BURNS: THERMAL/CHEMICAL/ELECTRICAL (ACUTE AND
Each year, more than 2 million burn injuries occur in the United States; approximately 100,000 people require hospital
care. Thermal burns, which are the most common type, occur because of fires, motor vehicle crashes, home fires, hot
liquid spills, electrical malfunctions, and war. Survival rates have risen because of newer treatments and skin barrier
development; however, moderate and severe burns account for many dollars spent on physical and psychological
Injuring agent can be flame, hot liquid, or contact with hot object. Flame burns are associated with
Occur from type/content of injuring agent, as well as concentration and temperature of agent.
Occur from type/voltage of current that generates heat in proportion to resistance offered and travels
the pathway of least resistance (i.e., nerves offer the least resistance and bones the greatest resistance). Underlying
injury is more severe than visible injury.
Superficial partial-thickness (first-degree) burns:
Involve only the epidermis. Wounds appear bright pink to red with
minimal edema and no blisters. The skin is often warm/dry.
Moderate partial-thickness (second-degree) burns:
Involve the epidermis and dermis. Wounds appear red to pink with
moderate edema and moist, weeping blisters.
Deep partial-thickness (second-degree) burns:
Involve the deep dermis. Wounds appear pink to pale ivory with
moderate edema and blisters. These wounds are dryer than moderate partial-thickness burns.
Full-thickness (third-degree) burns:
Involve all layers of skin, subcutaneous fat, and may involve the muscle, nerves,
and blood supply. Wound appearance varies from white to cherry red to brown or black, with blistering
uncommon. These wounds have a dry, leathery texture.
Full-thickness (fourth-degree) burns:
Involve all skin layers plus muscle, organ tissue, and bone. Charring occurs.
The following adult patients are admitted for acute care and during the rehabilitation phase may be cared for in a
subacute or rehabilitation unit: those with partial-thickness burns more than 15% total body surface area (TBSA) or
whose age is considered high risk (older than 65 years of age); full-thickness burns more than 2% of TBSA; burns of
face, both hands, perineum, or both feet; or inhalation and all electrical burns.
Fluid and electrolyte imbalances
Metabolic acidosis (primary base bicarbonate deficiency)
Psychosocial aspects of care
Respiratory acidosis (primary carbonic acid excess)
Total nutritional support: parenteral/enteral feeding
Upper gastrointestinal/esophageal bleeding
Patient Assessment Database
Data depend on type, severity, and body surface area involved.