Burn classifications
For the most part, injuries to the epidermis, or outer skin layer, present few serious health problems. However, once the dermis is exposed, contamination and infection become a major concern, as this skin layer contains a network of blood vessels, nerves, sweat glands, and hair follicles. Below the dermis lie layers of fat, muscle, and soft tissue called the subcutaneous layers.
First-degree bums involve only the epidermis, and are characterized by reddened skin, pain, and perhaps some swelling. These burns will heal themselves without scarring.
A second-degree, or partial thickness burn penetrates the outer skin layer and the upper dermis, but does not pass through to damage the underlying tissues. Second-degree burns cause severe pain; blisters and swelling last for weeks after the injury, as body fluids are released and rise to the top layer of skin. The skin is intensely red and has a mottled appearance. Depending on the depth of the second degree bums, they can produce from little to severe scarring.
Third-degree, or full thickness bums damage all the skin layers. Sometimes difficult to distinguish from second-degree burns, thirddegree burns usually have areas that are charred black or are dry and white. The victim may complain of severe pain, or, if enough nerves are damaged, he may feel no pain at all. Victims of third-degree burns lose large amounts of body fluids and may require skin grafting. As these burns heal, dense scars are formed.
Burns to the face and major joints are of particular concern, since they can damage the eyes and cause cosmetic and functional loss. Major burns can also affect the respiratory system and circulation.
Injuries to bum victims go a lot deeper than physical pain and (sometimes) deformity. Often psychological and emotional scars that begin at the emergency scene last long after the bandages are removed and the plastic surgery is completed.
