About 80% of thermal injuries (burns) occur in the home, and 5% (one million
per year) require hospitalization. Included among thermal injuries are sunburns
(most common), direct heat, scalding (a moist burn), electrical burns, and
chemical burns. The severity of the burn, based on depth, duration of exposure,
and extent, determines appropriate management.
Fires, hot water or steam, sun overexposure, electricity, and certain
chemicals produce burns.
- Hot water heater set above 120oF
- Careless smoking
- Unsafe storage of flammable or caustic materials
- Microwaved foods/containers
- Wood stoves or exposed heating sources or electrical cords
- Sun overexposure, especially for older and fair-skinned
|Signs and Symptoms|
- Superficial partial-thickness burns (first
degree)—epidermis only; red, painful but intact; no
- Deep partial-thickness burns (second
degree)—epidermis only; red, painful, blisters,
- Full-thickness burns (third degree)—all
layers of dermis and epidermis plus deeper layers; skin charred, pale, or
brownish yellow and leathery, often without pain or blisters; also injuries that
involve the face, neck, shoulders, elbows, hands, perineum, popliteal fossa,
ankles, or feet (where skin is thin). Requires specialist in burn
Infections or drug reactions causing toxic epidermal necrolysis (scalded skin
Evaluate depth and extent of injury using the rule of nines (Lund-Browder
chart): surface area estimated as each arm 9%, each leg 18%, front of torso 18%,
back of trunk 18%, head 9%, and groin 1%. For infants and small children, as
above but head is 18% and legs 13.5%. Determine the cause to see if smoke
inhalation is a possibility. Check for localized edema impeding
For thermal injuries:
- Cool the area with cold water.
- Gently debride and cleanse the wound.
- Give oral analgesics for pain; IV medications for major
- Open blisters and excise dead skin.
- Cover with bacteriostatic cream and apply soft bulky dressing, which
should be changed and medication reapplied twice a day.
- Review status of tetanus prophylaxis and update.
- Do not give systemic antibiotics.
- Fluid resuscitation.
For chemical burns:
- Remove patient's clothing.
- Irrigate area copiously with water, especially if the eyes are
For electrical burns:
- Damage depends on resistance, type of current, amperage, voltage,
duration of exposure, and pathway. Areas most affected are neurovascular bundles
- Because cardiorespiratory arrest is common, patient may require CPR
and advanced cardiac life support.
- Characteristic lesions are most intense at port of entry and
- Evaluate for other injuries.
- May need early decompressive fasciotomies and debridement to assess
the extent of damage; the incidence of major amputation with electrical burns is
- Transfer to a specialized center after patient's condition is
- ECG monitoring for 24 hours.
Hospitalization required for: second-degree burns over 10% of body;
third-degree burns; burns on hands, feet, face, or genitals; electrical/chemical
burns; smoke inhalation.
Burn center required for: second- or third-degree burns over 10% of body in
patients under 10 years or over 50 years; second- or third-degree burns over 20%
- Silver sulfadiazine (Silvadene). Topical antibiotic applied to burned
area, effective against most Pseudomonas, fairly good eschar penetration.
Some microorganisms are resistant. Side effects are leukopenia or fever and
delay in epithelialization.
- Mafenide. Penetrates eschar better than silver sulfadiazine, more
effective against Pseudomonas; recommended for burns over cartilage and
deep burns. Side effects are (in 10% solution) carbonic anhydrase inhibition,
causing metabolic acidosis, delay in epithelialization, pain; can be lessened in
5% solution. Limit use to no more than 10% of total body surface.
- Povidone-iodine (Betadine). Especially useful against Candida
and gram-positive and gram-negative microorganisms, but poor eschar
penetration. Side effects are desiccation of wound surface, pain, high blood
|Complementary and Alternative
Herbal support, both internally and externally, can facilitate wound healing,
reduce the risk for infection by stimulating the immune system, and may help
prevent scarring. Homeopathic remedies can provide excellent pain relief and
reduction of symptoms.
- Hydration is of primary importance in managing moderate to severe
burns. Fresh vegetable and fruit juices, water, and electrolyte replacement
drinks should be used liberally.
