From the Guidelines
A physical exam of a burn should assess the burn's depth, size, location, and any associated complications, prioritizing the identification of life-threatening conditions such as inhalation injury or compartment syndrome. Begin by noting the burn's appearance: first-degree burns appear red and dry without blisters; second-degree burns show blisters, moisture, and significant redness; third-degree burns look white, leathery, or charred with no sensation due to nerve damage, as described in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Measure the burn size using the "rule of nines" or palm method (patient's palm equals approximately 1% of body surface area). Document the burn's location, particularly noting involvement of face, hands, feet, genitalia, major joints, or circumferential burns, as these areas require special attention. Assess for signs of inhalation injury such as singed nasal hairs, carbonaceous sputum, or respiratory distress. Check for associated trauma, especially in electrical burns where internal damage may exceed visible injury. Evaluate circulation distal to the burn, particularly in circumferential burns which may cause compartment syndrome. Note any signs of infection including increased pain, redness beyond burn margins, purulent discharge, or fever.
When covering the burn, use a nonadherent bandage or clean cloth to protect the wound and reduce pain, as recommended in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach ensures proper burn classification and guides appropriate treatment decisions based on burn severity. The management of severe thermal burns in the acute phase should prioritize resuscitation over wound care, and wound care should be performed in a clean environment with deep analgesia or general anesthesia, as outlined in the management of severe thermal burns in adults and children 1.
Key considerations in the physical exam of a burn include:
- Assessing the burn's depth, size, and location
- Identifying associated complications such as inhalation injury or compartment syndrome
- Evaluating circulation distal to the burn
- Noting any signs of infection
- Covering the burn with a nonadherent bandage or clean cloth to protect the wound and reduce pain.