Severe burns are a severe injury to the body’s tissues, often resulting from heat, chemicals, electricity, or radiation. They can extensively harm the skin and underlying structures, including fat, muscle, and even bone. These injuries require immediate and specialized medical attention due to the risk of serious complications.
Understanding Severe Burns
Burns are categorized by their depth and the extent of tissue damage. First-degree burns, also known as superficial burns, affect only the outermost layer of the skin, the epidermis. These burns cause redness, pain, and mild swelling, similar to a sunburn.
Second-degree burns, or partial-thickness burns, extend beyond the epidermis to involve a portion of the dermis. These burns are characterized by redness, significant pain, swelling, and the formation of blisters.
Third-degree burns, referred to as full-thickness burns, are more severe, destroying both the epidermis and the entire dermis. These burns can appear white, leathery, or charred, and may cause little to no pain due to the destruction of nerve endings. Fourth-degree burns extend through all layers of skin, damaging underlying tissues such as muscle, tendons, and bone. Third- and fourth-degree burns are considered severe. Second-degree burns are also severe if they cover a large body surface area or involve sensitive areas like the face, hands, feet, groin, buttocks, or major joints.
Immediate Care for Severe Burns
Call 911 or your local emergency number if the burn is extensive, appears severe, is caused by chemicals or electricity, or if the person shows signs of shock or has inhaled smoke.
Stopping the burning process prevents further tissue damage. For thermal burns, this might involve removing the person from the heat source or extinguishing flames. Do not attempt to remove clothing stuck to the burn, as this can cause additional injury.
Gently cover the burn with a clean, dry cloth or sterile dressing to protect the injured area from contamination. Avoid applying ice, butter, or other home remedies, as these can exacerbate the injury or introduce infection. Keep the person warm, as severe burns can impair the body’s ability to regulate temperature, potentially leading to hypothermia.
Monitor the person for signs of shock, which may include pale and clammy skin, weakness, bluish lips and fingernails, and decreased alertness. Elevating the burned body part can help reduce swelling. Remain with the person and provide reassurance until emergency medical personnel arrive.
Medical Treatment and Recovery Pathways
Upon arrival at a medical facility, individuals with severe burns undergo an initial comprehensive assessment to determine the burn’s depth, size, and location. This evaluation also identifies any associated injuries, such as smoke inhalation or trauma. A common method for estimating burn size is the “rule of nines” for adults, or specific charts for children, which divide the body into regions representing percentages of total body surface area.
Fluid resuscitation is a primary medical treatment for extensive burns, especially for second-degree burns covering more than 10% of the body surface area and all third-degree burns. This involves administering large volumes of intravenous fluids, often lactated Ringer’s solution, to counteract the significant fluid loss from the damaged skin. Fluid administration is calculated based on the patient’s weight and burn size to maintain blood pressure and organ perfusion.
Wound care is initiated promptly, often involving debridement, which is the removal of dead or contaminated tissue to promote healing and prevent infection. After debridement, specialized dressings are applied to protect the wound, manage exudate, and create an optimal healing environment. These dressings can range from antimicrobial creams and synthetic coverings to biological dressings derived from animal or human tissue.
Pain management is a continuous aspect of burn care, utilizing a combination of intravenous opioids and other analgesics to control severe pain. Surgical interventions, such as skin grafting, become necessary for deep second-degree and third-degree burns that cannot heal on their own. This procedure involves transplanting healthy skin from another area of the patient’s body (autograft) or from a donor (allograft) to cover the wound, promoting closure and reducing scarring.
Physical and occupational therapy often begin early in the recovery pathway, even during the acute hospital stay. Therapists work to prevent contractures, maintain range of motion, and help patients regain functional independence through exercises, splinting, and positioning. This early intervention helps minimize long-term disability and facilitates recovery.
Potential Complications
Severe burns can lead to a range of complications, both immediately and in the long term, due to extensive damage to the body’s protective barriers and internal systems. One immediate risk is infection, as the compromised skin barrier allows bacteria and other microorganisms to enter the body easily. Burn wounds are susceptible to bacterial colonization, which can lead to localized infections or progress to systemic sepsis, a life-threatening condition.
Significant fluid loss is another immediate concern, as damaged capillaries leak plasma and electrolytes, potentially leading to hypovolemic shock. This loss of fluid volume can decrease blood pressure and reduce blood flow to organs, impairing their function. Severe burns can also disrupt the body’s temperature regulation, increasing the risk of hypothermia, especially in the initial hours after the injury.
Long-term complications often involve the skin and underlying tissues. Scarring is almost inevitable with severe burns, manifesting as hypertrophic scars, which are raised and red, or keloid scars, which extend beyond the original wound boundaries. These scars can be disfiguring and impact mobility. Contractures, a tightening of the skin, muscles, or tendons, can also develop, severely limiting joint movement and requiring surgical release.
Beyond physical effects, severe burns can have psychological impacts, including post-traumatic stress disorder (PTSD), depression, anxiety, and body image issues. These emotional challenges can persist long after physical healing. Organ dysfunction, particularly involving the kidneys and liver, can also occur as these organs work to filter damaged tissue from the bloodstream, or as a consequence of systemic inflammation and shock.