Citation

Teicher EJ, Blome-Eberwein S, Lozano DD, Howard PA. Inj. Extra 2008; 39(6): 222-224.

Affiliation

Department of Surgery, Lehigh Valley Hospital, Allentown, PA, United States (sally.lutz@lvh.com)

Copyright

(Copyright © 2008, Elsevier Publishing)

DOI

10.1016/j.injury.2007.11.012

PMID

unavailable

Abstract

Internal burns resulting from thermal injury are not well documented in the literature. Thermal burns are categorized as first, second, and third degree based on depth, however, those burns that extend into deeper tissues have not had such a clear classification. Fourth degree burns are defined as injury extending to the subcutaneous fat, muscle, or bone. Although cutaneous second and third degree burns can be mapped to yield a percentage burn, this does not adequately describe the deeper tissue damage in a given burn patient. There have been very few reports of diffuse deep tissue burns resulting from thermal injury. We will refer to this as internal thermal injury.

A 47-year-old male fire fighter was involved in a training exercise and was found unresponsive. This patient had been in the basement of a facility specially designed for fire fighter training exercises where he was found unconscious with an estimated exposure time of 8 min. The patient expired in cardiac arrest within 24 h of presentation.

The physiological impact of high ambient temperatures on fire fighters has been well documented in the literature. Internal thermal injury was suspected given the history. Values assessed in training buildings, such as the one in which the patient was found, showed temperatures of 50-130 degrees C on the ground and 100-190 degrees C at 1 m above the ground. Temperatures of over 278 degrees C had been recorded within training buildings. Pain threshold is reached at a skin temperature of approximately 44 degrees C, and burn injury can occur at lower temperatures, depending on time of contact. Skin temperatures of fire fighters were found to range from 39 to 45.5 degrees C and core temperatures were measured by a miniature sensor in the form of a pill and were found to rise by 0.6-1 degrees C in 1 h within a training building. Therefore, it is possible that fire fighters undergo internal thermal injury before the sensation of cutaneous burn injury may be perceived. Kevlar is a material found in fire fighting gear and has been documented to have a degradation temperature of 520 degrees C. Kevlar can withstand high environmental temperatures; however, a great number of thermal injuries are due to an overheating of the body regardless of the thermal properties of Kevlar.