Burn injuries are one of the global disease burdens, as post-burn trauma greatly impacts patients’ quality of life. In Vietnam, the situation of burn accidents is increasingly complex and is creating significant economic pressure on healthcare services, especially since 80% of burn victims live in low-income families and 70% are concentrated in rural mountainous areas.
To prevent burns and dangerous complications, while minimizing the cost of burn accident care, everyone needs to equip themselves with basic knowledge about burns: from causes of burns to burn degrees, from timely burn treatment to effective wound care solutions…
In this article, Urgo Medical will summarize common medical knowledge about burns for readers’ easy reference.
I. What is a burn? Classification of burn degrees
Burns (also called scalds) are common accidents in both wartime and peacetime, which can take human lives or leave serious sequelae such as loss of work ability, disability…
1. Definition of burns
According to Steven E. Wolf, MD, University of Texas – Southwestern Medical Center: Burns are injuries to the skin or other tissues caused by contact with heat, radiation, chemicals, friction, or electricity.
This is an acute injury to the body, but not just a simple burning sensation; burns can cause serious damage to the skin, harming and altering the structure of the skin or its components.
The danger of burns is not only due to the destruction of the protective outer skin layer but can also cause systemic disorders.
2. Classification of burn degrees and symptoms for each type
There are two common ways to classify burn injuries: by depth and by burn surface area. Specifically:
2.1. Classification of burns by depth
Currently, most burn institutes in Vietnam classify burn injuries into two groups: superficial burns (grades I, II, III) and deep burns (grades IV, V). Specifically:
- Grade I Burns
Also called localized superficial burns, injuries are limited to the outer epidermis with symptoms such as redness, pain, swelling, but no peeling. This is the mildest degree of burn, least severe, usually healing within 7-10 days, and patients can self-treat wounds at home.
- Grade II Burns
These are localized deep burns affecting part of the dermis and usually take about 3 weeks to heal. Compared to grade I burns, grade II burns are more severe with symptoms like blisters, pain, redness, and watery blisters…
- Grade III Burns
This is a full-thickness burn with deep and severe injuries causing major damage. Signs of grade III burns include large blistered areas, temperature contact areas turning white, with patches of dark brown scorched skin.
Not only affecting the surface and outer skin layer, grade III burns extend widely to the extent that pain may not be felt. Without timely treatment, severe muscle contractures or dangerous sequelae may result. Patients with grade III burns need to be treated at medical facilities to avoid complications.
- Grade IV Burns
Grade IV burns are deep burns, involving the full thickness of the skin, injuring the epidermis, dermis, and subcutaneous layers, and cannot heal by themselves as there are no epithelial components remaining.
- Grade V Burns
This is the most severe burn condition, with injuries extending to subcutaneous layers, nerves, blood vessels, bones, joints, and internal organs. Examination may reveal exposed tendons, muscles, and bones.
2.2. Classification of burns by surface area
This classification is based on the percentage of total body surface area (TBSA) burned. The larger the burn area percentage, the higher the risk of systemic complications, more severe, and possibly fatal.
Below is the classification of burn severity based on burn area, burn location, injuries, and accompanying chronic diseases:
| FEATURES | SEVERE BURN | MODERATE BURN | MILD BURN |
| Burn area | >= 25% | 15-25% | <15% |
| Deep burn area | >= 10% | 2-10% | <2% |
| Deep burn on neck, hands, feet, perineum | + | – | – |
| Respiratory burns | + | – | – |
| Associated injuries | + | – | – |
| Chronic diseases | + | – | – |
II. Causes of burns and burn stages
To prevent burns, we need to recognize the causes and avoid these risks.
1. Common causes of burns
There are many causes of burns, but domestic accidents account for 60-65%, occupational accidents about 5-10%, 2% from traffic accidents, and less than 1% from radiation therapy or hot compresses…
Common burn agents include:
– Thermal burns (heat):
+ Dry heat (oxygen, gas, gasoline, wood, cigarettes, friction, motorcycle exhaust pipes, hot solid objects…)
+ Wet heat (steam, hot oil, boiling water, asphalt…)
+ Cold burns (very cold metals, liquid oxygen, liquid nitrogen at -190°C…)
– Electrical burns: high voltage, low voltage, lightning strikes.
– Chemical burns: strong acids (H2SO4, HF…), strong alkalis (NaOH, KOH); heavy metal salts and similar substances like KMnO4…
– Radiation burns: strong ultraviolet lamps, radioactive sources, lasers, ultraviolet rays, infrared rays, gamma rays, X-rays, beta particles…
Among these burn agents, wet heat is the most common in children, while dry heat and chemical burns are more frequent in adults. For electrical burns, the rate is similar between adults and children.
2. Burn stages
Depending on the cause and severity, patients may experience the following stages:
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Stage 1: First 48 hours – Burn shock
– Patient vomits, feels nausea, moans, sweats, cold extremities, becomes weak due to pain.
