Burn injuries can range from minor to life-threatening depending on the degree and extent of the burn. Knowing when to seek emergency medical care for a burn is crucial for proper treatment and preventing complications. This article provides an overview of burn degrees, symptoms, and whether hospitalization is typically required.
First Degree Burns
First degree burns, also called superficial burns, only affect the outer layer of skin, or epidermis. These burns cause redness, pain, and swelling, but the skin remains intact. Blisters do not usually form with first degree burns. Common causes include sunburns, scalds from hot liquids, and brief contact with a hot object.
First degree burns are generally minor and can be safely treated at home in most cases. Home treatment includes:
- Cooling the burn by holding it under cool (not cold) running water for 10-15 minutes
- Applying aloe vera gel or a moisturizing lotion
- Taking over-the-counter pain medication like acetaminophen or ibuprofen
- Avoiding breaking any blisters that may form
See your doctor if the burn covers a large area, does not improve within a few days, or shows signs of infection like increasing pain, redness, swelling or pus. Otherwise hospitalization is not required for first degree burns.
Second Degree Burns
Second degree burns go deeper into the skin layers, injuring both the outer epidermis layer and the inner dermis layer of skin. This causes reddening, pain, swelling, and blisters. Second degree burns are classified into two categories:
Superficial Second Degree Burns
Superficial second degree burns involve injury to the upper layer of the dermis. Blisters will form and the skin may appear wet and weepy. There is typically intense pain and redness.
Deep Second Degree Burns
Deep second degree burns extend into the lower layers of the dermis, causing more extensive blistering and a blotchy, mottled appearance. There is often numbness due to nerve damage.
Second degree burns are serious injuries that require emergency medical care. Hospitalization or specialized burn care is often needed to prevent complications such as infections, fluid loss, and scarring. Treatment in hospital may include:
- Intravenous (IV) fluids and electrolyte replacement
- Wound care and frequent dressing changes
- Pain medication
- Antibiotics to prevent infection
- Skin grafting for larger or deep second degree burns
Third Degree Burns
Third degree, or full thickness burns, destroy the entire depth of the skin and underlying tissues. The skin often appears charred or leathery. Sensation is usually lost entirely due to nerve damage. While first and second degree burns are repairable, the skin in third degree burns cannot heal on its own.
All third degree burns require emergency hospitalization. Treatment is aimed at preventing complications, controlling pain, and removing damaged tissue in preparation for skin grafting. Skin grafting is a surgical procedure where healthy skin is transplanted to the burn site to help repair and regenerate new skin.
Electrical Burns
Electrical burns, including lightning strike injuries, have unique characteristics and risks compared to thermal burns. The electrical current can damage deep tissues like muscles, blood vessels, and nerves while leaving only minor skin burns. This can mask the true extent of injury.
All suspected electrical burns require emergency medical evaluation, even if minimal external signs of burn are present. Internal organ damage, cardiac arrhythmias, and other life-threatening complications can develop. Observation in hospital for 24 hours is usually recommended due to risk of delayed symptoms.
Chemical Burns
Chemical burns result from contact with corrosive substances such as strong acids or bases. The chemicals damage and penetrate the skin rapidly. Chemical burns can be deceivingly minor in appearance but lead to serious systemic effects.
All chemical burns should receive prompt medical care to properly cleanse affected skin and prevent further chemical exposure. Ongoing damage can occur while the chemical remains on the skin. Hospitalization is often required for treatment, monitoring intravenous fluids, and managing any respiratory or gastrointestinal effects from chemical inhalation or ingestion.
How Are Burn Degrees Classified?
Burns are classified by degree based on how deeply and severely they penetrate the skin’s layers:
| Degree | Depth of Injury | Appearance | Healing Potential |
|---|---|---|---|
| First (Superficial) | Outer layer of skin (epidermis) | Reddened, dry skin, pain, swelling | Heals well, no scarring |
| Second (Partial Thickness) | Epidermis and upper dermis | Reddened, blisters, wet appearance, severe pain | May heal without skin grafting |
| Third (Full Thickness) | Entire depth of skin, including epidermis, dermis and subcutaneous fat | Leathery, charred, or white appearance. Little to no sensation. | Requires skin grafting to heal |
| Fourth | Beyond skin layers, into muscles, tendons and bones | Charred black eschar, exposed tendons or bones | Extensive surgeries needed for healing |
What Total Body Surface Area (TBSA) Requires Hospitalization?
In additional to degree, the total percentage of body surface area (TBSA) affected is used to determine burn severity and need for hospitalization. Larger burns have higher risk of complications like infections, fluid or electrolyte imbalances, and hypothermia.
In general:
- Burns less than 10% TBSA can often be treated as outpatients unless other signs of severity are present.
- Burns 10-20% TBSA typically require observation and fluid management in the emergency department or hospital.
- Burns over 20% TBSA will require hospital admission for wound care, IV therapy, and rehabilitation.
- Burns over 30% TBSA are considered major and have high risk of mortality. Intensive care is needed.
The age and health status of the patient is also a factor. Very young children, older adults, or those with medical problems may need admission for more mild burns compared to a healthy adult.
When Should You Go to The Hospital For a Burn?
Seeking emergency medical care is advised for:
- All third and fourth degree burns
- Second degree burns larger than 3 inches in diameter
- Burns on face, hands, feet, genitals, over joints, or over large surface area
- Suspected inhalation burns if fire-related. Can cause respiratory complications.
- Electrical or chemical burns
- Any burn in a high risk individual – infants, elderly, chronic disease, immunosuppressed
- Burns with other trauma such as fractures, head injury
- Any burn causing difficulty breathing, change in consciousness, or other concerning symptoms
For mild, superficial burns with no concerning symptoms, self-care may be appropriate. See a doctor if signs of infection develop or if it does not start to heal within 2-3 days.
What Happens At the Hospital for Burns?
Those with major burns will be admitted directly to the intensive care unit. Stabilization and monitoring are the top priorities. Treatment may include:
- Airway management – Endotracheal intubation and mechanical ventilation if needed for respiratory support
- Fluid resuscitation – High volumes of IV fluids and electrolyte monitoring to stabilize fluid balance
- Wound care – Debridement of dead tissue, dressing changes, topical antibiotics
- Nutritional support – High calorie liquid diet or tube feeding
- Pain control – Opiate medications, anxiety management
- Infection prevention – Antibiotics, isolation protocols, wound cultures
- Surgeries – Escharotomy, fasciotomy, skin grafting, reconstructive surgeries
For milder burns, treatment may involve:
- Cleaning and dressing wounds
- IV fluids or electrolyte replacement
- Medications for pain control and prevention of infections
- Tetanus immunization if needed
- Wound care supplies and education if discharged home
Rehabilitation including physical and occupational therapy is also crucial for recovery of range of motion and strength after skin grafting and significant burns.
Conclusion
Knowing when to go to the hospital for a burn can mean the difference between life and death in severe cases. All full thickness third and fourth degree burns require emergency medical care to prevent complications like infections and fluid or electrolyte imbalances.
Superficial first degree burns can often be treated at home, but deeper second degree burns or any burns over small surface areas of the face, hands, feet or joints warrant ER evaluation. Seek immediate medical attention for suspected chemical or electrical burns as internal damage may not be visible.
Burn treatment focuses on stabilizing the patient, preventing infections, aggressively treating pain and replacing fluid losses. Admission is required for major burns while more mild cases may be treated as outpatients. Seeking prompt emergency care leads to better outcomes and lowers risk of complications for burn injuries.