What are the degrees of burns and how to treat them safely?

Burns are a major injury risk for all ages.

Children under the age of 5 are particularly at risk as they are restless, curious and will have an accident once or twice. Therefore, it is always important to think ahead and prevent this risk. It can leave permanent effects on the skin in the form of unsightly scars.

What is a sunburn?

A burn has the Latin name combustiones. It is one of the injuries caused by physical or chemical action.

Physical effects include excessive exposure to heat energy causing burns, but also excessive exposure to cold energy causing frostbite.

Physical effects include: electrical burns, radiation (ultraviolet, infrared), ionising, X-ray and radioactive radiation.

Chemical influences, when applied to the skin or mucous membranes, can also cause changes similar to excessive heat, which is called scalding.

Classification of physical and chemical burns (table)

Skin and types of burns

The skin is the largest organ of the human body.

The skin of an adult has an area of 1.6 to 2 m² and weighs approximately 13 to 15% of the body weight.

In a burn, significant pain is a good sign because it occurs only in superficial burns. In deep burns, the nerve endings are damaged and the burn is almost painless.

Burns are one of the most common injuries. Fortunately, they are overwhelmingly minor. About half of people with these types of burns don't even seek medical attention.

Burns occur at all ages

Types of burns

• Scalding - caused by scalding by a hot liquid
• Contact - by touching a hot object
• Chemical - acid burn
• UV radiation
• Inhalation - by inhalation of hot gases, which is often associated with burns in the facial area
• Burn by direct fire
• Explosion
• Electrocution
• Frostbite
• Radiation

Degrees of burns

As the extent of the burn, which affects a larger part of the body surface, increases and its depth increases, the severity of the burn also increases.

The deeper the burn, the worse the prognosis.

Table for grading burns by degree

Time course of severe burns

Severe burns and their treatment have a time course:

Stage 1: Immediate

Urgent care is required and takes 3 to 4 days.

During this period, the burn victim is admitted to the burn anaesthesia and resuscitation ward where he/she receives emergency care.

In severe cases, he is placed on artificial pulmonary ventilation. He is given nutrition, painkillers, drugs to dilate the blood vessels to improve blood flow to the fibroids for the best possible blood supply to the body, the necessary drugs required by the condition, antibiotics, prevention of thrombosis and the development of a stress ulcer.

Regular dressings are performed and burned areas are treated.

Stage 2: Acute

Lasts 2 to 3 weeks. Surgically, wounds are treated to encourage the formation of new skin tissue, with overlapping areas.

Phase 3: Recovery and rehabilitation phase

During this phase, reconstructive plastic surgery is performed and rehabilitation and psychological support is required.

How the burn is formed and its development

Tissue damage due to thermal energy contributes to:

Direct damage from excessive heat

Immediately after an excessive heat injury, effects on the tissues of the human body can be observed in the form of damage to the skin and its deeper tissues.

Excessive heat causes the leakage of proteins from cells, leading to their death.

The depth of tissue damage depends on the temperature, time and thermal conductivity at the site of the affected tissues.

The depth to which excessive temperature penetrates depends on the thickness of the skin and its hydration.

The thinner the skin at the site of the burn, the deeper it penetrates. It causes damage, even death. If the skin is poorly hydrated, which is often the case in the elderly, excessive heat penetrates more rapidly into deeper tissue structures.

Tissue damage

Early damage occurs on the first to third day after injury.

The healing process of burns is triggered by an inflammatory reaction at the site of the injury. This can disrupt surrounding tissues that have not been damaged by the burn.

Care must be taken during this period to reduce the risk of damage to healthy tissues from this inflammatory reaction. It is necessary to stop the progressive inflammation and cover open wounds with skin substitutes.

Delayed damage after the third day

Tissue damage involves a continuing inflammatory reaction taking place in the tissues. It is caused by tissue death, penetration of bacteria into the wound, damage, irritation of the skin.

Slowed healing and increased collagen secretion may occur, leading to excessive scar formation.

This can be prevented by timely removal of dead tissue and wound cleaning with an attempt to temporarily cover the wound as soon as possible.

Ischaemic tissue damage at the burn site when the vascular supply is disrupted

Impaired blood flow due to circulatory instability can also contribute to tissue damage. This often occurs in burn shock and leads to inadequate blood supply to organs and systems in the body.

Read:
Shock: what is the medical term shock, what are its causes, types and stages?

Another reason for inadequate blood supply is swelling at the site of the burn, which prevents microcirculation of blood.

There may also be minor blockages of blood vessels around the superficial burn. This causes inadequate blood supply to the deeper layers and tissue necrosis.

First aid for burns

First aid refers to efforts to provide rescue and mitigate the effects of the injury, either by self-help or by persons close to the casualty.

Read:
What is first aid for burns in children? (+what helps )

How to proceed and provide first aid in the most effective way:

Recognize how the burn was caused: by exposure to excessive heat, thermal energy transfers to the tissues and damages them.

If the tissue is heated above the critical temperature of 45 °C, the cells are damaged.

If the temperature does not exceed 56 °C, the cell damage is reversible. With rapid intervention of help and cooling of the burn site, the cells are able to maintain their viability, increasing the chance of tissue recovery.

If the temperature in the tissues exceeds 56 °C, the cells are irreversibly damaged and die.

The key to first aid is to cool the burn site as quickly as possible. This is the fastest way to remove heat from the tissues.

Principles of first aid

The most effective and affordable way to cool burns is to use cold water and cool the burn site.

Place the burn, if possible, under running cold tap water. Leave it on for at least 15 minutes.

If tap water is not nearby, use other available water options to cool the burn, i.e. well water, stream water, rainwater.

In this case, although there is a risk of wound infection, medications are available to eliminate any inflammation. Unlike deep tissue and cell damage caused by heat, inflammation is a reversible condition.

Cooling pads filled with gel, cooling sheets can also be used for cooling.

The first aid treatment for burns is similar to that for other injuries. Burns also have their differences, which are:

Carrying, taking the casualty out of the threatening environment, taking care of one's own safety and not endangering one's own life.

• Extinguishing clothing and cooling the burn site. Rolling the casualty to the ground and extinguishing the fire by covering with a low-flammable blanket or rolling on the ground, using water to extinguish the fire. Always prevent the burning person from escaping. Escaping will give air to the fire and fan it.
• Escape from the burning environment by walking on the ground and protecting your airway from the smoke. Smoke from a burn damages the respiratory tract when inhaled. When escaping the room, it is best to wrap yourself in low-flammable materials, certainly not synthetic!!! You can soak towels in water and cover yourself with them. Wet handkerchiefs provide excellent protection from the heat. A soaked drape to cover your face to breathe is effective in trapping solid smoke particles.
• Most toxic substances are lighter than air and rise upwards. It is therefore important to crouch down where the air is cooler and easier to breathe.
• Assess the casualty's condition and vital signs. Make sure he is conscious and breathing. Start cooling the burned areas as quickly as possible. If he is not breathing, start CPR immediately and call the emergency services.

Read also:
Carbon monoxide and carbon monoxide poisoning: how does it manifest itself and what are the risks?

Burns and their treatment

• Cool the burn immediately with cold water (not ice water or ice) for at least 10 to 15 minutes. Ice could cause further tissue damage.
• Carefully remove clothing near the burn, unless it is stuck to the skin. Remove rings, bracelets as soon as possible until the limb begins to swell.

If clothing is stuck to the burned skin, do not remove it, you could damage it further.