– Patient develops wound edema, low blood pressure, rapid weak pulse, and becomes weak due to reduced circulating volume.
– Blood tests show acidosis, decreased alkaline reserve, blood concentration, increased potassium and creatinine.
– Brain, kidney, liver… are affected due to burn shock.
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Stage 2: From 3 to 15 days – Septicemia and acute infection
– Toxicity from liver and kidney disorders after burn shock or absorption of toxins from destroyed tissues.
– Patient has high fever from 40-41°C, purple mottled skin and coldness, drowsiness, agitation, reduced consciousness, rapid shallow breathing, respiratory disorders, possibly coma.
– Blood tests show electrolyte disturbances, concentrated blood, acidosis, reduced proteins, increased urea and creatinine.
=> For mild burns, this is the healing and scarring stage, but for deep burns, this stage is highly fatal and requires good local treatment.
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Stage 3: Septicemia
If the patient passes the burn shock stage, 70% of severe burn cases die in stage 3. At this stage, common bacteria such as Pseudomonas aeruginosa, hemolytic streptococcus, Staphylococcus aureus, and tetanus can cause local wound infection and sepsis.
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Stage 4: Recovery or exhaustion
This is the stage where the burn wounds heal and scars form, organs gradually recover, and metabolic and nutritional disorders return to normal if treatment is good (usually 30-45 days).
However, with poor treatment or severe burns, patients may gradually become exhausted and die.
III. Burn management and treatment methods
Early burn management limits damage as much as possible. So what should be done when burned?
1. Immediate burn care (first aid)
– Quickly eliminate the cause of the burn such as cutting off electrical circuits, extinguishing fires…
– Remove all items that could constrict such as belts, shoes, rings…
– If clothing still causes burns, cut it off with scissors. Do not pull or peel clothing as it may stick to the burn wound and cause pain.
– Immerse the burn area in cold water (10-25°C) or run under cold water for 15 minutes.
– Cover the burn area with sterile dry gauze, such as Urgo Medical gauze. If not available, use clean clothes to cover and take the patient to the nearest medical facility.
– Morphine 1% can be used for pain relief (except for respiratory burns).
– If burns affect the face, neck, or head and circulation stops, perform external cardiac massage and artificial respiration. If possible, establish intravenous access on healthy skin or near the injured area.
– Do not apply medicine or burst blisters. Keep the victim warm.
2. Burn treatment at hospitals
– For mild burns: Doctors may provide outpatient burn care using wound care methods, antibiotics, painkillers, and tetanus prevention.
– For moderate or severe burns: Patients require systemic treatment (respiratory support, shock management) followed by wound treatment. Burn treatment steps include:
+ Infection control, reduce friction, limit plasma loss to promote healing.
+ Use isotonic saline to clean burn wounds.
+ Debridement if black necrotic skin is present.
+ Dress the burn with advanced dressings like UrgoTul, UrgoTul Ag, UrgoClean Ag.
For deep burns, surgical debridement and skin grafting may be performed…
V. Burn treatment solutions and fast wound healing care to minimize pain
To speed up healing, reduce infection risk, and minimize pain during dressing changes, medical experts recommend selecting appropriate dressings for burn wounds. Traditional dressings tend to stick to the wound bed, causing epidermal peeling and extreme pain during dressing changes.
One of the new generation dressings trusted by doctors and nurses is Urgo Medical’s products applying the proprietary Technology Lipido-Colloid (TLC) proven clinically on over 54,000 patients.
This technology has revolutionized wound care and treatment, helping patients heal quickly without enduring pain during dressing changes. Especially, the product UrgoTul mesh dressing is suitable for grade I burns and common home burns such as cooking burns, motorcycle exhaust burns…
The introduction of TLC technology shortens healing time and reduces care burden and treatment costs of burn injuries.
Currently, Urgo Medical products are available at over 150 hospitals and 2,000 pharmacies nationwide. Patients and relatives can buy directly at pharmacies or order dressings online via eDoctor, Long Châu, An Khang to receive products and care for burn wounds at home.
REFERENCES:
- Pham TN, Cancio CL, Gibran NS: American Burn Association practice guidelines for burn shock resuscitation. J Burn Care Res J 29 (1): 257-266, 2008. doi: 10.1097/BCR.0b013e31815f3876.
- Kagan RJ, Peck MD, Ahrenholz DH, et al: Surgical management of burn wounds and use of skin substitutes: Expert panel white paper. J Burn Care Res 34:e60–79, 2013. doi: 10.1097/BCR.0b013e31827039a6.
- International Society for Burn Injury (ISBI) Practice Guidelines Committee: Steering Committee; Advisory Committee. ISBI Practice Guidelines for Burn Care. Burns 42(5):953-1021, 2016. doi: 10.1016/j.burns.2016.05.013.
- Steven E. Wolf, MD, University of Texas – Southwestern Medical Center (MSD Manual – Professional version) https://www.msdmanuals.com/en/professional/critical-care-toxicology/burns/burns