1. Thermal Burns
Thermal Burns Overview
From simple sunburn on vacation to touching a hot pot on a stove, many of us have
experienced minor burns at one time or another. Thermal burn injuries are very
common. Annually, 500,000 people receive medical treatment for burn injuries.
Children are particularly at risk due to accidental burns.
The type of burn and the severity of the burn depend on the number of layers of skin
affected. Most burns are mild, but some may be severe. Most importantly, 75% of
burns are estimated to be preventable.
Thermal Burns Causes
You may get burned from any hot or heated source or from chemical reactions that
• Thermal burns
o Scald (from steam, hot or molten liquid)
o Contact (from a hot object, such as a hot cooking pan)
• Electrical burns
• Radiation burns (sunburn, medical radiation treatment for cancers, welding
• Chemical burns
Thermal Burns Symptoms
All thermal burns (from fire or flame) cause an injury to the different layers of the
skin. The type of burn and the severity of the burn depend on the number of layers
of skin affected.
Traditionally burns were described using the word degrees (first, second, and third).
Now most doctors describe burns as to their thickness (superficial, partial, and full).
The skin is made up of three important layers:
1. the epidermis (or the outer layer),
2. the dermis, and
3. the subcutaneous tissues.
2. Each corresponds roughly to the types of burns. (It is important to note that many
burn injuries may include all three types of burns at the same time.)
• Superficial burn or first degree burn: This burn involves only the
epidermis, the outermost layer of the skin. Most people are familiar with this
burn in the form of sunburn.
o Symptoms and signs – Painful, red, area turns white when touched, no
• Partial thickness burn or second degree burn: This burn involves the
epidermis and some portion of the dermis, the second layer of the skin. This
type of burn may be further categorized as superficial or deep, depending on
how much of the dermis is involved.
o Superficial symptoms and signs – Painful, red, area turns white to
touch, mottling, blisters, moist, hairs still present
o Deep symptoms and signs – May or may not be painful (it may be so
deep that nerve endings may be destroyed), may be moist or dry (so
deep that sweat glands are destroyed), may or may not turn white
when area is touched, hair is usually gone
• Full thickness burn or third degree burn: This is the most severe burn.
The burn involves all of the epidermis and dermis—the first two layers of the
skin. Nerve endings, tiny blood vessels, hair follicles, and tiny sweat glands
are all destroyed. If very severe, the burn may involve bone and muscle.
o Symptoms and signs – Painless, no sensation to touch, pearly white or
charred, dry, may appear leathery
When to Seek Medical Care
Seek emergency medical care if you have any partial or full thickness burn that
involves the genitals, eyes, ears, hands, or feet, or burns over major joints
regardless of size. Also seek immediate medical care for the following burns:
• Any full thickness burn, for example, that looks dry, is painless, or looks
• Any partial thickness burn that is more than twice the size of your palm
• If pain is uncontrollable
• Call 911 for emergency medical transport in these cases:
3. o If there are extensive partial thickness or full thickness burns to the
o For any problems breathing with burns to the face
o With a large amount of smoke exposure in a closed room
o If a person is unconscious after he or she has sustained a burn
• If you need to update your tetanus shot, your doctor can check your medical
records or if you have any questions about burn care, call your doctor.
Exams and Tests
At the hospital, the doctor will take a history and perform a physical examination to
determine the extent and severity of the burn.
• In determining the extent of the burn, the doctor may use a tool called the
"Rule of Nines." This tool is a formula that divides the surface area of the
body into sections, each roughly 9%. Determining the amount of surface area
burned helps the doctor decide on treatment of the burn.
• No special diagnostic tests are needed.
• The doctor will determine whether the burn or burns are superficial, partial
thickness, or full thickness and begin treatment appropriately
Thermal Burns Treatment
Self–Care at Home
The most important first step is to stop the burning process.
• Put out any fire or flames (the common advice is to 'stop, drop, and roll' to
put out flames on your clothing). Remove hot or burned clothing, if possible,
or stop contact with the hot steam, liquid, or a hot object.
• Cool the injured area with water (not ice) within 30 seconds. This may limit
the extent and severity of the burn. Run your burned hand or finger, for
example, immediately under cool tap water for several minutes.
Control the pain.
• Apply a cool wet compress for pain relief. Do not use ice. This may worsen the
injury to the skin.
• Other common remedies, such as butter or mayonnaise have not been proven
to work; and may increase the chance of infection.
4. • You may also use acetaminophen (Tylenol) or ibuprofen (Advil) for pain as
directed on the bottle.
Begin the healing process.
• For small burns and burns that are superficial in nature, you may use a triple
antibiotic ointment. This will aid in healing and limit the chance of infection.
• Do not remove blisters at home, especially those on the palms of the hands or
on the soles of the feet.
Depending on the nature and severity of the burned area, these treatments may be
• Gentle cleansing may be performed of the burned area.
• Blisters will be cared for. Some doctors may debride blisters (cut away dead
tissue). Others may leave them intact. There is no right or wrong approach.
Blisters on the soles of the feet or palms of the hands will usually be left
• Depending on the extent of the burn, the doctor may order fluids to be taken
by mouth or to be administered by IV.
Also, depending on the severity and extent of the burn, the doctor may advise or
request that care be continued at a special Burn Center. Specific criteria exist for
such cases and have been established by the American Burn Association. Criteria
may include any full thickness burn greater than 5%; partial thickness burn greater
than 20% in people between ages 10–50; any partial thickness burn greater than
10% in children younger than 10 years and older than 50 years of age; any
significant burns to the ears, eyes, hands, feet, or genitals.
• Topical antibiotic ointment may be applied. This may be a triple antibiotic
ointment, such asNeosporin, Bacitracin, or Silvadene (a topical antibiotic
commonly used for burn care).
• Pain medication – The doctor may tell you to use ibuprofen or acetaminophen
if the burn is minor and the pain is mild. If pain is severe, the doctor may
prescribe a narcotic pain reliever.
• Tetanus update