Thermal burns are one of the most common types of injuries, often caused by exposure to heat sources such as fire, hot liquids, steam, or heated objects. The severity of these burns ranges from mild to life-threatening, depending on the duration and intensity of the heat exposure. Understanding thermal burns, their causes, symptoms, and the appropriate first aid responses is crucial, especially in emergencies. This guide will provide a comprehensive overview of thermal burns to help you manage them effectively.

What is a Thermal Burn?

A thermal burn is an injury caused by exposure to high temperatures that damages the skin and underlying tissues. These burns occur when the skin comes into direct contact with a heat source, such as fire, hot liquids, steam, or hot objects. The severity of a thermal burn varies depending on factors such as the temperature of the heat source, the duration of contact, and the affected area of the body.

Thanks to advances in medical care, the survival rate for burn patients in developed countries has improved to over 96% for those receiving treatment at specialized burn centers.

What are the Causes of Thermal Burns?

Thermal burns result from various sources. Here are the most common causes:

• Fire-related Burns: Direct contact with flames or extremely hot surfaces causes severe thermal burns. These types of burns are often associated with accidents involving open flames or explosions.
• Scalds: Burns caused by hot liquids or steam are particularly common in household settings. They frequently occur in the kitchen due to spilled boiling water, hot oil, or steam from cooking appliances.
• Contact Burns: These burns occur when the skin touches hot surfaces such as stoves, ovens, or heated metal objects. Prolonged exposure leads to severe tissue damage.

Scald burns are the most common type of burn, accounting for 35% of all burn injuries in the U.S., especially among children under 5.

Types of Thermal Burns by Severity

Thermal injuries are classified based on their depth and the extent of damage to the skin and underlying tissues:

• First-Degree Burns: These are superficial burns that only affect the outer layer of the skin (epidermis). Symptoms include redness, mild swelling, and pain. First-degree burns usually heal within a week without scarring.
• Second-Degree Burns: These burns extend into the second layer of skin (dermis), causing blisters, intense pain, and swelling. Second-degree burns require medical attention and lead to scarring.
• Third-Degree Burns: The most severe type of burn, third-degree burns, damage both the epidermis and dermis and extend into deeper tissues. The affected area appears white, charred, or leathery, and nerve damage results in numbness. These burns require immediate medical care and often necessitate surgical intervention.

Symptoms of Thermal Burns

Recognizing the symptoms of thermal burns is crucial for appropriate first aid and medical treatment:

Mild Burns:

• Redness
• Minor swelling
• Pain

Moderate Burns:

• Blisters
• Severe pain
• Skin peeling

Severe Burns:

• Charred or white skin
• Numbness
• Severe pain or no pain due to nerve damage

First Aid Response for Thermal Burns

Prompt and proper first aid impact the recovery process for burn victims. Immediate and appropriate action minimizes the damage, reduces pain, and prevents complications such as infection or scarring. Here's a step-by-step guide on how to respond to thermal injury effectively:

1. Cool the Burn: Immediately run cool (not cold) water over the burn for 10-15 minutes. This helps reduce the temperature of the skin and prevents further damage.
2. Cover the Burn: After cooling, cover the burn with a clean, non-stick bandage or cloth. This helps protect the area from infection.
3. Do Not Use Ice or Butter: Applying ice or butter to a burn causes further tissue damage and increases the risk of infection.
4. Seek Medical Attention: Always seek professional medical help for second and third-degree burns, or if the burn covers a large area of the body.

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1. Cool the Burn

Cooling the burn is the first and most crucial step in treating a thermal burn injury. Applying cool water to the affected area helps to lower the skin’s temperature, which in turn reduces pain, minimizes swelling, and prevents the burn from worsening. Cooling helps to mitigate the spread of the burn into deeper layers of the skin, which occurs if the heat is not quickly dissipated.

How to Do It:

• Immediately hold the burned area under cool running water for 10 to 15 minutes. If running water is not available, immerse the burn in cool water or apply a clean, cool, wet cloth to the area.
• Make sure the water is cool, not cold, as cold water or ice causes vasoconstriction (narrowing of the blood vessels), which reduces blood flow to the area and leads to further tissue damage.
• Avoid using ice, as this causes frostbite-like symptoms and increases the risk of further injury.
• If the burn area is large, avoid prolonged cooling, as it leads to hypothermia, especially in children or the elderly.
• For facial burns, use a cool, damp cloth rather than running water to avoid inhaling water.

