Burns can range from minor to life-threatening. Understanding burn classification is crucial for proper treatment. This section covers burn degrees, depth assessment, and severity estimation using the Total Body Surface Area (TBSA) method.

Accurate burn assessment guides treatment decisions. First-degree burns affect only the outer skin layer, while deeper burns can damage underlying tissues. The Rule of Nines helps estimate burn severity, which is vital for determining fluid needs and overall patient care.

Burn Degrees

Superficial Burns

• First-degree burns involve only the epidermis, the outermost layer of skin
• Skin appears red, dry, and painful (sunburn)
• No blistering or skin breakdown occurs
• Typically heal within 3-5 days without scarring

Partial and Full-Thickness Burns

• Second-degree burns extend into the dermis, the layer beneath the epidermis
  • Partial-thickness burns cause blistering, severe pain, and swelling
  • Skin appears red, moist, and blanched when pressure is applied
  • Typically heal within 2-3 weeks with minimal scarring (superficial second-degree burns)
  • Deeper second-degree burns may require skin grafting and result in scarring
• Third-degree burns destroy the epidermis and dermis, extending into the subcutaneous tissue
  • Skin appears white, brown, or black and has a leathery texture
  • Pain sensation is lost due to nerve damage, but surrounding areas may be painful
  • Require surgical intervention, skin grafting, and result in significant scarring
• Fourth-degree burns extend beyond the subcutaneous tissue, damaging muscle, tendons, and bone
  • Most severe type of burn, often life-threatening
  • Skin appears charred or blackened, with possible exposed bone or muscle
  • Require extensive surgical intervention, debridement, and rehabilitation

Burn Depth

Assessing Burn Depth

• Superficial burns (first-degree) involve only the epidermis
  • Skin is red, dry, and painful, but no blistering occurs
  • Blanching occurs when pressure is applied, indicating intact capillary refill
• Partial-thickness burns (second-degree) extend into the dermis
  • Superficial partial-thickness burns cause blistering, severe pain, and swelling
  • Deep partial-thickness burns may appear mottled or have a waxy texture
  • Blanching may be absent or sluggish in deeper partial-thickness burns
• Full-thickness burns (third and fourth-degree) involve the epidermis, dermis, and deeper tissues
  • Skin appears white, brown, or black, with a leathery or charred texture
  • Pain sensation is absent in the burned area due to nerve damage
  • No blanching occurs when pressure is applied, indicating complete capillary destruction
• Accurate burn depth assessment is crucial for determining appropriate treatment and prognosis
  • Superficial burns can be managed with conservative measures (pain relief, moisturization)
  • Partial-thickness burns may require wound care, dressings, and monitoring for infection
  • Full-thickness burns require surgical intervention, skin grafting, and long-term rehabilitation

Burn Severity Assessment

Estimating Total Body Surface Area (TBSA) Burned

• Rule of Nines is a quick method for estimating the percentage of TBSA affected by burns
  • Body is divided into areas of 9% or multiples of 9% (head/neck 9%, each arm 9%, each leg 18%, etc.)
  • Percentages are adjusted for infants and young children due to different body proportions
  • Palmar surface of the patient's hand (including fingers) represents approximately 1% TBSA
• TBSA estimation is critical for determining fluid resuscitation needs and burn severity classification
  • Burns involving >20% TBSA in adults or >10% TBSA in children are considered major burns
  • Burns involving >30% TBSA are classified as severe and carry a high risk of complications
• Other factors influencing burn severity include age, comorbidities, and concomitant injuries
  • Extremes of age (young children, elderly) have higher morbidity and mortality rates
  • Pre-existing medical conditions (diabetes, cardiovascular disease) complicate burn management
  • Inhalation injuries, trauma, or circumferential burns increase the overall severity of the burn