Burns

Core Concepts

Causes and mechanisms

• Thermal burns (the most common) result from flames, scalding liquids, steam, or contact with hot surfaces. The temperature and the duration of contact determine how deep the injury goes.
• Chemical burns occur when acids, alkalis, or other corrosive substances contact skin or eyes; damage can continue after the initial contact, which is why rapid dilution and removal of the agent matter.
• Electrical burns can cause deep tissue damage along the current's path that looks far worse inside than the small entry and exit marks on the skin suggest; heart rhythm disturbances are a particular concern.
• Inhalation injury is a burn of the airway from breathing in heat or smoke. It threatens breathing directly and is a major determinant of outcome, so any burn sustained in a closed space or fire raises this concern.

Depth of injury

Depth terminology describes which layers are destroyed. Older texts use "first, second, third degree"; current practice commonly uses superficial, partial-thickness, and full-thickness:

• Superficial burns involve only the epidermis. The skin is red, dry, and painful but does not blister; healing is rapid.
• Partial-thickness burns destroy the epidermis and part of the dermis. They are marked by blisters and a moist, red or pink surface, and they are intensely painful because nerve endings remain exposed and irritated.
• Full-thickness burns destroy the epidermis and dermis and may extend deeper. The area can look white, brown, or leathery (a rigid, dead tissue layer called eschar may form) and may feel surprisingly numb because the nerve endings have been destroyed.

Depth guides prognosis and healing potential: superficial burns heal on their own, partial-thickness burns can heal with time and care, and full-thickness burns generally require more complex interventions because the skin's regenerative layers are gone.

Extent of injury

Extent is estimated as the percentage of total body surface area (TBSA) burned. The Rule of Nines is a quick bedside estimation tool that divides the adult body into regions of roughly 9% or multiples of 9% (head and neck, each upper limb, anterior and posterior trunk, each lower limb, plus the perineum). For small or irregular burns, the "palmar method" — the person's own palm is roughly 1% of their body surface — gives a fast approximation. These are estimation tools used by trained providers; pediatric estimates differ from adult ones because children's proportions are different, and more precise methods (such as the Lund-Browder chart) exist for that purpose.

The body's systemic response

In large burns, the injury triggers a whole-body response. Increased capillary permeability lets plasma leak into the tissues, producing edema and reducing circulating blood volume (the fluid-shift phase); this is why close monitoring of urine output, vital signs, and fluid balance is a core nursing concern in the early period. Because the skin barrier is gone, the person is at high risk of infection, and because the skin normally regulates temperature, large burns cause rapid heat loss. The metabolic rate rises dramatically, so nutrition support becomes part of recovery. The depth of the response scales with the size of the burn — which is exactly why extent and depth are assessed so carefully.

Phases of burn care

Burn care is often described in overlapping phases. In the emergent/resuscitative phase (the first hours to days), the priorities are securing the airway and breathing, managing the fluid shift, and stabilizing the person. In the acute phase, wound care, infection prevention, pain control, and nutrition dominate. The rehabilitation phase focuses on healing, scar and contracture management (tightening of skin and underlying tissues that can limit movement), and helping the person return to daily life — physically and emotionally. The boundaries between phases are not rigid, and the nurse's assessment priorities shift as the person moves through them.

Nursing considerations

Every burn is assessed for mechanism, depth, extent, location (burns of the face, hands, feet, joints, or perineum are particularly concerning), and the person's age and comorbidities. Beyond the wound itself, the nurse monitors breathing, circulation, fluid balance, pain, and signs of infection, and supports the person's nutrition, mobility, and emotional well-being. Treatment — fluid resuscitation, wound dressings, medications, surgery, and rehabilitation plans — is directed by the care team and follows current evidence, provider orders, and institutional protocol; scope of practice varies by setting. Person-first language (a person with a burn, not "a burn patient") and attention to dignity matter throughout, especially because burns often leave visible scars that affect self-image.

Common Confusions