Trauma part 4: Burns
In the final article in our series on trauma, Omar Mukhtar and Kirsten Jones explain how to assess and manage burns
Burns are common; they account for more than 12 000 admissions to hospital each year in England and Wales alone. Only a fraction of this number is seen in parts of Africa and Asia. Despite the geographical variation in prevalance, the situations in which burns occur are the same everywhere--about two thirds take place in the home, and most of the rest occur in the workplace. More importantly, most burns are preventable.
A burn is coagulative destruction of the skin; wounds are different because the epidermis (and sometimes the dermis) is breached. Four factors can cause burns (box 1), and burns are classed as either partial thickness (first degree or second degree) or full thickness (third degree).
Partial thickness burns, both superficial and deep, heal spontaneously without a skin graft because various elements of the epidermis are undamaged. If only the superficial epidermis is affected--that is, the underlying germinal layer