Holaday & McPhearson (2017) describe a burn as a trauma to the skin or its underlying tissues caused by exposure of the skin to extreme conditions of heat, cold, radiation, chemicals, or high voltage. The severity of injuries depends on the duration of exposure and the degree of extreme conditions. Medical practitioners categorize burn injuries as either superficial, partial-thickness, third-degree or complete burns depending on the extent of intrusion into the skin tissue and size of the injury.
First-degree/Superficial Burns
First-degree/superficial burns damage the epidermis, producing superficial redness, inflammation, tingling sensations. In most cases, superficial burn injuries do not cause scarification or blistering of the skin since they result from minimal exposure to chemicals, radiation, heat, or cold. Even without treatment, this type of injury can disappear in a matter of three to four days (Lynn & Namias, 2019).
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Second-degree Burns
Exposure of the skin to extreme conditions for a considerable duration of time causes damage to the epidermis and underlying dermal layer. If the burn does not affect the subcutaneous layer of the skin, it is known as a second-degree burn. Conventionally, this type of burn causes blistering and severe inflammation of the skin, which subsequently results in the scarification of the affected tissue. Partial-thickness burns take between eight and nine weeks to heal completely (Lynn & Namias, 2019).
Third-degree/Partial-thickness Burns
Full-thickness burns are relatively serious burn injuries that affect the epidermal, dermal, and subcutaneous layer of the skin. This injury results from prolonged exposure of the skin to extreme condition. In most cases, third-degree burns destroy the nerve-endings and blood vessels in the affected area, causing delocalized numbness and rigidity. The burn site also becomes exposed to tetanus and other infection. In isolated cases, third-degree burns cause shock due to loss of electrolytes and fluids in the body (Evans, Purnell, Robinett, Batchelor, & Martin, 2018).
Signs and Symptoms
Typically, the depth of a burn determines the characteristics of the injury. First-degree burns often cause moderate pain and redness that lasts between one to three days. After a few days, the damaged section of the skin may peel or become discolored. Patients with first-degree burns may experience tenderness on the skin and slight fever at night (Evans, Purnell, Robinett, Batchelor, & Martin, 2018).
Partial-thickness burns are relatively more severe and highly distinct. They cause extreme redness and blistering of the skin, which subsequently causes acute pain and discomfort. The appearance of the burn may be white or yellow with minimal blanching. The injury often causes hyperpigmentation of the skin as the wound heals. According to Lynn & Namias (2019), it takes up to nine weeks for a second-degree wound to heal completely. However, there might be variations. The time of healing depends on the location and extent of burn injury into the skin. Joint burns take extended periods to heal due to regular movements that destruct the healing tissue.
Full-thickness burns are often raised and have a leathery texture. They are distinct from the other types of injuries due to their dark brown color, which indicates hemorrhage underneath the skin. Third-degree burns, in most cases, do not cause blistering of the skin or swelling. Instead, the injuries make the skin rigid and light to touch. Third-degree burns caused by radiation often cause the formation of spots around the affected area and severe cell necrosis. Since full-thickness burns extend to all layers of the skin, they may predispose a patient to sepsis, skin infection, pneumonia, or tetanus.
Treatment
Superficial burns do not require medical intervention since they are mild and easy to manage. Home remedies can be used to relieve pain and redness on the skin immediately after exposure. First-degree injuries heal faster if they are treated as soon as they occur. Homecare treatment involves soaking the affected area of the skin in cool water for more than ten minutes. If the burn causes moderate to intense pain and discomfort, a person can take paracetamol or ibuprofen to relieve the pain. Neosporin or Bacitracin ointments can be applied over the affected area to prevent infection on the skin (Garside, Lee, Delaney, & Milliss, 2018).
Morphine and other mild opioids can be taken to relieve second-degree burn pain. In case a patient experiences anxiety and panic attacks, the doctor should administer benzodiazepines together with analgesics as suggested by Garside et al. (2018). Antibiotic ointments can also be applied over the burned area to prevent fungal infections on the affected area of the skin. As the wound heals, nerve stimulation and antihistamine administration can help to reduce itching and the tingling sensation experienced during the healing process. Patients who are unresponsive to antihistamines can be given gabapentin to reduce itching around the affected area.
Since third-degree burns cause extensive damage to all layers of the skin, more advanced clinical interventions are required to promote healing. According to Garside et al. (2018), recombinant human growth hormone (rhGH) therapy facilitates the rapid replacement of damaged skin cells. In other cases, surgical closure may be necessary to replace damaged tissue if the extreme conditions caused extensive nerve-ending and blood vessel damage. The surgical procedure involves the replacement of dead tissue with tissue grafts from other locations on the body. If a third-degree burn occurs on the scalp, hair transplants may be needed to replace lost hair follicles.
Tests
Visual examination can be used to diagnose thermal and chemical burns. However, biopsies are required for laboratory examinations in cases of electricity and radiation burns. Carbon monoxide and cyanide poisoning tests should also accompany the fire-related burn examination, as suggested by Evans et al. (2018). In the case of chemical burns, blood samples obtained from the patient should be subjected to toxicological tests to ascertain the chemical, which caused the trauma. X-rays can be used to detect burns along the respiratory tract caused by caustic aerosols or fumes.
References
Evans, E. I., Purnell, O. J., Robinett, P. W., Batchelor, & Martin, M. (2018). Fluid and electrolyte requirements in severe burns. Ann Surg , 135 (6), 804-817.
Garside, T., Lee, R., Delaney, A., & Milliss, D. (2018). Clinical practice variation in an acute severe burn injury. Anesthesia and Intensive Care, 46(3), 321.
Holaday, M., & McPhearson, R. W. (2017). Resilience and severe burns. Journal of Counseling & Development , 75 (5), 346-356.
Lynn, M., & Namias, N. (2019). Burns Mass Casualty Incident. In Disasters and Mass Casualty Incidents (pp. 67-69). Springer, Cham.
