1, 2, 3 and 4 degree of burns, signs and symptoms
Content:
- What is a burn?
- Burns
- 1st degree burn
- 2nd degree burn
- 3rd degree burn
- 4 degree burn
- How to help the victim?
What is a burn?
A burn is damage to body tissue due to external influences. Several factors can be attributed to external influences. For example, a thermal burn is a burn that occurs as a result of exposure to hot liquids or steam, or very hot objects.
Electric burn - with such a burn, internal organs are also affected by an electromagnetic field.
Chemical burns are those that have occurred due to the action of, for example, iodine, some acid solutions - in general, various corrosive liquids.
If the burn is due to ultraviolet or infrared radiation, then this is a radiation burn.
There is a percentage of the degree of total body involvement. For the head, this is nine percent of the entire body. For each arm - also nine percent, the chest - eighteen percent, each leg - eighteen percent, and the back - also eighteen percent.
Such a division by the percentage of damaged tissues to healthy ones allows you to quickly assess the patient's condition and correctly conclude whether a person can be saved.
Burns
Classification of burns by degrees is of great importance. Such a division is necessary in order to standardize the scope of therapeutic measures for varying degrees of burn. The classification is based on the possibility of reverse development of changes in a natural way without the use of surgical interventions.
The main area that determines the regenerative capacity of the affected skin is the intact germ and microvasculature. If they are affected, early active surgical measures in the burn wound are shown, since its independent healing is impossible or takes a long time with the formation of a rough scar and a cosmetic defect.
According to the depth of tissue damage, burns are divided into four degrees.
A 1st degree burn is characterized by redness and slight swelling of the skin. Usually, recovery in these cases occurs on the fourth or fifth day.
A 2nd degree burn is the appearance of blisters on the reddened skin, which may not form immediately. Burn blisters are filled with a clear yellowish liquid, when they rupture, the bright red painful surface of the growth layer of the skin is exposed. Healing, if an infection has joined the wound, occurs within ten to fifteen days without scarring.
A third degree burn is the death of the skin with the formation of a gray or black scab.
A burn of the 4th degree is necrosis and even charring of not only the skin, but also deeper tissues - muscles, tendons and even bones. The dead tissue is partially melted and rejected within a few weeks. Healing is very slow. On the site of deep burns, coarse scars are often formed, which, if burned to the face, neck and joints, lead to disfigurement. In this case, cicatricial contractures are usually formed on the neck and in the area of the joints.
This classification is unified all over the world and is used for almost all types of burns, regardless of the cause of their occurrence (thermal, chemical, radiation). Its convenience and practicality are so obvious that even a person who is not familiar with medicine can easily understand it.
The basis for the development of pathological changes and clinical manifestations of various degrees of burns is the direct destruction of skin elements by high temperatures. The second component is circulatory disorders in neighboring areas, which play a major role in aggravating the extent and area of damage over time.
A characteristic feature of burn injuries is considered to be an increase in these indicators compared to the initial ones. It is possible to estimate the true volumes of the burn only the next day after receiving it. By this time, there is a clear limitation of living and dead tissues, although the zone of microcirculatory disorders remains. The main therapeutic struggle is being waged for her.
Related article: Providing first aid for burns, both medical and pre-medical
1st degree burn
Pathomorphologically, it is represented by damage to the most functionally insignificant upper layer of the skin - the epidermal. This area is subject to permanent replacement under normal conditions. In a healthy person, millions of epidermal cells are exfoliated during the day. Usually, the sun's rays, hot liquids, weak acids and alkalis can cause such a burn. Therefore, such a burn is not accompanied by pronounced structural changes in the affected skin. Microcirculatory disorders are also minimal, which underlies the formation of clinical manifestations.
Signs of the first degree of skin burns are reduced to redness (hyperemia) of the affected areas, accompanied by moderate pain. Touching them causes an increase in the burning sensation. Edema is moderately expressed or completely absent, depending on the area of the burn. There are no other manifestations.
First degree burns are more often limited. Widespread isolated superficial lesions are rare and are usually associated with deeper types. There is no danger of developing a burn disease in case of damage to the epidermis, which is reflected in the minimum amount of therapeutic measures.
Healing of the affected surface with 1st degree burns occurs within several days. The process is characterized by gradual drying and wrinkling of the damaged epidermal layer. Then it is rejected in the form of peeling. It takes just over one week to fully recover. Rough scars and cosmetic defects, even in the face area, do not remain.
