03 May An Introduction to Fourth Degree Burns
Fourth degree burns are the most serious, insidious, and life-threatening of all burns. In order to understand their complexities, we must first understand the structure of each layer of skin. It is also important to know how all burns are classified – both by the depth of the burn and the “mechanism of injury,” the method by which damage to skin, muscles, organs and bones occurs.
The largest organ in the body, the skin serves many masters: protection from the environment and infection; regulation of body temperature, and dissemination of sensory input that helps you differentiate between sensations like pain, temperature, and pressure. The skin also synthesizes Vitamin D, essential to bone building and maintenance.
Skin has a fierce, hard job to do and it does it all in just three tough and stretchy layers:
The first layer is epidermis, the outermost layer of skin that provides a waterproof barrier. The epidermis makes new skin cells, gives skin its color, and protects the body. First degree burns affect only the epidermis. They cause redness and discomfort, but are rarely serious and heal by themselves within days. First degree burns are caused by exposure to sun (sunburn) or hot liquids. First degree burns can be very painful, but are easily treated with proper first aid measures.
The second layer down is dermis, or corium. Much thicker than epidermis, the dermis is comprised of tough connective tissue. The dermis hosts hair follicles, oil glands, and sweat glands. Nerve endings in the dermis help you feel sensation. Second degree burns (partial thickness burns) affect both portions of the epidermis and the dermis. These types of burns cause blistering, and can also be very painful. Skin grafting may be required. Second degree burns can be caused by exposure to hot fluids or from flame-related injuries. Barring infection, most second-degree burns heal in 10 to 14 days without complications. However, second degree burns that affect the feet, hands, or face; or that cover more than 15 percent of an adult’s body, or 10 percent of a child’s body, require immediate medical attention.
The deepest layer of skin is hypodermis. This subcutaneous fat attaches the dermis to your muscles and bones, and helps blood vessels and nerve cells control your body temperature.
Third degree burns (full thickness burns) affect all three layers of skin. These burns are severe and always require skin grafting as they result in the destruction of skin cells. These burns may be caused by prolonged exposure to chemicals, electricity, flame, steam, or scalding liquids. Victims of third degree burns need immediate medical attention. While seeking medical help, follow these guidelines:
• Elevate burned feet and legs. Raise burned hands above heart level.
• Separate the victim’s fingers and toes with dry, sterilized non-adhesive bandages
• Monitor victim’s breathing. Administer mouth-to-mouth resuscitation and/or CPR if needed
• Cover the burn with a neat, damp plaster or clean fabric if the victim is taking a breath
• Do not remove any clothing from the wound
• Do not immerse the wound in water
• Do not put anything on the wound. No ointment, butter, ice, medication, sprays, or home burn remedies
Fourth degree burns (also full thickness burns) not only destroy all layers of the skin, but also affect structures below the skin like tendons, bones, ligaments, and muscle. These burns are often called black or char burns. While the most severe of all burn wounds, these burns are not painful since all nerve endings have been destroyed. Surgery or grafting close to the wound is always required.
Victims of fourth degree burns experience nervous shock immediately after the burn injury. This is followed by a secondary shock, precipitated by an extreme fall in blood pressure that occurs a few hours later. During this period the victim suffers fright, confusion, anxiety, cold extremities, and pallor prior to collapse. This secondary shock is not solely caused by fluid lost in the destroyed tissue. It is caused by fluid that leaks from the burned area that has lost its protective covering of skin. This leakage of fluid and salts (sodium and potassium) can sometimes prove as fatal as the burn injury itself.
Fourth degree burns demand an immediate medical response, followed by a lengthy rehabilitation period. Despite all best efforts, survivors of fourth degree burns can be left with permanent disabilities and disfigurement.
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