• Protect the burned area from contamination. Cover it with a clean cloth (towel, sheet) or bandage. However, never cover the area with a material that has fine hairs, such as cotton wool, a furry blanket.
• Cover the wound and take precautions against hypothermia by covering to keep the sufferer warm.
• Do not apply any ointments, oils, creams or other preparations such as egg white to the burn.
• Provide anti-shock measures:
  1. Silence
  2. Heat
  3. Pain relief
  4. Transport
  5. Fluids

Electric shock

Do not touch the victim until the power is turned off. Otherwise, you could be shocked as well.

In the event of poisoning

If you are helping someone who has spilled a corrosive, be careful. Wear protective equipment to avoid touching the chemical and causing burns to yourself. Wear protective clothing, preferably gloves.

Remove contaminated clothing from the affected body.

Rinse the burned area with a longer rinse of running water to remove the caustic substance.

Sunburn

In summer, it often happens that one forgets and does not protect the skin with sunscreen. The pleasant sunny summer weather beckons you outside, to the water. Being in direct sun, especially at lunchtime, can easily end up with a skin burn.

Sunburned skin is hot, red and painful.

Move immediately to the shade or indoors to avoid further exposure to the sun.

Cool the skin with a cool shower or lukewarm bath for at least 10 minutes to cool the sunburned skin.

Apply an after-sun cream to moisturize, cool and soothe the skin. Do not use oily products that are not designed for sunburned skin.

If you are in pain, take painkillers such as paracetamol or ibuprofen.

Drink plenty of fluids.

Read also:
Heatstroke, sunburn, summer, heat, health. Do you know the difference between them and what the symptoms are?

Burning with hot water, liquid or steam

A burn caused by something moist, such as hot water or steam, is called scalding.

Scalding is most often accidental.

You have probably been scalded by hot water, for example, while making tea, coffee or hot soup.

It is very dangerous to leave children, especially young children under 5, unsupervised near boiling water.

Many scalds occur in infancy. A child accidentally splashes boiling water when he or she accidentally pulls a pot off the stove, for example.

They are also dangerous for older people who have slow reflexes and motor problems. For example, a kettle full of boiling water may fall out of their hand.

Scalding with hot water causes pain. It can also damage tissues and cells. If the skin is scalded over large areas, thermal shock can occur, which can be life-threatening, especially for children.

What should I do after scalding with water or steam?

Remove contact with boiling water or steam as soon as possible.

If you have been splashed, remove your clothing immediately unless it is stuck to your skin.

Soak the affected area immediately under running cold water for at least 20 minutes.

If the burn has affected a large part of the body, cover it with a wet bandage or clean wet cold sheet. Do not immerse yourself in a cold bath, which may cause loss of body heat.

Remove all jewellery and objects and clothing that is not stuck to the skin.

Don't peel off the stuck part of the clothing, don't tear it. Otherwise you could damage the skin even more.

How to calculate the extent of the burn?

The approximate extent for minor burns is calculated using the open hand rule.

The size of one hand of the burn victim is also valid for children and is one percent (1%).

For larger burns, it is determined by the Wallace-Pulaski rule - rule 9 as a percentage of body surface area.

Rule number 9 applies to adults only!

Each burned body part corresponds to 9% of the area.

• Head and neck - 9%
• Front of chest - 9%
• Back of chest - 9%
• Front of abdomen - 9%
• Back - 9 %
• One upper limb - 9 %
• One lower limb - 9 %
• Sexual organs 1 %

Table of the extent of burns in adults and children according to Lund-Browder

The extent of burns is divided into small and large burns.

• Minor burns account for less than 15% in adults and less than 10% in children.
• Extensive burns account for 15 % or more in adults and 10 % or more in children.

The severity of burns is judged by the extent and depth of the burns, the auxiliary criteria being:

• age
• cause of burn
• the site of the burn
• associated diseases and injuries

The severity of burns is classified as:

• Minor - mild
• Moderate - Moderately severe
• Severe
• Critical

Burn severity classification table

Read also:
Burns: do you know the grades, symptoms and risks?

Treatment of burns

Minor minor burns are treated in doctors' offices, surgical or trauma clinics.

Moderate burns require hospitalisation and are treated at a local hospital.

