Thermal burns result from tissue exposure to an external heat source, and there are three main thermal burn mechanisms. (Walker, & King, 2022). Flash and flame burns occur due to direct or indirect exposure of a patient to a flame source, which resulted from a triad of an ignition source, an oxidizing agent, and a fuel source. (Walker, & King, 2022). Inhalation injuries may occur if patients are exposed to open flames in a closed setting. (Walker, & King, 2022). Scald burns result from exposure of the patient to high-temperature liquids. Grease burns and those due to hot oils are often much deeper than the initial examination suggests. Finally, contact burns occur from direct contact with a high-temperature object. Chemical burns are divided into acid or alkali burns. (Schaefer, & Szymanski, 2021). Alkali burns tend to be more severe causing more penetration deeper into the skin by liquefying the skin (liquefaction necrosis), while acid burns penetrate less because they cause a coagulation injury (coagulation necrosis). (Schaefer, & Szymanski, 2021). Electrical burns can be deceiving with small entry and exit wounds, however, there may be extensive internal organ injury or associated traumatic injuries. (Schaefer, & Szymanski, 2021).

The major factors to consider when evaluating the burned skin are the extent of the burns (usually calculated by the percentage of total body surface area (% TBSA) burned) and the estimated depth of the burns (superficial, partial thickness or full thickness). (Schaefer, & Szymanski, 2021). Rule of Nines – the head represents 9%, each arm is 9%, the anterior chest and abdomen are 18%, the posterior chest and back are 18%, each leg is 18%, and the perineum is 1%. For children, the head is 18%, and the legs are 13.5% each. (Schaefer, & Szymanski, 2021). Lund and Browder Chart is a more accurate method, especially in children, where each arm is 10%, anterior trunk and posterior trunk are each 13% and the percentage calculated for the head and legs varies based on the patient’s age. (Schaefer, & Szymanski, 2021). Palmar Surface – for small burns, the patient’s palm surface (excluding the fingers) represents approximately 0.5% of their body surface area, and the hand surface (including the palm and fingers) represents about 1% of their body surface area. (Schaefer, & Szymanski, 2021).

References

Clardy, P.F., Manaker, S., & Perry, H. (2022). Carbon monoxide poisoning. Retrieved from https://www.uptodate.com/contents/carbon-monoxide-poisoning?search=smoke%20inhalation%20children&source=search_result&selectedTitle=2~100&usage_type=default&display_rank=2

Schaefer, T.J., & Szymanski, K.D. (2021). Burn evaluation and management. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430741/

Walker, N.J., & King, K.C. (2022). Acute and chronic thermal burn evaluation and management. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430730/