Burns: Third 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
third-degree burn is the most serious because it
destroys all the layers of the skin.
Who gets it?
Anyone can get a third-degree burn. Children
and the elderly are more likely to experience
complications from burns.
What causes it?
People are more likely to suffer third-degree
burns from contact with corrosive chemicals,
flames, electricity, or extremely hot objects;
immersion of the body in extremely hot water, or
clothing that catches fire.
What are the symptoms?
Skin with a third-degree burn may appear white
or black and leathery on the surface. Because the
nerve endings in the skin are destroyed, the
burned area may not be painful, but the area
around the burn may be extremely painful. Pain
causes the breathing rate and pulse to increase.
Some areas of the burn may appear bright red, or
may blister. Third-degree burns can also damage
fat, muscle, and bone. Electrical burns damage the
deep tissues. Often only the area of the skin
where the electricity entered the body looks black
and charred. Electrical shocks can make a person
stop breathing and interrupt the rhythm of the
heart. Third-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, nausea and vomiting, rapid pulse
and breathing, a blue tinge to the lips and finger
nails, and pale, cold, moist skin. If the victim
has been burned in a fire and has been exposed to
large amounts of smoke, he or she may also have
chest pain, red and burning eyes, and a cough. All
third-degree burns require emergency medical
treatment.
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. Third-degree burns that cover less than 2% of
BSA are considered minor. Third-degree burns that
cover 2 to 10% of BSA are considered moderate
burns. Those that cover more than 10% of BSA, as
well as those on the face, hands, feet, or
genitals, are critical.
What is the treatment?
All third-degree burns require medical
treatment. Minor third-degree burns can be
treated in a doctor’s office, but all others
should be considered a medical emergency that
requires hospital treatment, usually in a burn
unit. Call 911, or get the person to an emergency
room as soon as possible. If the person is on
fire, do not let him or her run. Smother any
flames with a blanket, jacket, or water, if
available, or have the victim use the “stop, drop,
and roll” method. Remove any clothing or jewelry
from the injured area, but DO NOT remove clothing
if it is stuck to the burn. Very briefly immerse
the burned area in cold water or use a clean towel
or wash cloth moistened with cold water to stop
the burning process. Don’t hold the burned area in
cold water for too long or you will cool down the
body too much. Also don’t use ice or ice water
because they will further damage the tissue. Do
not break open any 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 a person
has had contact with electricity, call 911 and
make sure the source of the electrical current is
disconnected before touching the victim.
Administer emergency cardiopulmonary resuscitation
(CPR) if the victim’s heart has stopped beating or
he or she is having trouble breathing. Lightly
cover the burned area with a dry, sterile bandage
until medical help arrives.
Moderate and critical third-degree burns
require hospitalization. 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. Sometime severe burns are treated by
putting the patient into a special room that is
filled with pure oxygen under high pressure. This
is called a hyperbaric chamber, and the patient
must receive this treatment within 24 hours of
being burned for the treatment to be effective.
The burned areas are cleaned and covered with an
antibiotic cream, then covered in sterile
bandages. These bandages are changed frequently
and the burned area is carefully monitored for
signs of infection. The dead tissue around the
burn is surgically removed, called debridement.
As burned skin heals, it develops a thick,
scabbed surface, called eschar, that makes it
difficult for blood to flow to the injured area.
Doctors often have to use a procedure called an
escharotomy to cut through the eschar so the
healthy tissue underneath can receive the blood
flow it needs. Severe third-degree burns leave
extensive scars because the burns are so deep. For
this reason, the burned area may need to be
covered with a skin graft, where a piece of
healthy skin is taken from an unburned area of the
body and transplanted permanently to the burned
area. This is called an autograft. If the
patient’s skin can’t be used, the plastic surgeon
may use the skin of another human donor (called an
allograft), or the skin of an animal, such as a
pig (called a xenograft). Allografts and
xenografts are temporary, but protect the skin as
it heals. Critical third-degree burns may take
weeks to months of hospital treatment and require
physical therapy to help restore movement to the
burned areas and to minimize scarring.
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. Always take shelter during severe
storms to avoid being struck by lightning.
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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