Severe and critical burns are taken to burn centres where they receive highly specialised care.

Light and moderate burns are also referred to burn centres when complications occur, when patients are at risk and when treatment fails.

Treatment of minor burns at home

• Grade I and II burns that are no larger than 3 cm can be treated at home.
• Grade I burns are more common in everyday life. They only cause damage to the upper layer of the skin. It is painful, red and may blister. Their healing time is approximately one to two weeks.
• The best treatment for burns is cooling with cold water for at least 20 minutes.
• Disinfect the burn with an alcohol-free disinfectant.
• Use cool compresses by applying them for 5 to 15 minutes.
• The use of aloe vera is very helpful in healing grade I and II burns.
• You can use antibiotic ointment on the burn with a doctor's prescription.

Small burns

All small burns where there is surface disturbance need to be properly medically treated and diagnosed. Even small burns can lead to complications and permanent consequences if not treated properly or adequately.

Precautions for minor burns

• When a burn occurs, try to cool the burn site as quickly as possible, preferably under running cold tap water, by applying cold wet compresses. Cooling also reduces the soreness of the burn.
• Do not cool the burn with ice, as frostbite and tissue damage could occur.
• If your hand is burned, try to remove the ring or tight objects (bracelet, watch) immediately before swelling develops.
• A correct diagnosis and determination of the depth of the burn is essential - whether it is only a superficial burn or also a deep burn.
• To treat a superficial burn without breaking the skin, it is necessary to use antibacterial disinfectants and cover the wound with a sterile drape.

The care of a burn blister depends on its size and whether it has been broken.

• Never puncture the blister yourself or try to break it. The fluid in the blister protects it from infection. If you puncture it with something sharp, such as the tip of scissors that are not sterile, you will bring infection directly into the wound.
• If they have only burst and the fluid has leaked out without opening and contaminating the wound, just cover them sterilely with oily tulle, which prevents the skin from sticking to the dressing, and cover them with gauze.
• If the skin is broken and the blister is open, the wound can be covered with a temporary covering.
• After the burn has cooled down, if it is not open and without a blister, you can apply a cream with aloe vera. This will prevent the skin from drying out.
• Cover the burn with a sterile dressing, not cotton wool. The dressing protects the skin, a slight tightening will relieve the pain and also protect the skin with blisters.

Small deep and inveterate burns

• For grade IIb burns, disinfection and the use of antibacterial agents is always necessary.
• For deeper burns that take more than 3 weeks to heal, surgery should be considered.
• If healing takes longer than 3 weeks, there is a risk of hypertrophic scar formation. At the first signs of scar formation, compression therapy, silicone sheets and creams are used to reduce the risk of hypertrophic scar formation.

Burn disease

You may have heard of burn disease or burn syndrome.

This is a condition that occurs in all extensive burns. It is a complex of overall symptoms resulting from an extensive burn.

There are three periods in burn disease. They progress from one to the next and are characterized by a set of symptoms.

1. Immediate period

Begins with a burn in which burn shock develops and circulation is unstable. Vital signs may be impaired, putting the patient at risk of death.

The patient is treated in an intensive care unit or resuscitation unit. He is monitored and his vital signs are supported.

During this period, a defect occurs in the small veins through which fluids from the bloodstream pass. Swelling occurs.

This period usually lasts 24 to 72 hours before blood circulation is restored and stabilized and before the patient's shock state is removed.

2. Acute period

Begins with the resolution of shock. It lasts until part of the open burn wound can be covered or the wound heals.

This period lasts several days, weeks or months.

During this time, sufficient organ and system function is ensured, and medication is given to prevent and treat infections and other complications. This includes overall intensive care of the burn wound.

For deep burns, surgical interventions are performed during this period. During these, dead tissue is removed and the wounds are covered with temporary or definitive covers.

3. Restitution and rehabilitation period

This lasts for several months to years, following healing of the wound or after most of the wound has healed.

