Thermal burn

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Rate of deaths due to fire between 1990 and 2017. [1]

A thermal burn is a type of burn resulting from making contact with heated objects, such as boiling water, steam, hot cooking oil, fire, and hot objects. Scalds are the most common type of thermal burn suffered by children, but for adults thermal burns are most commonly caused by fire. [2] Burns are generally classified from first degree up to fourth degree, but the American Burn Association (ABA) has categorized thermal burns as minor, moderate, and major, based almost solely on the depth and size of the burn. [3]

Contents

Causes

Hot liquids and steam

Scalding is a type of thermal burn caused by boiling water and steam, commonly suffered by children. Scalds are commonly caused by accidental spilling of hot liquids, having water temperature too high for baths and showers, steam from boiling water or heated food, or getting splattered by hot cooking oil. [4] Scalding is usually a first- or second-degree burn, and third-degree burn can sometimes result from prolonged contact. [5] Nearly three quarters of all burn injuries suffered by young children are scalds. [6]

Fire

Fire causes about 50% of all cases of thermal burns in the United States. [7] The most frequent event where people get burned by fire is during house fires encountered by firefighters and trapped occupants, [8] where 85% of all fire deaths take place. [9] Fireworks are another notable cause of fire burns, especially among adolescent males on holidays such as Independence Day in the US. [6] The most common cause of injury by fire or flame in children is touching candle flame.[ citation needed ] In some regions, such as the western United States, wildfires are responsible for an increase in burn injuries. Wildfires can suddenly shift due to changing wind directions, making it harder for firefighters and eyewitnesses to avoid getting burned.

If clothing catches fire, third-degree burn can develop in a matter of just a few seconds. [10]

Hot objects

Solid objects that are hot can also cause contact burns, especially in children, who may intentionally touch things they do not know are too hot to touch. [11] Such burns imprinted on the skin usually form a pattern that resembles the object. Sources of burns from solid objects include ashes and coal, irons, soldering equipment, frying pans and pots, oven containers, light bulbs, and exhaust pipes. [12]

Pathophysiology

Picture depicting Jackson's Burn Zones. Jackson Burn Zones.jpg
Picture depicting Jackson's Burn Zones.

There are three (or sometimes four) degrees of burns, in ascending order of severity and depth. For more information, see Signs and symptoms. According to Jackson's thermal wound theory, there are three zones of major burn injury.

Prevention

It is important to teach children how to avoid fire and scalding. Firefighters and community leaders often lead such programs in schools and clinics. [9]

Smoke alarms installed in homes can reduce deaths resulting from fire by half. Homeowners should change batteries at least once a year and replace smoke alarms every decade. Before fire occurs, a family should practice evacuating the home, and when fire occurs the family must leave the residence immediately (within two minutes). Sources of flame, like matches, should be kept out of children's reach. Stoves, ovens, space-heaters, and candles must not be left unattended, and flammable objects must be kept at least 30 cm away from open flames. Fire extinguishers should be stored in the kitchen, where most house fires start. [15]

To prevent children from getting burned, water temperature must not be set too high when taking baths or washing hands, nonflammable sleepwear should be worn, back burners should be used when cooking something on the stove, and hot foods, drinks, and irons should be kept away from the edge of counter and table. [16] Oven mitts and potholders must be used in handling hot containers. Care should be taken when taking hot foods out of microwave ovens, and covers should be opened gently to reduce the risk of steam burns. [17]

Treatment

The most important first action is to stop the burning process. The source of the burn should promptly be removed (or the patient removed from the source). If the person is on fire, they must be told to stop, drop and roll, or extinguish the fire by covering them with heavy blanket, wool, coat, or rug. Burning clothing should be removed as should all jewelry that could act as a tourniquet as swelling occurs, but burned clothing stuck to the skin must not be removed. Cooling the burn with cold running water has been shown to be beneficial if accomplished within 30 minutes of the injury. [18] The pain or inflammation can then be effectively treated using acetaminophen (paracetamol), or ibuprofen. Ice, butter, cream and ointment cannot be used since they can worsen the burn. [19]

Severe burn patients are often treated through trauma resuscitation, airway management, fluid resuscitation, blood transfusion, wound management, and skin grafting, as well as the use of antibiotics. [3] [20]

