Bad Burn? Here’s When You Should Go to the ER

Burns remain a common injury seen in hospital emergency departments every year. Approximately 5-10% of all injuries are related to either thermal burns, electrical burns, or chemical burns. Burns are significant because the skin, which is the largest organ in our body, is destroyed. The skin protects us from pathogens (organisms that can cause disease), regulates our temperature, and aids in sensation, among other functions. Most scholars of health care agree there are four different levels of burns, and the care for each is determined by that level. Burns are labelled as first degree, second degree, third degree or fourth degree. Here is how to differentiate them:

1st Degree Burns

These burns involve only the superficial layer of the skin. A sunburn is an excellent example of a first degree burn. The skin remains intact, and there is no blistering. Pain control is the top priority for these burns. If the pain can be controlled, the burn can be treated at home or at Urgent Care.

2nd Degree Burns

Second degree burns are also known as partial thickness burns. These burns extend past the skin and into the dermal layer. The most prominent indication of a second degree burn is the formation of blisters. Blisters actually serve as a source of protection to the wound, by providing a barrier for bacteria. They should be left intact if possible.

If a second degree burn is limited to a focal area, it can be treated at home. Immediately cool the area with cool water, then treat with an antibiotic ointment and cover with loose gauze. Remember to try not to break blisters if they are present.

If the burn is beyond a limited area or is substantial, it should be evaluated at an urgent care or ER. At an urgent care or ER, these wounds and blisters are cleansed and examined. If intact, they will most likely be left in place and the wound bandaged with antibiotic ointment and covered with gauze. If the blisters have already been broken, the physician will debride, or trim the skin around the wound. Then the wounds are covered with antibiotic ointment and gauze.

Since second degree burns are very painful, pain management is a huge part of the treatment for these burns. Burns of this nature are also measured in terms of what percentage of the body surface is impacted. For instance, burns may be categorized as covering 40% total body surface area (TBSA). Burns over 10% TBSA are significant burns.

3rd Degree Burns

Third degree burns are deep burns that extend past the skin, the dermis, and into the muscle tissue. These burns are not painful in themselves because the nerves are damaged, but they are often surrounded by second degree burns, which makes pain control a significant issue.  If these burns cover a substantial part of the body, they need to be treated in a designated burn center or in a hospital with a dedicated burn unit. This is also true if the burns involve the face, hands, feet, or the perineal area.

Treatment in the emergency department targets resuscitation of the patient. The patient may require support from the ventilator if they breathed in hot air and singed their airway. Fluid resuscitation by IV fluids is needed along with monitoring of urine output. These patients will be cared for in a burn center and will be subject to multiple skin grafts and lengthy hospitalizations.

4th Degree Burns

Fourth degree burns extend all the way down to the bone. These burns destroy incredible amounts of tissue, and often result in amputations and death.

Prevention is the key to treatment of most burns. Make sure smoke alarms are installed properly and are functional. Be sure when cooking on a stove that all handles of pots and pans are turned towards the back of the appliance so that little curious hands cannot grab them. Never use accelerants when igniting trash, and handle combustible materials carefully. Burns are some of the most disfiguring injuries that can occur. Preventing them will save you from their pain and destruction.

Know where to go for urgent or emergency care services.

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