During this period, the patient begins rehabilitation aimed at practicing posture, walking and returning to self-sufficiency.

Once he or she has mastered self-sufficiency skills such as independent eating, independent hygiene, and dressing, he or she may be discharged home.

Deep and extensive burns leave unsightly permanent effects in the form of scars and contractures. In some cases, they prevent adequate movement of, for example, the limbs.

This period requires both long-term wound care and prevention of hypertrophic scarring by sufficient dressing, wound massage, compression therapy, silicone preparations and rehabilitation.

Reconstructive plastic surgery is performed to alleviate permanent sequelae.

For more information on burn scar care, see our article:
Skin scars: what causes them + what are the treatment options?

What not to do after a burn

Do not paint the burn!!!

• Butter, which can be full of bacteria and cause an unpleasant infection of the burned skin.
• Oil of any kind - coconut, olive or other vegetable oil or lard will cover the burn and keep the heat in. To treat a burn that is already healing nicely and not healing, you can use a burn massage with lavender oil, for example.
• Egg whites can contain bacteria and cause an infection or even an allergic reaction.
• Toothpaste is drying and not sterile. It can not only irritate the burn, but also promote infection.
• Ice constricts blood vessels. It can cause tissue damage, irritate the burn and cause frostbite.

Suitable preparations for burns

You can use a variety of products available for burns.

Covering burns

If the burn is more extensive or higher than a grade 1, a visit to the doctor and follow-up and treatment of the burn wound is necessary.

Disinfect the wound with an alcohol-free disinfectant. Betadine solution is suitable if you are not allergic to iodine. Betadine does not sting or burn the wound.

• The basics of burn care are: take care of the burn and cover it with sterile preparations such as pads, ointment-containing compresses, which are sterile and do not traumatise the wound.
• They do not stick to the skin due to the ointment contained in the cloth. When they are changed, the skin is not damaged or torn, which could cause further complications. Another option is oily tulle containing silver for superficial wounds.
• For wetting burns, you can use an absorbent hydrocolloid dressing, which you apply to the wound after disinfection. This will absorb the exudate from the wound
• Hydrogel dressings are specifically designed for grade I and II burns. They heal the wound thanks to the moist gel, absorb wound secretions, are gently cooling, breathable, yet do not let water or bacteria into the wound. They can be left on the wound for 7 days.
• There are also collagen coverings, sterile alginate coverings, various absorbent coverings that absorb exudate, leave the wound clean and have good skin regenerating capabilities.

Creams and ointments for superficial burns

• To speed up healing, you can try a spray with hyaluronic acid or in cream form (cicatridine).
• Ointments for first-degree burns leave the wound oily, do not dry it out and promote faster healing.

Herbal oils and gels suitable for superficial burns

For superficial burns, you can try natural oils or gels. Apply them to burned skin that is whole, free of blisters and wounds.

Suitable oils are: aloe vera, St. John's wort oil, geranium oil, macadamia oil, nimba oil, baobab oil, moringa oil, avocado oil, jojoba oil, turmeric oil and others.

A decoction prepared from herbs to apply to burns

• Honey can also be used on minor 1st degree burns as it is anti-inflammatory, antibacterial and antifungal.
• Calendula helps to regenerate damaged skin.
• Chamomile is disinfectant, promotes wound healing and prevents scar formation.
• Comfrey is anti-inflammatory and regenerates the skin.

There is a lot of old wives' advice on the internet about treating burns. It is important to note that most of the advice only applies to small, mild first-degree burns where the skin is intact and undisturbed.

Once the skin barrier is broken and blistering occurs, there is a high risk of introducing infection into the burn wound. This can lead to various complications in the form of suppurative inflammation, delayed healing, and scar formation.

Therefore, larger and deeper burns belong in the hands of doctors. It is not advisable to try various home alternatives for their treatment if you want to avoid complications and unpleasant healing resulting in scarring of the skin.