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(figure 3-2) extend into, but not through, the second layer of skin (the dermis), giving
these burns the name "partial thickness." The color of the burn varies depending upon
its depth. Deep burns may be dark or pale and colorless. Burns of less depth may be
pink or red and blotchy. The sensitivity of these burns also varies, depending on the
depth of the burn. A superficial second-degree burn can be very painful and sensitive to
touch and air movement. A deeper second-degree burn can have normal or decreased
sensation to touch. A second-degree burn that is very deep may be hard to distinguish
from a third-degree burn and may have no sensation. The most common condition is
that the burn is very painful. Slight pressure or air movement causes intense pain.
Swelling and blistering occur for about 48 hours after the injury. Usually, second-
degree burns heal in 14 to 30 days, frequently without scarring.
Figure 3-2. Second-degree burn.
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c. Third-Degree Burn (Full Thickness Burn). Third-degree burns (figure
3-3) are also known as full-thickness burns because they involve the full thickness of
the epidermis and the dermis. The burns may look yellow-brown, dark red, charred, or
white and translucent. Those with red-colored areas will not blanch. The nerves in the
deeper layers of the dermis have been destroyed; therefore, unlike the first- and
second-degree burns, there is no pain or sensation in the burned areas. The skin is
dry, firm, and leathery. The burn has caused the skin to lose its normal elasticity, thus
restricting movement. A third-degree burn on a large part of the chest wall can limit
lung expansion. A third-degree burn around an arm or a leg can constrict blood flow.
These burns usually heal with scars or require skin grafts to heal. Unless the body
surface burned is small, a third-degree casualty requires hospitalization.
Figure 3-3. Third-degree burn.
NOTE: A burn that involves muscle or bone as well as subcutaneous tissue is
sometimes classified as fourth-degree burn. Electrical burns can damage
muscle or bone as the current travels through the body.
NOTE: Those areas of thermal injury that are waxy-white, soft and pliable, yet
nonpainful formerly were regarded as full-thickness injuries, but are really
deep partial-thickness burns. They frequently heal without the need for
grafting if protected from infection. Charring with thermal injury of
subcutaneous and deeper tissues is infrequent, but may occur in an
unconscious victim, in individuals sustaining high voltage electric injury, in
persons trapped by burning debris, or in occupants of a burning vehicle.
3-11. THERMAL BURNS: CRITICAL
Burns are classified according to severity as critical, moderate, or minor. The
following burns are classified as critical.
a. Burns complicated by respiratory tract injuries or other major injuries or
fractures.
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b. Third-degree burns involving the face, hands, feet, or genital area.
c. Third-degree burns that cover more than 10 percent of an adult's body.
d. Third-degree burns that cover more than 2-3 percent of a child's body.
e. Second-degree burns that cover more than 30 percent of an adult's body or
20 percent of a child's body.
f. First-degree burns that cover more than 75 percent of the body.
g. Burns of the hands, feet, or genitalia.
h. Most chemical burns.
i. Most electrical burns.
j. Burns in patients with serious underlying medical conditions such as diabetes,
seizure disorders, and hypertension.
k. Burns complicated by fracture or soft-tissue injury.
3-12. THERMAL BURNS: MODERATE
These following burns are classified as moderate.
a. Third-degree burns covering 2 to 10 percent of an adult's body and exclude
the face, hands, feet, and genital area.
b. Second-degree burns that cover between 15 and 30 percent of an adult's
body.
c. First-degree burns covering between 5 to 75 percent of an adult's body
surface.
d. Uncomplicated second degree burns covering 10 to 20 percent of a child's
body surface.
e. Minor burns that have complicating factors.
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3-13. THERMAL BURNS: MINOR
Burns like the following are classified as minor.
a. Second-degree burns covering less than 15 percent of the body in an adult.
b. Second-degree burns covering less than 10 percent of the body of a child.
c. First-degree burns involving less than 20 percent of the adult or child.
3-14. ADDITIONAL FACTORS IN THERMAL BURN ASSESSMENT
Consider these factors when assessing the criticality of a burn:
a. Irregular Burn Distribution. To estimate burns that are irregularly
distributed, use the fact that one surface of a casualty's hand represents about one
percent of his body surface.
b. Burns Over 15 Percent of the Body surface. Patients with burns of more
than 15 percent of the body surface typically require some resuscitative treatment.
These patients are best cared for in a hospital.
c. Location of the Burn. Burns of the face, hands, feet, or genitalia need
immediate treatment. Small burns on these areas may require hospitalization, even if
these limited areas are the only sites of burn injury. Transport such patients to a
medical treatment facility.
d. Configuration of the Burn. A burn which surrounds a body part may
completely cut off circulation due to tissues swelling. For example, neck burns can
result in airway obstruction and chest burns can cause breathing difficulty.
e. Complicating Medical Problems. Circulatory problems such as diabetes
and peripheral vascular disease affect burns.
f. Patient Age. Young adults tolerate thermal injury best. Those under four
years and over 60 years of age have more complications and a greater mortality rate for
the same extent of burn that a young adult survives.
g. Severity of Injury. The percent of burn and the depth of burn determine the
severity of burn injury. Usually, burns covering more than 20 percent of the body
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