Second Degree Burns

When the epidermis and part of the dermis of the skin are involved in any burn injury, it is known as a second-degree burn. Depending on the level of nerve involvement, the severity of the pain varies in second-degree burns. In the case of second-degree burns, in addition to superficial blistering, there is accumulation of clear liquid in the area. Involving superficial or papillary dermis, second-degree burns sometimes involve the reticular or deep layer of the dermis.

When the skin experiences any burn or surface damage, the surrounding layer of the skin expands resulting in a blister. The Plasma or serum is released as the result of the damaged Keratinocytes - outermost layer of the skin. The released plasma /serum helps to prevent further damage and also to help in the healing process. This is the reason why blisters should not be punctured as it would invite infection to the affected skin. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

According to the severity of these burns, they are further classified as deep or superficial. When only the outermost part of the dermis is involved, it is called superficial. Extreme pain and hypersensitivity to touch are characteristics of superficial burns. Appearing moist and red or mottled pink in color, the skin at the area of the burn blanches on pressure. Usually blisters appear after some time. Normally, this kind of superficial second - degree or partial thickness burns heal by themselves.

Blood Blister : This ensues when a part of the skin is pinched or crushed with force. The capillaries affected by the force rupture leaking blood into the skin.

Tissue destruction to the deeper layers of the dermis is involved in deep second - degree and deep partial thickness burns. In contrast to the superficial type, these deep second -degree burns are usually dry and whitish in appearance, but they may appear like superficial burns. Normally pain is associated with this type of burns, though the skin does not blanch. It may take three to four weeks for the burn to heal. Thick or hypertrophic scars may remain even after the injury heals.

Causes of a second-degree burn include scald injuries, flames and a brief contact of the skin with a hot object. Sometimes deep sunburn, contact with hot liquids or chemicals and burning gasoline or kerosene also may cause second-degree burns. With second degree burns, the skin color turns to deep red and you will notice blisters. The burnt area appears shiny and moist. Second-degree burns that are only superficial normally heal in about three weeks. Care should be taken to keep the wound clean and protected. For effective treatment of second degree burns, the following conditions are considered:

• The medical history, overall health and the age of the patient
  
• To what extent the burn has damaged the skin
  
• Site of the burn
  
• Incident that caused the burn
  

Person affected by burns of this type may go into shock, since they lose lots of fluid from the burned site, if the injury involves more than 10% of skin. If a second-degree burn is greater than 2 or 3 inches in diameter, only a medical professional should treat it. It is safe to treat a burn like this at home only when it is a smaller. According to the severity of the burn, treatment may vary from antibiotic ointments to systemic antibiotics. Every day cleaning of the wound is necessary to remove dead skin. Depending on the severity of the burn, the dressing should be changed at least once or twice a day. It may be painful for the patient when the dressing is changed. A pain reliever or analgesic will help to reduce the pain. Care should be taken not to burst any blisters that have formed.

First Aid for second-degree burns

• Before the area begins to swell, tight clothing and jewelry should be removed.
  
• Cold-water compresses like a wet towel can be applied or flushing the burn with cool running water may also help to lessen the pain. Using ice or ice water can do more harm to the burned area and should be avoided.
  
• Do not try to burst the blisters. Breaking blisters will expose the skin which will lead to infection.
  
• Covering the burn with a sterile, non-fluffy and dry bandage can be done, but tapes should not be used on top of it.
  
• Ointments, grease, petroleum jelly, butter or any home remedies are better avoided.
  
• By keeping the burned arms or legs raised, you can reduce swelling.
  
• Getting medical help is the best for second-degree burns greater than 2 to 3 inches in diameter or for those on hands, buttocks, penis or vaginal region.

When there are open blisters following second-degree burns:

• If the clothing is stuck to the burn, better not remove them.
  
• Running water over the burn or using water on the bandage will increase the risk of shock and so do not do it.
  
• You can cover the burn with a clean, dry, non-fluffy bandage like gauze pad, but do not use tapes on the bandage.
  Get the help of a doctor if the burn is very extensive and more than 2 to 3 inches in diameter.
  

First Degree Burns

Burns are classified as first-degree burns, second-degree burns and third-degree burns according to their severity. In the case of first-degree burns, only the outer layer of the skin is affected. Swelling, pain and redness is the resulting discomfort caused by this type of burns. Dry heat like fire, wet heat such as steam or boiling liquids, heated objects, sun, chemicals, electricity and friction accidentally become the causes for burns. When hot metals, scalding liquids, flames or steam accidentally gets into contact with one's skin, thermal burns occur. They can also occur due to fire and automobile accidents, electrical malfunctions and space heaters. Unsafe handling of firecrackers and kitchen accidents are some of the other causes for thermal burns. Inhaling smoke, steam, toxic fumes and superheated air in a badly ventilated space can cause burns to the airways.

The severity of the burn is not directly proportional to the degree of pain. The most serious burns often occur with less pain. Blisters occur at the place of the burn. There will be peeling of the skin and it will turn red. Pale and clammy skin, weakness and drop in alertness are often noticed with the shock due to burns. Lips and fingernails may turn blue due to shock. Swelling and white or charred skin also are some of the symptoms. If burns affect the airways, the symptoms may vary from charred mouth, burned lips, wheezing and difficulty in breathing. There may be a change in voice of the patient. A dark, carbon-stained mucus will ooze out from the place of the burn. Sunburn can be classified as a first-degree burn.

Fourth Degree Burns

The medical community is still debating about the existence of fourth-degree burns or if it is just sufficient to have a three tired classification system. Fourth-degree is generally used when the injury is due to electrical burns and irreparable. Normally muscle tissue, tendons and bones are damaged permanently in fourth -degree burns. Bone and cartilage damage only are taken into account to define fourth-degree burns by some.

Hospitalization is very important for fourth-degree or transmural burns. Amputations of extremities or surgical interventions may be necessary during hospitalization. Fourth-degree burns may lead to death in some cases and hence the burn victim should be rushed to a medical treatment facility or a burn unit as soon as possible.

Fourth-degree burns are also considered as full thickness burns. Involving destruction of all the epidermal and dermal layers, fourth-degree burns can extend down to the subcutaneous tissue. Since the nerve endings have been destroyed, full thickness burns are not painful. With fourth-degree burns, the bone is burnt. Skin grafting is required in the case of third and fourth-degree burns.

When burns involve tissues like muscles or bones that underlie the skin, they are called fourth-degree burns. In addition to this fourth-degree burns are further classified into three additional degrees. If the skin is irretrievably lost, it is known as fourth-degree burn; when there is irretrievable loss to the muscles, it is called fifth-degree burn; and when the bone is charred, it is categorized as sixth-degree burn.

Ascertain whether the person is breathing or not, while you are waiting for the arrival of paramedics. If the person is not breathing, a gentle attempt of CPR will help. Since the person has lost large amount of water and there may be dehydration, if the person is able to drink and is breathing normally, you can administer little water. It will make them recover their body. It may not be easy for you to keep them comfortable, but if it is possible for you to keep them conscious till the arrival of assistance, their chances of survival will improve.