Which of the following statements regarding burns is not universally true: A. Burn of low temperature but long contact produces mild injury, B. Epithelium is intact with erythema, C. Every burned patient must receive tetanus vaccination, or D. Any burn affecting the face should be referred to a burn unit?

Identifying the False Statement About Burns

The false statement is "A. Burn of low temperature but long contact produces mild injury" as low-temperature burns with prolonged contact can actually cause severe injuries, not mild ones. 1, 2, 3

Analysis of Each Statement

A. Burn of low temperature but long contact produces mild injury - FALSE

• Low-temperature burns with prolonged contact can cause severe injuries, contrary to what this statement suggests
• According to evidence, the depth of burn injury is determined by both temperature and exposure duration (time-temperature relationship) 2
• Research specifically on low-temperature burns indicates they can cause severe burn-like injuries with extended contact periods 3
• The rate of tissue damage increases logarithmically with temperature, but even at lower temperatures, prolonged exposure can lead to significant injury 2

B. Epithelium is intact with erythema - TRUE

• This accurately describes a first-degree burn
• First-degree burns are characterized by erythema (redness) with intact epithelium 1
• The American Burn Association guidelines recognize this as a characteristic of superficial burns 1
• Burn damage experimental work confirms that when skin reaches approximately 44°C, burn injury occurs but may only affect the superficial layers with erythema while leaving epithelium intact 2

C. Every burned patient must receive tetanus vaccination - TRUE

• Tetanus prophylaxis is a standard recommendation for burn patients
• Even patients with previous immunization may require tetanus prophylaxis, as demonstrated in case reports 4
• The risk of tetanus infection is significant in burn wounds due to potential contamination
• Current burn management guidelines include tetanus prophylaxis as part of standard care 1

D. Any burn affecting face should be referred to a burn unit - TRUE

• Burns involving the face are considered serious regardless of depth or size
• According to burn severity assessment criteria, burns affecting the face require immediate medical attention and referral to specialists 1
• The American College of Surgeons recommends referral to burn specialists for burns involving the face 1
• This is due to both functional and cosmetic concerns, as facial burns can affect vital structures and have significant psychological impact

Important Considerations in Burn Management

Burn Assessment and Classification

• Burn depth is determined by multiple factors including temperature, duration of exposure, and skin thickness 2
• Pain perception in adult human skin occurs just above 43°C, with burn injury occurring at 44°C 2
• Skin thickness affects burn depth, with children's skin being more susceptible to deeper burns at lower temperatures 2

Cooling Burns

• Active cooling is strongly recommended for thermal burns (strong recommendation, low-quality evidence) 5
• Optimal cooling involves using cold tap water (approximately 15°C) for 20 minutes 6
• Ice should not be used as it may worsen tissue damage 6
• Cooling can reduce burn depth and decrease the percentage of burns requiring hospital admission 5

Wound Care

• Keep blisters intact to maintain a sterile environment and reduce infection risk 1
• If necessary, blisters should be decompressed by piercing rather than deroofed, leaving the blister roof intact as a biological dressing 1
• Apply appropriate dressings based on burn depth and characteristics 1

Referral Criteria

• Burns requiring specialist referral include:
  • Burns involving face, hands, feet, genitalia, or perineum
  • Full-thickness burns
  • Burns exceeding 10% Total Body Surface Area (TBSA) in children
  • Burns exceeding 20% TBSA in adults 1

Remember that proper early intervention for burns, including appropriate assessment, cooling, wound care, and referral when indicated, significantly improves outcomes and reduces treatment duration 3.