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Burns

Specialties > Dermatology

Differential Diagnosis Schema 🧠

Thermal Burns

  • Scalds: Often from hot liquids, more common in children.
  • Flame burns: Typically from direct contact with fire, commonly affecting hands and face.
  • Contact burns: Occur from direct contact with a hot object (e.g., iron), often deep.

Chemical Burns

  • Acid burns: Cause coagulation necrosis, typically with a well-demarcated area.
  • Alkali burns: Cause liquefaction necrosis, leading to deeper tissue penetration.
  • Organic compounds: Can result in chemical burns and systemic toxicity (e.g., phenol).

Electrical Burns

  • Low-voltage burns: Typically cause superficial burns; may have entry and exit wounds.
  • High-voltage burns: Can cause deep tissue damage and complications such as arrhythmias.
  • Lightning strikes: Often associated with multiple system injuries, including cardiac arrest.

Friction Burns

  • Abrasion burns: Result from skin rubbing against a rough surface, can be painful and prone to infection.
  • Road rash: Common in motorcyclists or cyclists, associated with high risk of infection.

Radiation Burns

  • Sunburn: Caused by UV radiation, usually superficial but can cause severe pain and blistering.
  • Radiation therapy burns: Associated with cancer treatment, may have delayed onset.

Key Points in History 🥼

Mechanism of Injury

  • Thermal: Establish the source (e.g., flame, hot liquid) and duration of exposure.
  • Chemical: Identify the chemical agent involved, concentration, and duration of contact.
  • Electrical: Determine voltage, current type (AC/DC), and duration of exposure.
  • Radiation: Clarify the type of radiation (e.g., UV, ionizing) and duration of exposure.

Extent and Depth of Burn

  • Total Body Surface Area (TBSA): Assess using the Rule of Nines or Lund and Browder chart.
  • Depth: Superficial, partial-thickness, or full-thickness—each has different prognostic implications.

Associated Injuries and Complications

  • Inhalation injury: Signs include hoarseness, singed nasal hairs, and carbonaceous sputum.
  • Fractures or other trauma: Particularly relevant in electrical burns and falls from height.
  • Infection risk: Particularly in patients with large surface area burns or delayed presentation.

Background

  • Past Medical History: History of conditions that may impair healing (e.g., diabetes, peripheral vascular disease).
  • Drug History: Medications that may increase infection risk or complicate wound healing (e.g., steroids).
  • Social History: Home environment and support, smoking status (impacts healing), alcohol and drug use.
  • Family History: Genetic conditions that may affect wound healing or skin integrity.

Possible Investigations 🌡️

Laboratory Tests

  • FBC: To check for signs of infection (e.g., raised WCC) or anemia from extensive burns.
  • U&E: To monitor for renal impairment, especially in severe burns with significant fluid loss.
  • CRP: As a marker of systemic inflammation, especially if sepsis is a concern.
  • Carboxyhemoglobin: In cases of suspected inhalation injury from smoke.

Imaging

  • CXR: Useful in suspected inhalation injury or in assessing complications such as ARDS.
  • CT scan: May be necessary in cases of electrical burns to assess for deep tissue involvement.
  • MRI: Occasionally used for detailed assessment of soft tissue damage in electrical burns.

Specialist Assessments

  • Bronchoscopy: Indicated in suspected inhalation injury to assess airway damage.
  • Burn center referral: For severe burns, including those with >10% TBSA or involving critical areas (e.g., face, hands).

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Dermatology