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 aid for burns

First aid should be given after evaluating the extension of the burn and the condition of the person. Determination of the depth of seriousness of the most affected part is necessary before treating the burn accordingly. In case of doubt, it is better to treat it as a serious burn. Try to minimize the severity of the burn by giving first aid before the arrival of professional medical help. Prevention of disability, scarring and deformity is possible by providing prompt medical attention. Especially, when burns occur on the hands, feet, face and genitals, they can be serious. Small children under the age of four and adults over 60 run the risk of complications and even death due to burns.

Immerse or bathe the affected area with cold water for at least 10 minutes if the burns are due to friction or if it is a dry burn. Restricting clothing and jewelry should be removed before the place starts to swell. Sterile dressing of clean, non-fluffy material should be used to cover the area. Since the burn may cover a larger area, usage of adhesive dressings is not advisable. Risk of infection is more if you apply any cream or oil. Breaking the blisters will unlock the area to infection. Injured area should be kept clean and treatment should be given for any possible infection. Some of the indicators of infection are fever, swelling, redness and pain. If redness begins to spread or enlarges, it is cause of concern for infection.

Cold Burn

Cold burn or Frostbite occurs when the skin is in touch with an extremely cold body. Extreme cold can cause damage to the skin and underlying tissues. For example, if there is a prolonged contact of the skin with moderately cold body like snow or very cold bodies like dry ice, liquid helium or liquid nitrogen for a brief period, cold burns or ice burns will occur. Here heat is transferred from the skin and organs to the cold body that is in contact. In other kinds of burns, the body that causes the burn is hotter and heat is transferred to the skin or the organ.

Symptoms of frostbite include pins and needles sensation and then numbness in the area. Initially there may be throbbing or aching. The affected part seems to become insensate. In severe frostbite, when the tissue starts to freeze, the skin at that area may appear white and numb. In areas affected by frost burn, abnormal accumulation of blood takes place. In addition to accumulation of body fluids, a blood clot may form thereby preventing blood circulation around the area resulting in tissue decay. Mottled and violaceous tissue is noticed. Normal functioning of the body is disturbed because of cooling of the internal organs, which will lead to a critical condition called hypothermia. Cooling of the brain or heart is very dangerous.

The accumulated plasma in the blister is intended to prevent further damage and also to help in the healing process. To avoid infection from the blister, it is important that it is not punctured as it would expose the raw skin for further infection. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

Severe frostbite may also damage tendons, muscles, nerves and bones. Gangrene is inevitable in the case of very severe frostbite. Frostbite may affect any part of the body.

The most vulnerable parts are hands, feet, nose and ears. Recovery may be significant when the skin and underlying body tissues are injured and it may be permanent if there is injury to the blood vessels. If gangrene follows, the affected part may have to be amputated. When warming up of the affected part begins, the patient will experience intense pain. There will be tingling or burning sensation in the affected area also.

People taking beta-blockers that decrease blood flow to the skin and those who suffer Peripheral Vascular Disease are at risk when exposed to cold for a prolonged period. Any person who is exposed to extreme cold for a long period is susceptible to frostbite. Diabetes, peripheral neuropathy or Raynaud's phenomenon are some conditions that may have increased risk of cold burns. Smoking and windy weather when the rate of heat loss from the skin is more will hinder the healing process. Cold burns at the work place are common. People who work in factories where they may come in contact with metal surfaces that are at extremely cold temperatures are prone to cold burns. When the skin is moist, they may receive almost instantaneous cold burns.

Prevention of freeze burns

Extreme cold, wet clothes, high winds and poor circulation are some of the factors that can contribute to freeze burns. Tight boots or clothing and conditions like cramped positions, some medications, smoking or alcohol can cause frostbite. Wearing appropriate clothing in winter when the temperature goes below normal and will help. Winter clothes like mittens, layered clothing that is wind-proof and water resistant gives good protection.

First Aid for cold burns

It is essential that the ice burn treatment is correctly done as soon as possible.

• If you anticipate prolonged exposure to cold, avoid alcohol or smoking and take sufficient food and rest. Increase physical activity that maintains body temperature and find shelter in a snowstorm as early as possible.
  
  
• Victims should be moved to a warmer place to give shelter from the cold. Constricting jewelry and wet clothes should be removed. If there are symptoms of hypothermia, treat it immediately.
  
  
• Wrap the affected areas using sterile dressings. Dressings should be done after separating affected fingers and toes.
  
  
• In case immediate care is unavailable, you can go for re-warming first aid. This can be done by immersing the affected parts in warm water. Otherwise repeated application of warm clothes to injured ears, cheeks or nose for 20 to 30 minutes helps. Water temperature should be kept between 104 to 108 degrees F. To aid the warming process, the water should be kept circulating. During the warming process, swelling, color changes and severe burning pain may be noticed. The wound will heal when there is a slow heat transfer from water to the affected part.
  
  
• The frost bitten areas should be dressed with dry, sterile dressings. Remembering to keep the fingers or toes separated is important.
  
  
• Thawed areas should not be moved as far as possible.
  
  
• In case of extensive freeze burns, giving warm drinks to the victim helps in replacing lost fluids.
  
  
• Wet clothing must be removed and replaced with warm clothing.
  
  
• Until you reach a warm and safe location, do not go for re-warming process. There is the danger of severe damage because of re-freezing of thawed extremities.
  

Frostnip is the least severe form of cold injury that occurs after the distal extremities are exposed to prolonged period of cold but non-freezing temperatures. Vasoconstriction is felt. Frostnip is a precursor to frostbite and does not involve the same levels of tissue destruction. The affected area appears pale.

Immersion foot is a condition where there is severe tissue injury due to prolonged and persistent exposure to wet conditions, cold or hot. It results in tissue edema and inflammation. This is often seen in homeless persons who are exposed to the elements. The extremities appear swollen and erythematous (skin turning red often manifested in patches). Bad odor is often noticed as also tissue sloughing.