89 180 Definition Injury to the tissue as a result of exposure to, or contact with, dry heat (fire), wet heat (steam or hot liquids), or flame exposure or contact with a hot substance (e.g., scalding liquids, hot metals). Severity is determined by the amount of BSA involved and the burn depth. Superfi- cial (first-degree) burns involve the epithelial layer (erythema) partial thickness (second- degree) burns include the epidermis and some portion of the dermal skin layer (erythema with blister) and full thickness (third-degree) burns involve the full thickness of the dermal skin layer (white or leathery, with no blisters and charred appearance), and can extend to muscle and bone (sometimes called fourth-degree burns). Many burns will have a combina- tion of different degrees of thermal burn. It is important to quantify the extent of total burn as well as of each degree. Burns to airways can be caused by inhaling smoke, steam, superheated air, or toxic fumes. Characteristics Superficial burns, such as sunburn, result initially in reddening of the skin, which turns white when touched, and pain. Partial thickness burns are accompanied by severe pain, erythema, latent blister formation, cell fluid loss, and eventually peeling of affected skin. In full thick- ness burns, the area can appear black, white, or leathery, and is painless. Excessive fluid loss can cause shock and cardiovascular collapse. Symptoms of an airway burn include charred mouth, singed nasal hairs, burned lips, burns on head, face, or neck, difficulty breathing, coughing, wheezing, or change in voice. Policy Remove employee from the source of the heat or fire. Immediately evaluate at the scene or in the occupational health unit any employee who sustains a thermal burn. Depending on degree and extent of burn, hospital transport might be required. Objectives Clinical Assessments and Interventions Referral for Medical Action Burn: Thermal ● Burn involving hands, face, eyes, feet, or perineum. ● Electrical or inhalation burn. ● Burn with associated major trauma. ● Second-degree burn 10 percent of BSA or any third-degree burn. ● Elderly employee or employee with chronic disease. ● Any circumferential burns. Remove employee from burn source, determine status, and stabilize. ● At the scene, remove employee from heat source and extinguish the fire or remove from source of heat. ● Maintain patent airway. ● Anticipate airway obstruction if inhalation injury. ● Inspect face and neck for early swelling, soot in the mouth or nose, and sputum (if employee can cough). ● Assess extent and degree of burns (see Rule of Nines, page 182). ● Administer oxygen if needed per standing order. ● Examine employee for other injuries. ● Obtain vital signs. Guideline continues on next page