It’s cold out and people are trying to warm themselves up by any means necessary. In the Emergency Department that means you may end up seeing some burns. It is important not only to assess these burns, but also determine what percentage of the body surface area is superficial versus partial AND full thickness. Wait a second… Aren’t we supposed to specify the percentage of second and third degree burns. yeah, that’s technically true as well, but the terminology has changed and thus I wanted to make sure that everyone was up to date.
Before we get in to staging, let’s look at the major tenets of burn first aid:
- Remove of clothing
- Wash off chemicals
- Cover the burn with a clean dry sheet – it’s OK to put a cold wet compress on small burns, but not for large burns. This can lead to hypothermia. Do not use butter.
Again, burns were formerly classified by degree, now the emphasis is placed on burn depth:
Formerly known as First Degree Burns
Involve only the epidermis. The skin is red, dry and blanches with pressure. There is minor swelling and pain but no blisters. Resolution by 5–7 days. A good example is a sunburn.
Superficial Partial Thickness
Formerly known as Second Degree Burns - but to better differentiate between deeper partial thickness burns it was broken off into its own subgroup.
These involve the epidermis and dermis and thus form blisters within 24 hours. A burn initially thought to be superficial may actually be partial thickness since these blisters might not initially be there. They are painful, red, weeping and blanching. Healing can take 1-3 weeks, usually without scarring.
Formerly known as Second Degree Burns
These burns extend down to the deep dermis injuring hair follicles and glands. They are painful to the touch and form easily unroofed blisters. The skin is mottled and non-blanching. These take 3 to 9 weeks to heal and generally leave hypertrophic scars
Formerly known as Third Degree Burns
These result in the destruction of the entire dermis and underlying subcutaneous tissue. Sometimes painless (damaged nerves). The skin is dry, waxy and white/gray. There are no blisters and the skin is non-blanching. If the eschar that encircles a limb or digit it can lead to strangulation. Skin grafting is required.
From Wikipedia.com – One week old Deep Partial Thickness Burn
These burns are deep and potentially life threatening. They extend to muscle, fascia and/or bone and the damaged tissues need to be excised because they are dead.
Measurement of burn surface areas follows the rule of nines (> 14 years old):
- Head and neck: 9%
- Each upper limb: 9%
- Thorax and abdomen, front: 18%
- Thorax and abdomen, back: 18%
- Perineum: 1%
- Each lower limb: 18%
Rule of palm (< 10 years of age):
Child’s palm not including fingers = 1% body surface area. More useful in smaller burns. Children have a proportionally larger head – thus it represents 18% BSA in infants and small children.
A final point – take a good history – many burns have a great story behind them.
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