Outcome

95% of people hospitalized for thermal burns survive. Survival rates have increased steadily over the last half century due to advances in treatment and better burn centers. Patients with uncomplicated burns have a 99.7% survival rate. Three risk factors—patient age above 60, burns covering more than 40% of the body, and inhalation injury—greatly reduce the odds of survival, which decline to 97% with any one of these complications, to 67% with any two, and to only 10% in cases with all three. [3]

Epidemiology

In the United States, over two million people required medical attention for thermal burns every year. About 1 in 30 of those victims (75,000) are hospitalized for thermal burns every year, with a third of those patients staying in the hospital for more than two months. About 14,000 Americans die each year from burns. [21]

Children

Thermal burns are one of the most common early childhood injuries. [11] In the United States, burns are the third most common cause of accidental death among children. [22] Nearly 96,000 children around the world died as a result of thermal burns in 2004, [6] and 61,400 died in 2008 from thermal injuries. [9] Deaths from burns dropped by 55% from 1999 to 2011. [23] Burns are the only mode of unintentional injury which more girls suffer from than boys worldwide, including by fire. [6]

Related Research Articles

<span class="mw-page-title-main">Fire</span> Rapid and hot oxidation of a material

Fire is the rapid oxidation of a material in the exothermic chemical process of combustion, releasing heat, light, and various reaction products. At a certain point in the combustion reaction, called the ignition point, flames are produced. The flame is the visible portion of the fire. Flames consist primarily of carbon dioxide, water vapor, oxygen and nitrogen. If hot enough, the gases may become ionized to produce plasma. Depending on the substances alight, and any impurities outside, the color of the flame and the fire's intensity will be different.

<span class="mw-page-title-main">Microwave oven</span> Kitchen cooking appliance

A microwave oven or simply microwave is an electric oven that heats and cooks food by exposing it to electromagnetic radiation in the microwave frequency range. This induces polar molecules in the food to vibrate and produce thermal energy in a process known as dielectric heating. Microwave ovens heat foods quickly and efficiently because excitation is fairly uniform in the outer 25–38 mm(1–1.5 inches) of a homogeneous, high-water-content food item.

Liebeck v. McDonald's Restaurants, also known as the McDonald's coffee case and the hot coffee lawsuit, was a highly publicized 1994 product liability lawsuit in the United States against the McDonald's restaurant chain.

<span class="mw-page-title-main">Burn</span> Injury to flesh or skin, often caused by excessive heat

A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation. Most burns are due to heat from hot liquids, solids, or fire. Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids. In the workplace, risks are associated with fire and chemical and electric burns. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence between people (assault).

<span class="mw-page-title-main">Outdoor cooking</span>

Outdoor cooking is the preparation of food in the outdoors. A significant body of techniques and specialized equipment exists for it, traditionally associated with nomad in cultures such as the Berbers of North Africa, the Arab Bedouins, the Plains Indians, pioneers in North America, and indigenous tribes in South America. These methods have been refined in modern times for use during recreational outdoor pursuits, by campers and backpackers.

<span class="mw-page-title-main">Ear candling</span> Alternative medicine practice for ear cleaning

Ear candling, also called ear coning or thermal-auricular therapy, is a pseudoscientific alternative medicine practice claiming to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear canal. Medical research has shown that the practice is both dangerous and ineffective and does not functionally remove earwax or toxicants, despite product design contributing to that impression.

<span class="mw-page-title-main">Injury in humans</span> Physiological wound caused by an external source

An injury is any physiological damage to living tissue caused by immediate physical stress. Injuries to humans can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or overexertion. Injuries can occur in any part of the body, and different symptoms are associated with different injuries.

<span class="mw-page-title-main">Water heating</span> Thermodynamic process that uses energy sources to heat water

Water heating is a heat transfer process that uses an energy source to heat water above its initial temperature. Typical domestic uses of hot water include cooking, cleaning, bathing, and space heating. In industry, hot water and water heated to steam have many uses.

<span class="mw-page-title-main">Firefighting</span> Actions to prevent damage from fire

Firefighting is a profession aimed at controlling and extinguishing fire. A person who engages in firefighting is known as a firefighter or fireman. Firefighters typically undergo a high degree of technical training. This involves structural firefighting and wildland firefighting. Specialized training includes aircraft firefighting, shipboard firefighting, aerial firefighting, maritime firefighting, and proximity firefighting.

<span class="mw-page-title-main">Solar cooker</span> Device for cooking with the heat of sunlight

A solar cooker is a device which uses the energy of direct sunlight to heat, cook or pasteurize drink and other food materials. Many solar cookers currently in use are relatively inexpensive, low-tech devices, although some are as powerful or as expensive as traditional stoves, and advanced, large scale solar cookers can cook for hundreds of people. Because they use no fuel and cost nothing to operate, many nonprofit organizations are promoting their use worldwide in order to help reduce fuel costs and air pollution, and to help slow down deforestation and desertification.

A flash fire is a sudden, intense fire caused by ignition of a mixture of air and a dispersed flammable substance such as a solid, flammable or combustible liquid, or a flammable gas. It is characterized by high temperature, short duration, and a rapidly moving flame front.

<span class="mw-page-title-main">Scalding</span> Medical condition

Scalding is a form of thermal burn resulting from heated fluids such as boiling water or steam. Most scalds are considered first- or second-degree burns, but third-degree burns can result, especially with prolonged contact. The term is from the Latin word calidus, meaning hot.

<span class="mw-page-title-main">Electrosurgery</span> Use of high-frequency, alternating polarity, electrical current in medical operations

Electrosurgery is the application of a high-frequency alternating polarity, electrical current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.

<span class="mw-page-title-main">Smoke inhalation</span> Breathing in of harmful fumes produced by combustion

Smoke inhalation is the breathing in of harmful fumes through the respiratory tract. This can cause smoke inhalation injury which is damage to the respiratory tract caused by chemical and/or heat exposure, as well as possible systemic toxicity after smoke inhalation. Smoke inhalation can occur from fires of various sources such as residential, vehicle, and wildfires. Morbidity and mortality rates in fire victims with burns are increased in those with smoke inhalation injury. Victims of smoke inhalation injury can present with cough, difficulty breathing, low oxygen saturation, smoke debris and/or burns on the face. Smoke inhalation injury can affect the upper respiratory tract, usually due to heat exposure, or the lower respiratory tract, usually due to exposure to toxic fumes. Initial treatment includes taking the victim away from the fire and smoke, giving 100% oxygen at a high flow through a face mask, and checking the victim for injuries to the body. Treatment for smoke inhalation injury is largely supportive, with varying degrees of consensus on benefits of specific treatments.

<span class="mw-page-title-main">Combustibility and flammability</span> Ability to easily ignite in air at ambient temperatures

A combustible material is a material that can burn in air under certain conditions. A material is flammable if it ignites easily at ambient temperatures. In other words, a combustible material ignites with some effort and a flammable material catches fire immediately on exposure to flame.

<span class="mw-page-title-main">Thermostatic mixing valve</span> Valve that blends hot water and cold water

A thermostatic mixing valve (TMV) is a valve that blends hot water with cold water to ensure constant, safe shower and bath outlet temperatures to prevent scalding.

Microwave burns are burn injuries caused by thermal effects of microwave radiation absorbed in a living organism.

<span class="mw-page-title-main">Electrical burn</span> Burn to the skin caused by electricity

An electrical burn is a burn that results from electricity passing through the body causing rapid injury. Approximately 1000 deaths per year due to electrical injuries are reported in the United States, with a mortality rate of 3-5%. Electrical burns differ from thermal or chemical burns in that they cause much more subdermal damage. They can exclusively cause surface damage, but more often tissues deeper underneath the skin have been severely damaged. As a result, electrical burns are difficult to accurately diagnose, and many people underestimate the severity of their burn. In extreme cases, electricity can cause shock to the brain, strain to the heart, and injury to other organs.

<span class="mw-page-title-main">Oxygen firebreak</span> Safety mechanism designed to extinguish a fire in a medical oxygen delivery tube

An oxygen firebreak, also known as a fire stop valve or fire safety valve, is a thermal fuse designed to extinguish a fire in the delivery tube being used by a patient on oxygen therapy and stop the flow of oxygen if the tube is accidentally ignited. Oxygen firebreaks are fitted into the oxygen delivery tubing close to the patient, typically around the patient's sternum where the two nasal cannula tubes join and connect to the delivery tubing.

