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Severity of Burns
The damage caused by burns depends on the degree (depth) and extent of the burn. This will depend on temperature and type of the heat source and the duration of contact. Higher the temperature of the heat source and longer the time of contact, more the severity of the burn.
First degree burns are superficial burn in which the outermost layer of the skin, called the epidermis, remains intact. This enables the skin to function normally. These burns can usually be managed by simple first aid at home and the scars are usually not long lasting.
Second degree burns (partial thickness burns) occur when the heat penetrates deeper and damages the epidermis (outermost layer of the skin). The epidermis begins to separate from the second layer of the skin, the dermis. Fluid from the dermis may accumulate within the epidermis and cause blisters to appear. As the seal of the skin is broken, this may lead to infection, loss of fluid and heat. Nerve endings in the dermis are exposed causing pain.
Third degree burns (full thickness burns) happen when the severity of the burn is such that both the epidermis and the dermis (first and second layers of the skin) are damaged. Blisters may form. As the protective covering of the skin is lost- infection, loss of fluid and heat can become life threatening. If the nerve endings are completely damaged, the patient may not feel any pain.
It may be difficult to differentiate partial thickness and full thickness burns clinically, but both are serious and need medical attention if extensive.
Extent of the burn injury is expressed as a percentage of the total body surface area. For the lay person, the area of the patients palm is taken as approximately 1% of the body surface area. Any burn involving more than 10% of the body surface area needs urgent medical attention. In burns involving children even smaller involvement may need referral. Burns involving special areas like eyes, nose/mouth, circumferential burns (involving the skin all around he arm or leg) and inhalation burns always need urgent treatment.