Chapter 20: Acute Burn Management

Incidence of Burn Injuries

The incidence of burn injuries in the United States and Canada is 1.55 million injuries per year (Box 20.1). Many, including the authors of this chapter, feel that this number is grossly underreported. The majority of the fatalities associated with burn injuries occur before rescue personnel can extricate victims from homes, buildings, or motor vehicles. It has been reported that 75% of burn injuries occur in or around the home. A summary of burn etiologies is presented in Table 20.1.

One disturbing fact is that approximately 70% of all burn injuries remain in the category of accidental and, possibly, preventable. Regardless of how small the area injured, the traumatic events of the accident are branded on the victim's body and in the memory of the responsible party forever.

Burn Care Facilities

The vast majority of minor burn injuries are treated with Neosporin^® and an adhesive bandage without evaluation by a licensed health-care professional. Emergency rooms and pediatrician's offices examine and either treat or refer burn injuries to wound care specialists. Those referrals will depend upon the severity of the injury. The American Burn Association outlined specific criteria necessitating referral to burn centers as a means to aid the evaluating physician. Box 20.2 lists these transfer criteria.

Anatomy of Skin

Chapter 1 (and other chapters) has already clearly defined the anatomy of the skin. Common sense and science tell us that burn depth is directly related to the temperature of the offending agent and the duration of contact or exposure. Children and the elderly have much thinner skin than adolescents and young adults. Thus, these groups will have different reported burn depths from the same hot bowl of soup spilled onto their laps. To further complicate the situation, the thickness of human skin will vary from one anatomical site to another. The skin of the upper eyelids is obviously thinner than the skin of the back.