Burn Classification and Depth of Injury

Burn Classification and Depth of Injury

Introduction

• Burn injuries are classified based on the depth of tissue damage.
• This classification is crucial for determining treatment and long-term outcomes.
• The skin consists of three main layers: epidermis, dermis, and subcutaneous tissue.
• Burn severity depends on the depth of damage to these layers.
• Healthcare professionals must accurately assess burn depth to provide appropriate wound care, pain management, and fluid resuscitation.

First-Degree Burns (Superficial)

• Affects only the epidermis (outermost layer of skin).
• Appearance: red, dry, and blanches with pressure (turns white when pressed).
• Hallmark symptom: Pain.
• No blistering.
• Self-limiting and heal within 3-6 days without scarring.
• Treatment:
  • Supportive.
  • Hydration.
  • Soothing lotions (e.g., aloe vera).
  • Pain relief (NSAIDs or acetaminophen).
• Example: Mild sunburn (reddish hue of the skin after sun exposure).

Second-Degree Burns (Partial Thickness)

• Extends beyond the epidermis and affects part of the dermis (middle layer of skin).
• Appearance: red, moist, and blisters.
• Blisters may rupture, exposing raw and painful tissue.
• Blistering occurs at the junction between the epidermis and dermis.
• Pain is more intense due to exposed nerve endings in the dermis.
• Healing typically takes 2-3 weeks.
• Superficial second-degree burns may heal without scarring, but deeper burns can cause pigmentation changes or mild scarring.
• Treatment:
  • Topical antibiotics.
  • Non-adherent dressings.
  • Pain management.
  • Infection prevention.

Third-Degree Burns (Full Thickness)

• Extends through the epidermis, dermis, and reaches the subcutaneous tissue.
• Appearance: white, leathery, or charred; do not blanch.
• Key finding: Absence of pain in the burn area due to destroyed nerve endings.
• Surrounding areas may still be painful.
• Healing usually requires skin grafting, as full-thickness burns do not regenerate on their own (basal layer is destroyed).
• High risk of infection, fluid loss, and complications, especially over joints with high range of motion.

Key Considerations for Exams (INPLEX)

• First-degree burns: symptomatic care only.
• Second-degree burns: require dressing changes to prevent infection.
• Third-degree burns: usually need medical intervention and will not heal on their own.
• Lack of pain in a severe burn suggests deep nerve damage.
• Fluid resuscitation is a priority intervention, especially in extensive burns.
• Parkland's formula will be discussed in a separate video (common tested concept).