Pavement Burns

dok_zlo — 24.04.2025

The Images in Clinical Medicine featured in this issue of the Journal spotlight some of the effects of the climate crisis on clinical health.
A 56-year-old man with a history of alcohol use disorder was transferred to a burn center for management of burns on his feet. The patient had walked barefoot on asphalt for 1 minute while he was intoxicated. The injury had occurred during the 2021 Pacific Northwest heat dome, a heat wave during which maximum air temperatures reached 42°C (108°F), approximately 21°C (38°F) above historical averages. On physical examination, the patient was in severe pain. He had unroofed blisters with oozing and erythema on the soles of both feet, on the plantar surfaces of the toes of the right foot, and on the heel of the left foot. An intact blister was also present on the right heel. A diagnosis of second-degree pavement burns was made. Extreme heat events increase the risk of contact burns from hot surfaces in the environment. Young children, older adults, unhoused persons, and persons with substance use disorder are at elevated risk for these types of burns. The patient was admitted to the burn unit. He received treatment with an analgesic agent, wound débridement, bacitracin, and an antimicrobial foam dressing. At an 18-day follow-up visit, the patient’s burns were healing without complications.
Author: Jeremy J. Hess, M.D., M.P.H.
Published April 19, 2025
N Engl J Med 2025;392: e40
VOL. 392 NO. 16

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