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The depth of damage to the skin and tissue and the size of the burn are important factors in burn assessment.
A traditional method gauges burn depth by degrees, although most burns are a combination of different degrees and thicknesses. (See Depth of burn.)
❑ First-degree — Damage is limited to the epidermis, causing erythema and pain.
❑ Second-degree — The epidermis and part of the dermis are damaged, producing blisters and mild-to-moderate edema and pain.
❑ Third-degree — The epidermis and the dermis are damaged. No blisters appear, but white, brown, or black leathery tissue and thrombosed vessels are visible.
❑ Fourth-degree — Damage extends through deeply charred subcutaneous tissue to muscle and bone.
The size is usually expressed as the percentage of body surface area (BSA) covered by the burn. The Rule of Nines chart most commonly provides this estimate, although the Lund-Browder classification is more accurate because it allows for BSA changes with age. A correlation of the burn’s depth and size permits an estimate of its severity.
❑ Major — third-degree burns on more than 10% of BSA; second-degree burns on more than 25% of adult BSA (more than 20% in children); burns of hands, face, feet, or genitalia; burns complicated by fractures or respiratory damage; electrical burns; all burns in poor-risk patients
❑ Moderate — third-degree burns on 2% to 10% of BSA; second-degree burns on 15% to 25% of adult BSA (10% to 20% in children)
❑ Minor — third-degree burns on less than 2% of BSA; second-degree burns on less than 15% of adult BSA (10% in children).
❑ Location: Burns on the face, hands, feet, and genitalia are the most serious because of possible loss of function.
❑ Configuration: Circumferential burns can cause total occlusion of circulation in an extremity as a result of edema. Burns on the neck can produce airway obstruction, whereas burns on the chest can lead to restricted respiratory expansion.
❑ History of complicating medical problems: Note disorders that impair peripheral circulation, especially diabetes, peripheral vascular disease, and chronic alcohol abuse.
❑ Other injuries: Consider injuries sustained at the time of the burn such as with a blast injury or motor vehicle accident.
age alert Victims younger than age 4 or older than age 60 have a higher incidence of complications and, consequently, a higher mortality. Elderly people are at risk for complications due to preexisting medical conditions and delayed wound healing, as well as prone to complications due to fluid resuscitation required (heart failure, pulmonary edema).
❑ Pulmonary injury: Smoke inhalation can cause pulmonary injury.
Source: Handbook of Diseases, 2003
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