Extensive burns belong among very serious injuries. They may not be caused only by fire and warm fluids - we also distinguish chemical and electric burns.


We evaluate burns according to the location, surface of burned area and the degree of burns. The extension is counted from the rule of nine percent. Out of 100% of body surface, 9% represents the head, 18% represent chest + abdomen, 18% represents the back, 9% one upper extremity, 18% one lower extremity and 1% the groin.


Schema - 9rule at adults


According to the severity and depth of the skin damage, we distinguish four degrees of burns.

1st degree

The first stage is the least serious. The burned skin is red, painful, but it heals quickly without scarring.

2nd degree

This is a more serious stage. The skin is not only red, but it forms blisters. The pain is stronger and the healing takes a significantly longer time.

3rd degree

This type of burns is painful only at the start, later it is painless due to destruction of local nerve endings in the skin. The healing lasts for months and multiple scars are formed. Skin transplant is usually necessary.

4th degree

The fourth grade exists only in certain classifications and it is related to a complete destruction of the skin and subcutaneous tissues. The affected tissues may be totally charred.


Acute burns manifest particularly by severe pain and extensive burns lead to a development of a shock condition. The shock occurs due to pain and fluid loss. The affected skin loses its barrier function, which causes the leakage of fluid and protein losses. The patient is also threatened by bacterial infections as the microorganisms can invade the weakened organism through the damaged skin cover.


As first aid, it is necessary to extinguish the fire or stop the direct contact with any combustibles. When the cause is a caustic liquid, it is important to quickly take down clothes stained by the chemical. Burns of the 1st and 2nd degree may be cooled in a stream of cold water. A sterile cover should be put on the burned areas and any clothing scorched to the body should not be forcibly taken off.


Cases of large burns should be transported into special burn centers. In the early stages, it is necessary to reduce pain, provide an adequate intravenous access and secure the airways (intubation and artificial lung ventilation may be needed). If the shock condition develops, it is vital to keep the patient well hydrated (intravenous infusions) to prevent the cardiovascular failure. Intravenous antibiotics are also the drugs of choice as it is important to prevent or treat any infectious complications. Destroyed burnt skin ceases to be a defensive barrier and the microorganisms can almost freely penetrate it into the body.


When the patient's life is saved, it is necessary to minimalize any cosmetic defects by plastic surgery interventions. The modern surgery has usually means to ensure a good cosmetic result with maximal preservation of functions of the affected tissues. Patients with large burns associated with cosmetic defects should get skilled help by a psychologist or psychiatrist.


Note: Effective first aid is almost impossible in burns caused by chemical flammable warfare substances such as the napalm. These substances adhere to the skin cover, burn into depth and the water has only minimal effect. This is the reason, why victims of a napalm attack are severely burned even if they jump into the water. Burns caused by these flammable liguids belong among the most serious.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources