Section III. EFFECTS ON TISSUE, SIGNS AND SYMPTOMS, AND TREATMENT
OF THERMAL BURNS
Thermal burns generally damage the skin, an organ vital to our survival. The
skin acts as a protective barrier against infection and water loss, a body temperature
regulator, and a sensory organ for touch, pain, temperature, and pressure perception.
Thermal burns can damage this protective barrier. The result can be loss of body
temperature control, loss of body fluids and water, and susceptibility to infection. Repair
of the skin is critical in maintaining body health. To treat thermal burns successfully,
information which must be determined includes the degree of the burns, the percent of
the body area burned, and the severity of the burns.
3-10. DETERMINING THE DEPTH OF THERMAL BURN (DEGREE OF THICKNESS)
The true depth of a thermal burn injury can be determined with certainty only by
examining the tissue. During resuscitation of the patient, the primary concern is the
total percentage of skin surface involved in second-degree and third-degree burns.
Later, this information will be useful in determining treatment; for example, whether or
not there is a need for skin grafts to close the wound. But, initially, you are concerned
with the amount of skin surface burned. Most thermal burns are a combination of first-
degree, second-degree, and third-degree burns.
a. First-Degree Burn (Mild Partial Thickness Burn). A first-degree burn
(figure 3-1) is a superficial injury involving only the outer layer of skin, the epidermis. A
common example of first-degree burn is sunburn. As in sunburn, a first-degree burn is
very painful. Typical characteristics are reddened skin which is dry and warm to the
touch without blisters. These burns usually heal on their own in two to five days without
scars. The outer layers may peel. The name "partial thickness" comes from the fact
that the burn extends only partially through the epidermis, the first skin layer. Usually,
first-degree burns are not included in an estimate of the total body surface area (TBSA)
burned. The reason is that these burns cause no loss of skin function even though a
person with first-degree burns may feel ill and have a body temperature a little above
normal. (The exception is that the TBSA of first-degree burns is important when the
severity of the burn is being determined. See paragraphs 3-11f, 3-12c, and 3-13c.)