2. Cover the Burn

After cooling the burn, covering it is essential to protect the area from exposure to air, bacteria, and other contaminants that could lead to infection. Covering helps to keep the area moist, which reduces pain and prevents further damage to the skin.

How to Do It:

• Gently pat the burn dry with a clean towel or cloth, taking care not to rub the area, which could worsen the injury.
• Cover the burn with a sterile, non-stick bandage, gauze, or a clean cloth. The dressing should be loose to avoid putting pressure on the burned skin.
• If the burn is small and in an easily movable area (like a finger), wrap the bandage around it. For larger burns, place a loose covering over the area without wrapping.
• Avoid using materials that could stick to the burn, such as cotton wool or other fluffy dressings.
• If a non-stick bandage is not available, a clean plastic wrap is used as an alternative, particularly for larger burns.

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3. Do Not Use Ice or Butter

Applying ice or butter to burns is a common myth that causes more harm than good. Ice exacerbates the injury by causing frostbite, as it constricts blood vessels and reduces blood flow to the burned area. This constriction deepens the burn and impedes the healing process. On the other hand, butter and other oils trap heat in the skin, preventing the burn from cooling properly and thereby prolonging the damage. Additionally, these substances are not sterile and introduce bacteria to the wound, raising the risk of infection and complications.

Alternative Treatments: Over-the-counter burn ointments or creams should only be used if recommended by a healthcare professional, and only after the burn has been properly cooled and covered.

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4. Seek Medical Attention

Not all burns are treated at home. For severe burns, prompt medical attention is critical to prevent complications, manage pain, and ensure proper healing. Burns that are deep, large, or located on sensitive areas of the body require professional evaluation and treatment.

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When to Seek Medical Help?

• Second- and Third-Degree Burns: If the burn is deep, causes blistering, or turns the skin white, charred, or leathery, seek immediate medical care. These burns damage deeper tissues and require specialized treatment.
• Large Burns: If the burn covers more than 3 inches in diameter or is located on the face, hands, feet, groin, buttocks, or a major joint, it should be evaluated by a healthcare professional.
• Signs of Infection: If the burn area becomes redder, more swollen, or starts to ooze pus, or if the person develops a fever, these could be signs of infection that require prompt medical attention.
• Other Severe Symptoms: Difficulty breathing, severe pain that does not subside with over-the-counter pain relievers, or signs of shock (such as fainting, dizziness, or a rapid heartbeat) warrant immediate medical care.

What to Expect at the Hospital?

A healthcare provider will clean the burn more thoroughly, apply a special dressing, and prescribe antibiotics if there’s a risk of infection. Pain management will be a priority, and for more severe burns, intravenous fluids is administered to prevent dehydration.

In some cases, particularly with third-degree burns, surgery such as skin grafting might be necessary to repair damaged tissues.

The cost of treating a burn patient in a specialized burn unit averages around $200,000 per patient. Burn victims often require extensive rehabilitation that includes physical therapy, skin graft surgeries, and psychological support.

Complications from Thermal Burns

Severe burns lead to various complications if not properly treated:

• Infection: Burns that break the skin open are highly susceptible to infection, which complicates healing and increases the risk of severe health issues.
• Scarring and Skin Grafts: Deep burns do not heal completely on their own and could require surgical intervention, such as skin grafts, to restore damaged tissues.

How to Prevent Thermal Burns?

Preventing thermal burn injuries involves taking proactive steps to minimize the risk of exposure to heat sources. Here's how to prevent thermal burns:

• Keep Hot Liquids and Foods Out of Reach: Store hot beverages and foods away from the edges and use back burners on the stove.
• Be Cautious When Cooking: Use oven mitts and be mindful of steam when handling hot items.
• Maintain Fire Safety Protocols: Install smoke detectors, keep a fire extinguisher in the kitchen, and check batteries regularly.
• Educate Children: Teach children about the dangers of hot surfaces and supervise them closely around heat sources.
• Avoid Using Flammable Products Near Heat Sources: Keep flammable materials away from stoves, heaters, and open flames.
• Wear Protective Gear in the Workplace: Use heat-resistant gloves, aprons, and face shields when working with hot materials.
• Follow Safety Protocols: Adhere to safety procedures and ensure proper installation of safety guards on equipment.
• Provide Proper Training: Train employees on fire safety, burn prevention, and emergency response.
• Maintain Equipment: Regularly inspect and maintain heat-generating equipment to ensure safety.
• Use Warning Signs: Label areas with hot surfaces or equipment to alert individuals of potential hazards.
• Avoid Sunburn: Use sunscreen and wear protective clothing to prevent sunburn.
• Handle Hot Items with Care: Use oven mitts or thick towels when removing items from the oven or microwave.
• Know Emergency Procedures: Familiarize yourself with first aid for burns and have access to first aid supplies.

Following these preventive measures ensures a safer environment and reduces the risk of thermal burns. Implementing these practices helps protect yourself and those around you from potential burn injuries.

How do thermal burns differ from other types of burns, such as chemical or electrical burns?

Thermal burns differ from other burns in their causes and effects on the body. Thermal burns occur from direct exposure to heat sources like fire, hot liquids, or steam, which primarily damage the skin and underlying tissues.

Chemical burns, on the other hand, are caused by contact with corrosive substances such as acids or alkalis, which cause ongoing damage through chemical reactions. Electrical burns result from electrical currents passing through the body, potentially causing severe internal injuries as the electricity damages tissues along its path.

While thermal burns affect the surface layers of the skin, chemical and electrical burns often lead to more complex and deep-seated injuries requiring different treatment strategies.

What are the latest advancements in treating thermal burns, such as skin grafting or bioengineered skin?

The latest advancements in treating thermal burns include innovations in skin grafting and bioengineered skin. Recent developments in skin grafting techniques involve using mesh grafts to cover larger areas and enhance healing. Bioengineered skin options, such as cultured epithelial autografts (CEAs) and acellular dermal matrices, provide sophisticated solutions for burn wounds. CEAs involve growing skin cells in the lab to create sheets of skin that is grafted onto burn areas, while acellular dermal matrices act as scaffolds for new tissue growth. These advancements aim to improve healing times, reduce scarring, and enhance overall recovery from severe burns.

How do age and pre-existing health conditions affect the healing process of thermal burns?

Age and pre-existing health conditions impact the healing process of thermal burns significantly. Older adults often experience slower healing due to thinner skin, reduced circulation, and decreased immune function. These factors increase the risk of complications such as infections and delayed recovery. Pre-existing health conditions, such as diabetes or cardiovascular diseases, affect healing by impairing circulation and nutrient delivery to the burn site. Effective burn treatment in these populations requires addressing both the burn injury and underlying health issues to improve recovery outcomes and reduce the risk of complications.

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Why is first aid training important for managing thermal burn injuries?

First aid training is essential for managing thermal burn injuries because it provides individuals with the skills to act quickly and effectively in emergencies. By learning how to cool the burn, cover the wound, and avoid harmful practices such as applying ice or butter, trained individuals minimizes damage, reduce pain, and prevent complications like infections. Proper first aid prevent burns from worsening by teaching how to handle different degrees of burns appropriately.
Additionally, basic first aid training prepares people to recognize when professional medical attention is necessary, ensuring timely treatment for more severe injuries.

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References:

• World Health Organization (WHO). (2018). Burns Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/burns
• American Burn Association (ABA). (2020). National Burn Repository: 2020 Report of Data from 2010–2019. Retrieved from https://ameriburn.org/NBR2020
• Centers for Disease Control and Prevention (CDC). (2016). Burn Injury Fact Sheet. Retrieved from https://www.cdc.gov/niosh/topics/burns
• American Academy of Pediatrics (AAP). (2020). Preventing Scald Burns in Young Children. Retrieved from https://www.aap.org/en/patient-care/scald-prevention
• National Institute of General Medical Sciences (NIGMS). (2017). Trauma and Burn Research. Retrieved from https://www.nigms.nih.gov/Research/specificareas/TraumaBurn

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