Which of the following statements about burn patients is not true: A) burn of low temperature but long contact produces mild injury, B) epithelium (outer layer of skin) is intact with erythema (redness of the skin), C) every burned patient must receive tetanus vaccination, or D) any burn affecting the face should be referred to a burn unit?

Incorrect Statement About Burn Patients

The incorrect statement is A: Burn of low temperature but long contact produces mild injury.

Understanding Burn Classification and Management

Burns are classified based on their depth and severity:

1. First-degree burns (superficial burns):

   • Involve only the epidermis
   • Characterized by erythema (redness) with intact epithelium
   • Example: Mild sunburn
   • This corresponds to option B, which is correct: "Epithelium is intact with erythema" 1

2. Second-degree burns (partial thickness):

   • Involve epidermis and part of dermis
   • Characterized by blisters, pain, and redness
   • Can be superficial or deep partial thickness

3. Third-degree burns (full thickness):

   • Destroy entire epidermis and dermis
   • Appear leathery, dry, and may be white, brown, or charred
   • No sensation due to destruction of nerve endings

Why Option A is Incorrect

Burns caused by low temperature but long contact actually produce severe injuries, not mild ones. This is because:

• The duration of contact significantly affects burn depth and severity
• Prolonged exposure, even at relatively low temperatures, allows heat to penetrate deeper into tissues
• Examples include burns from heating pads, hot water bottles, or prolonged contact with hot surfaces

Regarding Other Options

Option C: Tetanus Vaccination

This statement is incorrect. Not every burned patient must receive tetanus vaccination. According to guidelines:

• Tetanus prophylaxis depends on the patient's vaccination history and wound characteristics
• For clean and minor wounds, a booster is only needed if the patient has not received tetanus toxoid within the past 10 years
• For all other wounds (including most burns), a booster is appropriate if the patient has not received tetanus toxoid within the preceding 5 years 1
• Patients with unknown or uncertain vaccination histories should be considered to have had no previous tetanus toxoid doses 1

Option D: Facial Burns Referral

This statement is correct. Any burn affecting the face should be referred to a burn unit because:

• Facial burns carry risks of airway compromise
• They may lead to significant functional and cosmetic impairment
• Special expertise is required for optimal management
• Facial burns are considered a criterion for referral to specialized burn care

Clinical Implications

When treating burn patients:

• Assess burn depth and extent carefully, recognizing that prolonged contact, even at lower temperatures, can cause severe injury
• Evaluate tetanus immunization status and provide prophylaxis based on wound characteristics and vaccination history, not universally
• Refer facial burns to specialized burn units for optimal management
• Document epithelial integrity as part of your assessment, as this helps determine burn classification

Common Pitfalls to Avoid

• Underestimating the severity of burns caused by prolonged contact at lower temperatures
• Administering unnecessary tetanus vaccinations without considering patient history and wound characteristics
• Failing to refer facial burns to specialized care
• Misclassifying burns based solely on appearance without considering mechanism of injury