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Chapter 31: Burns, Blast, Lightning, & Electrical Injuries
Burns
LTC Lee Cancio, MC, USA & 1LT Harold Becker, SP, USARIntroduction: Burns can be classified by their cause, as thermal (i.e., heat), flame, flash, contact (with a
hot radiator, etc.), scald (hot water, oil, or other liquid), chemical, electric (covered in Lightning and Electrical
Injuries section), or radiation (sunburn, x-rays, nuclear). Inhalation burn injury may occur with or without skin
injury, and may be life threatening. The depth of burn is often classified as first, second, or third degree
(see below). “Partial-thickness burns” refers to first- and second-degree burns, whereas “full-thickness burns”
refers to third degree burns. A burn of 20% of the total body surface area (20% TBSA) or greater is a
life-threatening burn (in the very young, very old, or those with serious medical diseases, 10% TBSA or more
can be life-threatening). These patients need IV fluid resuscitation and aeromedical evacuation, if possible.
Eschar (a layer of burned skin) will form at the site of injury. With time, the eschar will slough off and be
replaced with epithelium (new skin) if the burn is partial thickness, or with granulation tissue if the burn is full
thickness. Full thickness burns may eventually heal, particularly across the joints, by wound contracture. The
best definitive treatment for large open wounds is skin grafting.
Subjective: Symptoms
Painful, red skin without (1st degree) or with (2nd degree) blisters; or dry, charred, non-painful skin (3rd
degree), or a combination. May complain of hoarseness or coughing.
Objective: Signs
First-Degree Second-Degree Third-Degree
Typical causes Sun, hot liquids, brief Hot liquids, flash or Flame, prolonged contact
flash burns flame, chemical with hot liquid or hot
object, electricity, chemical
Color Pink or red Pink or mottled red Dark brown, charred,
pearly white, translucent with
visible, thrombosed veins
Surface Dry Moist, weeping, blisters Dry and inelastic
Sensation Painful Very painful Anesthetic
Depth Epidermis Epidermis and portions Epidermis, dermis, and
of the dermis possibly deep structures
Healing Few days Few weeks Skin grafting or slow inward
contraction of edges
Warning: Airway obstruction may present suddenly or gradually over a period of hours with: stridor, hoarse-
ness, coughing, carbon in the sputum or in the mouth, rapid or labored breathing, and finally respiratory dis-
tress.
Assessment:
Differential Diagnosis - dermatitis with erythematous or bullous features, abrasions, blast, other trauma.
Plan:
Treatment
Directed toward burns of 20% TBSA or greater, and those with inhalation injury. (For small burns, focus