Burns

In flame burns, there is actual contact of body and flame, with scorching of the skin progressing to charring. Flash burns are a variant of flame burns. They are caused by the initial ignition (or "flash") from flash fires that result from the sudden ignition or explosion of gases, petrochemicals or fine par-ticulate material. Typically, the initial flash is of short duration, a few seconds at most. All exposed surfaces are burned uniformly. If the victim's clothing is ignited, a combination of flash and traditional flame burn occurs. Flash burns usually result in partial-thickness burns and singed hair (Figure 13.1). If the heat pulse is very short, because the thermal conductivity of the skin is low, the burn is superficial.

Contact burns involve physical contact between the body and a hot object. At surface temperatures of 70°C and higher, trans-epidermal necrosis occurs in less than a second.2 Radiant heat burns are caused by heat waves,

Figure 13.1 (A) and (B) Flash burns from methane explosion. Hair singed.

a type of electromagnetic wave. There is no contact between body and flame, or contact with a hot surface. Initially, the skin appears erythematous and blistered, with areas of skin slippage. With prolonged exposure to low heat, the skin will become light brown and leathery such as one sees in a well-done turkey (Figure 13.2). With most radiant heat burns, the hair is intact, at least initially. If the radiant heat continues long enough, there will be charring of the body. Three factors determine whether radiant heat burns occur, their extent and their severity. These are:

1. Temperature of the heat wave contacting the skin

2. Time of exposure

3. Whether the skin is covered with clothing

Extremely high radiant heat temperatures can cause burns in seconds. Thus, Ripple et al. concluded that air temperatures above 1500°C will cause second-degree burns on bare skin in less than 10 milliseconds.3

Scalding burns are caused by contact with hot liquids, most commonly water. Scalding burns generally occur on exposed skin, since even one layer of clothing can be sufficient to protect the body. The last two forms of burns are chemical burns and microwave burns.

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