On 23 October 2016, a five-year-old boy was pronounced dead at a children's hospital in Singapore. He was found to have been a victim of child abuse by his conservative parents Azlin binte Arujunah and Ridzuan bin Mega Abdul Rahman for months leading up to his death. This involved both Azlin and Ridzuan using boiling hot water to scald the boy on several occasions, inflicting severe burns and scald injuries which caused the boy to die in hospital weeks after the first of the four scalding incidents. The couple was later arrested and charged with murder. To protect his surviving siblings' identities and their privacy, the boy was not named in the media.

References

  1. ↑ "Fire death rates". Our World in Data. Retrieved 17 November 2019.
  2. ↑ Phillip L Rice, Jr.; Dennis P Orgill. "Classification of burns". UpToDate. Retrieved 14 October 2014.
  3. 1 2 3 Phillip L Rice, Jr.; Dennis P Orgill. "Emergency care of moderate and severe thermal burns in adults". UpToDate. Retrieved 14 October 2014.
  4. ↑ Eisen, Sarah; Murphy, Catherine (2009). Murphy, Catherine; Gardiner, Mark; Sarah Eisen (eds.). Training in paediatrics: the essential curriculum. Oxford: Oxford University Press. p. 36. ISBN   978-0-19-922773-0.
  5. ↑ Maguire, S; Moynihan, S; Mann, M; Potokar, T; Kemp, AM (December 2008). "A systematic review of the features that indicate intentional scalds in children". Burns. 34 (8): 1072–81. doi:10.1016/j.burns.2008.02.011. PMID   18538478.
  6. 1 2 3 4 Peden, Margie (2008). World report on child injury prevention. Geneva, Switzerland: World Health Organization. p. 86. ISBN   978-92-4-156357-4.
  7. ↑ National Burn Repository Pg. i
  8. ↑ Herndon D, ed. (2012). "Chapter 4: Prevention of Burn Injuries". Total burn care (4th ed.). Edinburgh: Saunders. p. 46. ISBN   978-1-4377-2786-9. Archived from the original on 2016-03-05. Retrieved 2016-10-26.
  9. 1 2 3 "Fire, Burns and Scalds Prevention". Safe Kids Worldwide. Retrieved 18 October 2014.
  10. ↑ Panté, Michael D. (2009). Advanced Assessment and Treatment of Trauma. pp. 192–194. ISBN   978-0-7637-8114-9 . Retrieved 19 October 2014.
  11. 1 2 "Burns". KidsHealth. Retrieved 13 October 2014.
  12. ↑ "Contact Burn Treatment". Burn Remedies. Archived from the original on 2014-09-22. Retrieved 18 October 2014.
  13. 1 2 3 Hettiaratchy, Shehan; Dziewulski, Peter (2004-06-12). "Pathophysiology and types of burns". BMJ: British Medical Journal. 328 (7453): 1427–1429. doi:10.1136/bmj.328.7453.1427. ISSN   0959-8138. PMC   421790 . PMID   15191982.
  14. ↑ "Pathophysiology of thermal burn injury". Civic Plus. 2007. Archived from the original (DOC) on 31 October 2014. Retrieved 26 October 2014.
  15. ↑ "Fire Safety Tips". Safe Kids Worldwide. Retrieved 18 October 2014.
  16. ↑ Eric D. Morgan; William F. Miser. "Skin burns". UpToDate. Retrieved 18 October 2014.
  17. ↑ "Burns and Scalds Prevention Tips". Safe Kids Worldwide. Retrieved 18 October 2014.
  18. ↑ "Pediatric Trauma: Management of Burn Injuries".
  19. ↑ "Burns". MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. Retrieved 19 October 2014.
  20. ↑ "Burn Triage and Treatment: Thermal Injuries". Radiation Emergency Medical Management. U.S. Department of Human and Health Resources. Archived from the original on 31 October 2014. Retrieved 19 October 2014.
  21. ↑ "Acute Thermal Burn Injury". Undersea and Hyperbaric Medical Society. Retrieved 26 October 2014.
  22. ↑ Phillip L Rice, Jr.; Dennis P Orgill. "Emergency care of moderate and severe thermal burns in adults". UpToDate. Retrieved 14 October 2014.
  23. ↑ "Burns and Fire Safety Fact Sheet". Safe Kids Worldwide. Archived from the original (PDF) on 24 October 2014. Retrieved 18 October 2014.
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