be estimated by the depth, extent, and location of theburn, the age and health of the victim, and othermedical complications.Classification of SeverityBurns are classified according to their depth asfirst-, second-, and third-degree burns (as shown infigure 4-47).FIRST-DEGREE BURN.—With a first-degreeburn, the epidermal layer is irritated, reddened, andtingling. The skin is sensitive to touch and blancheswith pressure. Pain is mild to severe, edema isminimal, and healing usually occurs naturally within aweek.SECOND-DEGREE BURN.—A second-degreeburn is characterized by epidermal blisters, mottledappearance, and a red base. Damage extends intobutnot throughthe dermis. Recovery usually takes 2 to3 weeks, with some scarring and depigmentation. Thiscondition is painful. Body fluids may be drawn intothe injured tissue, causing edema and possibly a“weeping” fluid (plasma) loss at the surface.THIRD-DEGREE BURN.—A third-degree burnis a full-thickness injury penetrating into muscle andfatty connective tissues, or even down to the bone.Tissues and nerves are destroyed. Shock, with blood inthe urine, is likely to be present. Pain will be absent atthe burn site if all the area nerve endings are destroyed,and the surrounding tissue (which is less damaged)will be painful. Tissue color will range from white(scalds) to black (charring burns). Although thewound is usually dry, body fluids will collect in theunderlying tissue. If the area has not been completelycauterized, significant amounts of fluids will be lost byplasma “weeping” or by hemorrhage, thus reducingcirculation volume. There is considerable scarring andpossible loss of function. Skin grafts may benecessary.Rule of NinesOf greater importance than the depth of the burn inevaluating the seriousness of the condition is the extentof the burned area. A first-degree burn over 50 percentof the body surface area (BSA) may be more seriousthan a third-degree burn over 3 percent. The Rule ofNines is used to give a rough estimate of the surfacearea affected. Figure 4-48 shows how the rule isapplied to adults.Other FactorsA third factor in burn evaluation is the location ofthe burn. Serious burns of the head, hands, feet, orgenitals will require hospitalization.The fourth factor is the presence of any othercomplications, especially respiratory tract injuries orother major injuries or factors.4-57Figure 4-47.—Classification of burns.Figure 4-48.—Rule of Nines.
Integrated Publishing, Inc. - A (SDVOSB) Service Disabled Veteran Owned Small Business