Classification and external resources|
Second-degree burn of the hand|
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin (epidermal tissue and dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an out-of-hospital setting, or may require more specialized treatment such as those available at specialized burn centers. Managing burn injuries properly is important because they are common, painful and can result in disfiguring and disabling scarring, amputation of affected parts or death in severe cases. Complications such as shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress may occur. The treatment of burns may include the removal of dead tissue (debridement), applying dressings to the wound, fluid resuscitation, administering antibiotics, and skin grafting. While large burns can be fatal, modern treatments developed in the last 60 years have significantly improved the prognosis of such burns, especially in children and young adults. In the United States, approximately 1 out of every 25 people to suffer burns will die from their injuries. The majority of these fatalities occur either at the scene or on the way to hospital. * |
Sign and symptoms
Burns can be classified by mechanism of injury, depth, extent and associated injuries and comorbidities. By depth
Currently, burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third , and fourth degrees. This system was devised by the French barber-surgeon Ambroise Paré and remains in use today. It is often difficult to accurately determine the depth of a burn. This is especially so in the case of second degree burns, which can continue to evolve over time. As such, a second-degree partial-thickness burn can progress to a third-degree burn over time even after initial treatment. Distinguishing between the superficial-thickness burn and the partial-thickness burn is important, as the former may heal spontaneously, whereas the latter often requires surgical excision and skin grafting. The following tables describe degrees of burn injury under this system as well as provide pictorial examples. Names| Layers involved| Appearance| Texture| Sensation| Time to healing| Complications| Example| First degree| Epidermis| Redness (erythema)| Dry| Painful| 1wk or less| Increased risk to develop skin cancer later in life| | Second degree (superficial partial thickness)| Extends into superficial (papillary) dermis| Red with clear blister. Blanches with pressure| Moist| Painful| 2-3wks| Local infection/cellulitis| | Second degree (deep partial thickness)| Extends into deep (reticular) dermis| Red-and-white with bloody blisters. Less blanching.| Moist| Painful| Weeks - may progress to third degree| Scarring, contractures (may require excision and skin grafting)| | Third degree (full thickness)| Extends through entire dermis| Stiff and white/brown| Dry, leathery| Painless| Requires excision| Scarring, contractures, amputation| | Fourth degree| Extends through skin, subcutaneous tissue and into underlying muscle and bone| Black; charred with eschar| Dry| Painless| Requires excision| Amputation, significant functional impairment, possible gangrene, and in some cases death.| | Cause
Burns are caused by a wide variety of substances and external sources such as exposure to chemicals, friction, electricity, radiation, and heat. Chemical
Most chemicals that cause chemical burns are strong acids or bases. Chemical burns can be caused by caustic chemical compounds such as sodium hydroxide or silver nitrate, and acids such as sulfuric acid. Hydrofluoric acid can cause damage down to the bone and its burns are sometimes not immediately...