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Student Education

Trauma part 4: Burns

BMJ 2003; 327 doi: (Published 01 July 2003) Cite this as: BMJ 2003;327:0307230
  1. Omar Mukhtar, final year medical student1,
  2. Kirsten Jones, consultant in emergency medicine2
  1. 1University of Bristol
  2. 2Frenchay Hospital, Bristol

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.

What is a burn?

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).

Box 1: The four causes of burns

  • Thermal--flames (dry thermal burns) or scalding (wet thermal burns)

  • Chemical--acids or alkalis

  • Electrical--electrical current through the skin

  • Radiation--ionising radiation, such as depleted uranium


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 is intact and tissue is minimally damaged with blistering and erythema (due to capillary dilatation)--the burn heals in days and leaves no scars.

Deep partial thickness burns extend beyond the germinal layer, and only the sweat glands and hair follicles are undamaged. New skin will form from adjacent areas of intact epidermis and from sweat glands and hair follicles. Blistering and slough are visible and scarring is inevitable, especially if secondary infection occurs. In contrast to full thickness burns, deep partial …

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