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Potentially life-threatening emergency
Thermal or electrical burn in Adult
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Potentially life-threatening emergency

Thermal or electrical burn in Adult

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Contributors: Anahita Azharian DO, Jeffrey D. Bernhard MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Thermal or electrical burn : Linear configuration
Thermal and electrical burns of skin can result in painful and debilitating injuries and in some instances may be fatal. With any burn injury to the skin, it is important to obtain an accurate history of the manner, duration, and intensity of the exposure.

Scald burns are the most common type of thermal burn to the skin, and severity is dependent on duration and on the viscosity of the liquid involved. Flame burns are the next most common, followed by flash burns and contact burns to the skin. E-cigarettes and exploding lithium batteries from cell phones have been associated with thermal burns.

Electrical burns of skin are of two main types, depending on the voltage involved:
  • High voltage (>1000 volts)
  • Low voltage (<1000 volts)
Numerous vital functions of the skin, including fluid homeostasis, thermoregulation, immunologic functions, neurosensory functions, metabolic functions, and primary protection against infection (by acting as a physical barrier), can be impaired by burn injury. In particular, the skin barrier is damaged to various degrees, allowing pathogens a direct route to infiltrate / infect the body. Careful physical examination is necessary to determine the depth of skin burn, total body surface area (TBSA) involved, and injury to any other vital organs.

To determine the TBSA involved, one can use the "rule of nines" or the Lund-Browder chart. It is important to note that because of differences in body proportion, the percentage assigned for each body area is different in adults and children.

Depth of skin injury in burn is classified as follows:
  • Superficial (1st degree) – Involves the epidermis only.
  • Partial thickness (2nd degree) – Involves all of the epidermis and part of the dermis. Characterized further according to the depth of dermal injury: superficial partial thickness or deep partial thickness.
  • Full thickness (3rd degree) – Involves all of the epidermis and the dermis.
Note: Chemical burns from specific agents (eg, hydrogen fluoride and ammonia and sulfur dioxide) have different presentations. Oral mucosal burns and ocular burns (thermal, chemical) have unique local presentations.

Immunocompromised Patient Considerations:
Burns in this group can result in increased morbidity and mortality due to infection.

Codes

ICD10CM:
T30.0 – Burn of unspecified body region, unspecified degree

SNOMEDCT:
314534006 – Thermal burn

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

It is important to note that cultural practices such as cupping, coining, and moxibustion lead to burn-like lesions in distinctive patterns.

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Management Pearls

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References

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Last Updated:10/12/2017
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Potentially life-threatening emergency
Thermal or electrical burn in Adult
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A medical illustration showing key findings of Thermal or electrical burn : Linear configuration
Clinical image of Thermal or electrical burn - imageId=556861. Click to open in gallery. caption: 'An extensive reddish-brown, wrinkled, eroded plaque on the arm.'
An extensive reddish-brown, wrinkled, eroded plaque on the arm.

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