidant foods involving fruits and vegetable is the best way to go about as studies have shown that high doses of Vitamin C administered to a burn victim reduced burn tissue water quantity by 50%, liquid needs by 40% and decreased ventilator days. 
  • Must avoid refined and processed food (white bread, sugar, pasta, etc.)
  • Red meat consumption should be reduced. Patient should be given more lean meat, soy, cold water fish and beans as a source of protein.
  • Unhealthy cooking oil should be replaced with those of healthy ones like olive oil or vegetable oil
  • Unsaturated fatty acids should not be eaten. These can be generally found in cracker, cookies, fries, donuts, margarine and processed foods.
  • Stay clear of stimulants like caffeine, alcohol and tobacco.
  • 6-8 glasses of water should be taken per day. 

The following supplements will also help burns:

  • Multivitamin capsule comprising of  antioxidant vitamins A, C and E and trace minerals such as magnesium, calcium, zinc, and selenium tend to help the burns.
  • Omega-3 fatty acids aid in the reduction of inflammation, immunity and healing. This can be easily obtained from fish oil. One can take a capsule a day or 1 tablespoonful of oil 1 or 2 times a day. Note that this supplement can interfere with blood thinners in the likes of Warfarin and aspirin. Although, cold water fish are good sources of Omega-3 fatty acids it may not be adequate.
  • Vitamin C helps in the healing of burned skin by increasing growth of new tissue.
  • Vitamin E also enhances healing of burned area. An additional advantage of vitamin E is that it can be applied to the skin after healing of the skin.
  • Another source of antioxidant is Coenzyme Q10, which is also perceived to have blood clotting effects and enhancement of immunity when administered.
  • L-glutamine helps in immunity as well as in gastrointestinal well being. That being said, high doses of it can affect one’s mood and it should not be prescribed to  patients who suffer from hepatic encephalopathy which manifests as severe liver disease and confusion.
  • Probiotics or “friendly” bacteria can also be prescribed which help immunity and gastrointestinal health. These supplements should be refrigerated for optimum results.


Electrical stimulation called TENS or Transcutaneous Electrical Nerve Stimulation applies a low voltage current to the skin to reduce the pain felt by the sufferer.  Research and ongoing studies suggest that when TENS is used at  electroacupuncture points which are acupuncture points, on places like the ear (auricular acupuncture) may elevate the pain felt.

Massage and Physical Therapy

Studies have declared that massage therapy is helpful and beneficial to the patient during emergency care as well as during recovery. Pain, itching, depression, anxiety etc. are all suffered by the patient. Massage therapy will help with these symptoms and studies have shown that patients who underwent massage therapy had relatively less incidence of these symptoms compared to those who didn’t. Consult your doctor before receiving any sort of massage therapy.

Physical therapy, on the other hand, try to improve movement and function of the injured region. It may also help decrease formation of scar. Moreover, this kind of therapy generally starts early for the patients who are hospitalised. Physical therapy may use any of the following practices to make better one’s condition:

  • Proper positioning of limbs and joints
  • Use of splints
  • Exercises- both passive and active
  • Help to perform simple daily self care activities until normal function of affected areas are restored.
  • Provide help to get back on your feet


Professional homeopaths tend to examine the patient first before starting to treat a person- they may look into one’s physical, emotional as well as mental disposition. After which, any one of the below mentioned therapeutics may be suggested:

  • Immerse the injured area in cold water  until you get relief from your pain.
  • Calendula can be smeared on the area for first degree burns and sunburns.  It can also be applied for second or thirds degree burns for  new growth of skin and to reduce formation of scar.
  • Arnica Montana (Leopards bane) can be taken by mouth instantly after the burn.
  • For severe and shooting pain  Hypericum perforatum can be used,
  • For burns that arose from electrical currents phosphorus can be taken orally.
  • Urtica urens can also be taken orally for pain, pricking sensation and swelling. It is used and may be applied as an ointment for sunburns and first degree burns. Also recommended for children.

 Mind-Body Medicine 

Hypnosis is proven to improve pain and anxiety in patients. Furthermore, it can help the patient feel relaxed. Therapeutic touch or simply TT is built on the belief that the body, mind and its emotions are on a complex field of energy. Thus, therapists use a procedure called “the laying on of hands” where the body’s unevenness or its lack of harmony with other parts of the body is corrected by using hand movements to fix it. It works to direct human energy in order to heal. Pain, anxiety, healing abilities are said to improve after TT.

Complications associated with Burns

A number complications are associated with burns, some of them being:

  • Infection- a major complication of burns where 10,000 people in the United States are said to die from the infection attained due to burns.
  • Immune system of the patient can be weakened
  • Damage to the function as well as appearance of the injured area.
  • There is a risk of developing cancer at the site of injury.
  • Poisoning due to Carbon monoxide.
  • Heart attacks are also a possibility.

Only 10-20 days are required for healing first degree burns, if say, the burned area is not infected. Having mentioned that, it is possible that a first degree burn may progress to a second degree, and the second to a third degree, in the case of infection. Skin grafting may be required for third degree burns.


Burns can be attained due to exposure of skin to thermal heat, electricity, radiation or chemicals. Burns are generally in the risk of attaining infection, dehydration and deformity. Thus, one should study its risk factors and take necessary preventive steps to ensure safety. There are a number of first aid treatments available for burns depending on the degree of the burn. If an individual is on fire one should know the drill: STOP, DROP and ROLL. Antimicrobials, antibacterial and pain medications are some of the medications available for the injured party. Surgery, Acupuncture, massage therapy, physical therapy, homeopathy, mind-body medicine are all available to the patient for a speedy recovery.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

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We welcome your comments at the end of the article.

The Team Manager Web Diseases

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