Degree of Burns

First-Degree Burns or Superficial Burns

• Appearance: Similar to sunburn – painful, dry, swollen, erythematous without blisters & involves only the epidermis
• Not included in estimates for fluid resuscitation
• Hospitalization not required; pain resolves in 48-72 hours, peels off without residual scarring in 2-5 days

Second-Degree Burns or Partial-Thickness Burns

• Appearance: Moist blebs, formation of vesicle & blister; underlying tissue is mottled pink & white with good capillary refill; this involves the entire epidermis & a variable portion of the dermal layer
• Considered significant burns & are counted in burn size estimates
• Subclassification
  
  • Superficial:
    
    • Extreme pain attributed to a large number of remaining viable nerve endings exposed
    • Re-epithelialize in 7-14 days in the absence of infection
  • Deep
    
    • Pain is less because fewer nerve endings remain viable; fluid losses & metabolic effects are similar to those of third-degree burn
    • Heals in 21-35 days if without infection; converts to full thickness burns if with wound infection, some may require grafting

Third-Degree Burns or Full-Thickness Burns

• Appearance: Dry, leathery eschar, mixed white waxy, khaki, mahogany, soot-stained
• Involves the entire epidermis & dermis, leaving no residual epidermis cells, may include fat, subcutaneous tissue, fascia, muscle & bone
• No pain sensation & capillary filling
• Wound cannot epithelialize, heals only by wound contracture or skin grafting
• The difference in the growth rate of the head & extremities throughout childhood makes it necessary to use surface area charts
  • The “rule of nines” used in adults is applicable only to children >14 year or as a very rough estimate to initiate therapy before transfer to a burn unit
• In small burns <10%, the “rule of palm” (area from the wrist crease to finger crease in the child) may be used
  • This equals 1% of the child’s body surface area (BSA)
• Calculation of the fluid for resuscitation depends on the total BSA involved in the burn injury

Lund & Browder Classification

Relative percentage of body surface area affected by growth

• A brief, accurate history must be obtained from guardian upon presentation of the patient
  
  • Determine the time of injury, causative agent & type of burn, any first aid measures done, patient’s associated medical problems, & vaccination status
• Stop the burning process by applying cold water on burned area & removing smoldering clothing or clothing saturated with hot liquid or chemicals
•  Assess degree, site & extent of burn

• All trauma patients will have their own specific radiologic & laboratory examinations depending on the involved organ during the injury

• General
  • Complete blood count (CBC)
  • Serum electrolytes
  • Blood glucose
  • Blood urea nitrogen (BUN)
  • Creatinine (Cr)
  • Clotting factor tests
  • Blood typing & cross-matching
  • Urinalysis
  • Arterial blood gas (ABG)
• Inhalational injuries
  • Chest X-ray
  • Carboxyhemoglobin levels
• Inhalational injuries
  • 12-lead electrocardiography (ECG)
  • Cardiac enzymes