Burns: Second Degree
What is it?
A burn is an injury to the tissues of the body.
Burns are classified according to the amount of
tissue they affect and how deep they are. A
second-degree burn injures the top layers of skin,
called the epidermis, and extends down to the
deeper layers of skin, called the dermis.
Who gets it?
Anyone can get a second-degree burn. Children
and the elderly are more likely to experience
complications from burns.
What causes it?
Most second-degree burns are caused by contact
with flames, hot liquids, or chemicals, or by
severe sunburns. Burns caused by heat are called
thermal burns. Burns caused by hot liquids or
steam are called scalds.
What are the symptoms?
Skin with a second-degree burn is extremely red
and blistered, and may look wet because of fluid
loss. Second degree burns are very painful, and
the victim’s pulse rate usually increases in
response to the pain. Small second-degree burns
usually heal without scarring. Larger
second-degree burns can cause the victim to go
into shock. Shock occurs when loss of fluids
causes the blood pressure to become so low that
not enough blood reaches the brain and other major
organs. The symptoms of shock include fainting,
general weakness, rapid pulse and breathing,
nausea and vomiting, a blue tinge to the lips and
finger nails, and pale, cold, moist skin. See a
doctor immediately if a second-degree burn is on
the face, hands, feet, or genitals; is caused by
an electrical source; or covers an area larger
than two to three inches.
How is it diagnosed?
Your doctor will examine the burned area and
classify it according to the amount of tissue
affected and the depth of the burn. He or she will
ask how the burn occurred. The doctor will check
for other conditions related to burn injuries,
such as smoke inhalation, carbon monoxide
poisoning, or other injuries. If the patient is a
child, the doctor will ask further questions to
ensure the patient is not a victim of child abuse.
Doctors assess the severity of a burn by
determining what percentage of the total body
surface area (BSA) is affected. In patients older
than nine years, they apply what’s called the
“rule of nines” to determine the percentage of
BSA.
For example, the genital area is considered 1% of
BSA. The head and neck are 9%. Burns on each arm,
including the hand, is also 9% of BSA. Each leg,
including the foot, is 18%. The front of the torso
is 18%, as is the back of the torso, including the
buttocks. In children younger than nine, the palm
of the child’s hand is used as a measure of 1% of
BSA. Second-degree burns that cover less than 15%
of an adult's body or less than 10% of a child's
body are considered minor. Second-degree burns
that cover 15 to 25% of an adult's body, or 10 to
20% of a child's body, are considered moderate
burns. Those that cover more than 25% of an
adult's body or more than 20% of a child's body,
as well as those on the face, hands, feet, or
genitals, are critical.
What is the treatment?
Minor burns are treated at home, while moderate
and critical burns require hospital treatment. The
goal of treatment for second-degree burns is to
reduce pain and prevent infection. If the burn was
caused by fire, and the victim’s clothing is on
fire, smother any flames with a blanket or water,
if available, or have the victim use the “stop,
drop, and roll” method. If the burn has blisters
that are not open, first remove any clothing or
jewelry from the injured area. Then, hold the
burned area under cool running water for around 10
minutes to stop the burning process. You can also
use a clean towel or wash cloth moistened with
cold water. However, don’t use ice or ice water
because they will further damage the tissue. Do
not break open the blisters, or there will be a
greater risk of infection. If the blisters are
open, don’t remove any clothing that might be
stuck to the burn, and don’t run water over the
burn. This will increase the risk of shock.
Whether the blisters are broken or not, you can
place a dry, sterile gauze pad over the burn, but
do not use any bandages with adhesive. If the
burned area is larger, lightly drape a clean sheet
over it to protect it until you get medical
treatment. It is important for the bandage to be
loose so the burn gets air.
Never apply butter, oils, or burn ointments.
They make it more difficult for the burn to heal
and can actually make the burn worse because the
heat can’t escape. Arms or legs that are burned
should be kept raised to reduce the amount of
swelling. If the face or neck are burned, raise
the person’s head slightly. This will also help if
he or she is having trouble breathing. If the
person appears to be going into shock, lay him or
her flat on the ground, raise the feet around 12
inches (30 cm), and call for medical help. You can
cover the patient with a blanket to keep him or
her warm.
Do not give a person who is in shock anything
to drink. Otherwise, you can provide the patient
with small sips of clear liquid, such as water or
juice.
Chemical burns are treated a little
differently. For liquid chemicals, first remove
any clothing or other items that the chemicals
have spilled on. Then, thoroughly wash any
chemicals off the skin under running water for 15
to 30 minutes. For dry chemicals, use large
amounts of water to flush the chemicals from the
skin. Never use small amounts of water because
they may actually activate the chemicals. If no
water is available, use a clean cloth to brush any
dry chemicals off the skin. Loosely cover the burn
with a dry, sterile bandage, and see a doctor for
further treatment. Different chemicals have
different effects, so you should always check the
chemical label, if possible, for additional
directions. Always see a doctor if the chemicals
have gotten into the eyes or mouth. If the area of
the burn is larger than two to three inches, you
should get immediate medical treatment. The body
loses a great deal of fluid through the burned
area, so replacement fluids are given through an
intravenous (IV) line, which is a tube placed into
a vein. If the lungs are damaged, or breathing is
difficult, a tube is inserted into the throat to
help with breathing. The patient will need to take
antibiotics to protect the burned area from
infection, as well as a prescription pain
medication. If the patient’s immunizations aren’t
up to date, he or she may also need a tetanus
booster. If your doctor thinks there will be a
great deal of scarring, he or she may recommend a
skin graft, where a piece of healthy skin is taken
from an unburned area of the body and transplanted
to the burned area. This is called an autograft.
For smaller burns that can be treated at home,
gently wash the area with an antiseptic cleanser,
loosely bandage the burn, then leave it alone for
at least 24 hours. You can apply an aloe-based
cream to relieve pain before bandaging it. Pain
relievers such as acetaminophen, ibuprofen, or
aspirin can help with inflammation and pain, and
should be used according to directions. Never give
aspirin to a child under the age of 18 because of
the risk of a serious illness called Reye’s
syndrome. If you have seen a doctor, follow his or
her instructions for changing the bandages. Make
sure you wash your hands with soap and water. Be
sure to remove the bandage slowly and carefully.
You will need to soak it before removing if it is
sticking to the burn. Gently wash the burn, check
for signs of infection, apply a thin layer of
antibiotic cream, then cover it with a clean
bandage.
Signs of infection include increased swelling
or redness, blisters filled with greenish or
brownish fluid, oozing pus in the burned area, or
red streaks spreading away from the burn, and are
a reason to call your doctor. Also call your
doctor if you have a fever, swollen lymph nodes,
or notice numbness or a cold feeling in the arms
or legs. A second-degree burn can take anywhere
from 10 days to 3 weeks to heal. Call your doctor
if it doesn’t heal within that time. Vitamins C
and E, and zinc may help the burn to heal, but
should be taken only in safe amounts.
Self-care tips
Many burns occur at home and could have been
prevented. You can avoid first-degree burns by
handling hot liquids and objects carefully. Make
sure electrical cords are in good condition,
household chemicals are safely stored and labeled,
and hot beverages and objects are out of reach of
small children. When handling chemicals, wear
protective gloves and eyewear, and follow label
directions for safe handling. Never wear clothing
with long, loose sleeves while cooking or around
any type of open fire. Never put a child into a
tub unless you have first tested the water
temperature. You can guard against burns from hot
water by keeping your hot water heater set lower
than 120 degrees Fahrenheit (49 degrees Celsius).
Children should also sleep in flame-resistant
pajamas or nightgowns. Do not smoke, or make sure
discarded cigarettes are completely extinguished.
Teach your children fire safety and make sure they
do not have access to matches or lighters. You can
also protect you and your family from burns by
making sure you have operating smoke detectors on
every floor of your house. Also check the
temperature of a child’s car seat or seat belt
before buckling the child in. Even these objects
can cause burns after a period of time in direct
sunlight. Never allow children to handle fireworks
without adult supervision. Fireworks are a leading
cause of burns and other injuries. You can avoid
sunburns by using a sunscreen of at least a 15 SPF
rating. Apply sunscreen liberally at least 20
minutes before sun exposure and reapply after
swimming or sweating. Avoid spending time in the
sun from 10 a.m. to 3 p.m., when the rays are
strongest.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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