- Vitamin C (1,000 to 1,500 mg tid), zinc (30 to 50 mg/day), and
beta-carotene (100,000 IU/day) supports immune function and enhances dermal
- Vitamin E (1,200 IU d-alpha tocopherols tid) is a strong antioxidant
and reduces scarring.
- Bromelain (250 to 500 mg qid between meals) is a proteolytic enzyme
that decreases inflammation. Use with turmeric (Curcuma longa, 500 mg
qid) to potentiate effects.
- L-glutamine (3 to 10 g tid) provides amino acids to the gut that may
be necessary to prevent damage secondary to severe
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
- To mobilize the immune system and minimize risk of infection during
the acute phase, combine equal parts of tinctures of coneflower (Echinacea
purpurea) and goldenseal (Hydrastis canadensis). Take 30 to 60 drops
every three to four hours.
- Gotu kola (Centella asiatica) has been used in patients with
second- to third-degree burns with great success. Daily topical application
prevented or limited shrinking and swelling of the skin, inhibited scar
formation, increased healing, and decreased fibrosis.
- Herbs that enhance circulation to the skin can facilitate the
delivery of nutrients and elimination of metabolic waste. Combine equal parts of
the following in a tea (1 cup four to six times/day) or tincture (30 to 60 drops
tid to qid). Yarrow (Achillea millefolium), cleavers (Gallium
aparine), prickly ash bark (Xanthoxyllum clava-herculis), marigold
(Calendula officinalis), plantain (Plantago major), and ginger
root (Zingiber officinale).
- For acute pain relief combine equal parts of tincture of Jamaica
dogwood (Piscidia piscipula), valerian (Valeriana officinalis),
St. John's wort (Hypericum perforatum), and California poppy
(Escholizia californica) with one-half part of gelsemium (Gelsemium
sempervirens). Take 10 to 15 drops every 15 minutes up to eight doses,
acutely. For general pain relief, take 30 drops tid to qid.
- Aloe vera: Cut a fresh leaf and apply the gel to skin, or peel leaf,
blend pulp, then apply to skin.
- Comfrey leaf (Symphytum officinale): Make a strong tea with 1
heaping tsp. herb/cup. Use as a wash. Do not use internally for prolonged
periods due to potential for liver damage.
- Combine powders of slippery elm (Ulmus fulva), marshmallow
root (Althaea officinalis), goldenseal, and comfrey root. Apply to burns
to speed healing and reduce risk for
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing, use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Cantharis for burns and scalds with cutting, burning, or
smarting pains that are relieved with cold applications. Specifically for
extensive burns causing renal involvement.
- Carbolic acid for rapid prostration following a burn, with
coldness of the skin and rapidly progressing to shock and collapse.
- Carbo vegetabilis for burns with great prostration and
sluggishness of circulation. Patient has air hunger and wishes to be fanned even
though they are chilly.
Topical homeopathic preparations for burns may provide acute pain relief. Do
not apply over broken skin.
Patient should return 72 hours after injury, then every five to seven days
until the wound is healed.
- If excessive swelling: Assess circulation and instruct patient to
keep injured area elevated to avoid developing a compartment syndrome, wherein
the injury progresses to full-thickness burn.
- If superficial infection: Do wound culture and
- If systemic signs of sepsis (fever, leukocytosis, extensive
erythema): Manage aggressively with systemic antibiotics.
- If moderate swelling and erythema: Use elevation and warm moist
- For itching: Use moisturizing cream.
- To prevent functional disability, refer to physical therapist or
- Safety inspection of home by fire department.
- Plan fire/emergency escape route.
- Keep hot water heater set at maximum of 120Ю
- Local edema: maintain adequate circulation
- Functional or cosmetic defects (risk greater with partial-thickness
- Burn sepsis
- Carcinoma developing in burn
Partial-thickness burns generally heal in three to five weeks. Third-degree
burns require skin graft.
Topical applications and homeopathic remedies may provide excellent support
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Forgey WW, ed. Wilderness Medical Society Practice Guidelines for
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Binghamton, NY: Pharmaceutical Products Press;
Copyright © 2007 Drugs Area
This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein.