An EMT Guide to Burn Assessment and Treatment
Your patient has been burned. You are going to have to make two important decisions and you may need to make them fast. First you’re going to need to decide the thickness or “degree” of the burn. Then you’re going to need to determine if the patient meets critical burn criteria.
You may not have a lot of time to put all this together. Your assessment of what does and does not constitute a critical burn will effect your decision to transport emergent or not. It can determine if you transport to a burn center and if the burn team is activated. In many rural areas, the decision to call advanced caregivers or fly a helicopter may all hinge on what you feel is a critical burn … and the determination may not always be that obvious.
Today we’ll begin a three part series on burn assessment. Here, we’ll take a look at identifying burn degree or thickness by appearance and in our next installment we’ll look at the factors that separate our critical burn patients from our moderate and lesser burns. In part three, we’ll talk about management of burn patients.
So what does burn thickness mean?
And what difference does it make anyway?
Burn thickness is important because the layers of the skin all have multiple functions. Your skin protects you, pads you and insulates you. It has the ability to growing new skin, regulate body temperature, growing hair, guard against infection and communicate with you brain about what your environment feels like. The supple flexibility of your skin allows you to move and breath.
How deep a burn penetrates through the layers of the skin determines which of these functions may be damaged and which of these functions may be lost forever. A close inspection of the texture, moisture, color and general appearance of a burn will give you important clues regarding what thickness or “degree” of burn the patient has suffered.
Superficial Burns (Formerly known as 1st degree burns)
• Superficial burns involve only the uppermost layer of the skin, also known as the epidermis. The epidermis is a thin layer of interlocked cells that coat the outer surface of the body. This thin coating of cells is what we traditionally think of when we reference the skin.
• The epidermis functions primarily as a protective layer. It protects us from infection and UV rays.
• Burns of the epidermis are red and painful. They do not tend to blister. Blisters are the first sign of damage to the dermal layer below the epidermis. The most typical variety of superficial burn is sunburn. Contact burns that redden and hurt but do not blister are also classified and superficial burns.
Partial – Thickness Burns (Formerly known as 2nd Degree Burns)
• Partial Thickness burns burn down into the dermal layer. The epidermis is destroyed and the dermis is damaged to varying degrees but the underlying subcutaneous issues remain uninvolved.
• The dermis is a fluid rich layer of skin beneath the epidermis. Within the dermis lay our nerve endings, pores, hair follicles and cells responsible for the growth and regeneration of skin. Depending on the depth of involvement, all of these functions become at risk.
• Without the intact epidermis, the skin tissues are no longer protected from UV light and, more importantly, bacteria. Partial and full thickness burns are at great risk for infection. Depending on the extent of dermal damage the patient may also loose the ability to sweat and, therefore, cool the body. If nerve endings are destroyed the patient will loose feeling in the region. Hair may no longer grow within the damaged area and if growth cells are destroyed, the skin will loose its ability to regenerate and heal. Patients with partial thickness burns are at danger for loosing some of the mobility in the body region affected.
• Partial thickness burns may be covered by the destroyed epidermal layer or open. If skin covers the burn it will be gray, wrinkled or blistered. Open burns will be red or white and appear moist.
Full-Thickness Burns (Formerly known as 3rd Degree Burns)
• Full thickness burns burn completely through the epidermal and dermal layer. All epidermal and dermal functions are lost at the burn area. These burns enter the subcutaneous fat layer and occasionally the muscle or bone.
• Full thickness burns appear waxy and dry. They will be white, brown or black and appear charred. The patient will not experience pain at the site of the full thickness but will likely feel intense pain in the partial thickness burn areas around the full thickness site.
In part two we’ll look at how to estimate burn area and rapidly decide if your patient meets the criteria for a critical burn classification. I’ll see you then.