2nd degree burn
Such burns are characterized by damage to the deeper layers of the skin and moderate disorders of microcirculation in the affected area and adjacent areas. This type of damage occurs most often and is characterized by a relatively favorable course even with large areas of the burn.
The epidermis and superficial areas of the dermis, up to the papillary layer, are destroyed. Its significance lies in the fact that the bulk of the capillaries and nerve endings pass here, which forms the clinical manifestations of a 2nd degree burn. These structures remain intact. Only their function is temporarily impaired with preserved pain sensitivity.
The clinical description of such a burn consists in the formation of bubbles of various sizes and areas, filled with a transparent straw-yellow liquid. The surrounding skin may be reddened or unchanged. Their formation is possible due to the fact that the dead epidermis forms a cavity, which is filled with plasma (liquid part of blood) through expanded, partially altered microvessels. The victims are worried about burning pains that persist for several hours after receiving a burn. Any touch increases the pain. The tissues in the affected area and adjacent areas are swollen.
Grade 2 burns heal on their own, leaving behind reddened areas that eventually acquire a natural shade and do not stand out among healthy ones. The process of complete restoration of damaged tissues takes, on average, about two weeks. Small burns do not cause any burn disease hazards.
But if their surface is large enough, there is a threat of infection and dehydration, which requires appropriate specialized medical care. It is limited to fluid therapy and antibiotic prophylaxis. All active surgical interventions on the burn surface are reduced to piercing or cutting blisters with evacuation of fluid under aseptic conditions.
Sometimes controversial issues arise when determining the degree of a burn and conducting a differential diagnosis between burns of 2 and 3 degrees. After all, both are manifested by bubbles. But here the key role belongs to the preservation of pain sensitivity when touching the burnt surface. If present, it is a second degree burn.
3rd degree burn
When characterizing this type of burn, it should be noted that it is divided into two subspecies. The need for this arose due to the fact that the deep layers of the dermis have certain features that are also significant in determining the treatment tactics. In general, a grade 3 burn characterizes a complete defeat of the entire thickness of the skin, up to the subcutaneous tissue.
Consequently, its complete independent recovery becomes impossible. Microcirculatory disorders in the adjacent areas are so pronounced that they can often turn into 2nd degree burns over time.
In terms of the risk of developing a burn disease, this degree of damage is in a very important place. This is due to the fact that burns of this type are often extensive, spreading over a long distance. The volumes of dead tissue and wound surfaces formed in their place are large. These features lead to the fact that all decay products are actively absorbed into the bloodstream, causing severe intoxication.
Accordingly, the possibility of infection of such burns with the development of a septic state remains high. The restoration of the skin can take several months and, in most cases, requires surgical intervention. Such damage leaves behind rough scars that can cause cosmetic defects.
Clinical manifestations determine the division of the 3rd degree burn into two subspecies:
- Grade 3a - damage to the dermis, including the papillary layer. Only the deepest parts of it, in which the appendages of the skin (hair follicles and sebaceous glands) are laid, remain intact. This fact determines the possibility of independent healing of small-area burns due to granulation and marginal epithelialization from the surrounding healthy areas;
- Grade 3b - damage to all elements of the skin, including accessory formations. This makes it impossible for its independent restoration, since the underlying subcutaneous fatty tissue does not have this ability.
Burns 1 and 2, as well as 3a degrees are classified as superficial, due to the ability to self-heal. Determining the degree of burn is not so difficult if you know what you need to pay attention to.
The criteria for a grade 3 burn can be distinguished as follows:
- With burns 3a, various-sized bubbles are formed, filled with bloody fluid against the background of reddened surrounding tissues;
- Wound defects with profuse serous-hemorrhagic (mucous-bloody) discharge, touching which does not cause pain;
- Grade 3b burns are characterized by the formation of thick-walled bloody blisters or dense scabs of dead skin;
- Severe edema and hyperemia of the surrounding skin;
- General manifestations in the form of intoxication and dehydration (tachycardia, rapid breathing, drop in blood pressure, increase in body temperature).
It is very important for such burns to hospitalize the victims in a specialized hospital, where early surgical treatment and appropriate medical correction will be carried out, which will prevent the development of burn disease. It is very difficult to get patients out of the latter state. Therefore, with a given degree of burns, modern combustiologists recommend early surgical treatment with one-stage or staged plasty of burn wounds.
4 degree burn
This type of burn is the most severe, regardless of the area of the lesion. If it spreads within one segment, it can cause death of the patient or loss of a limb. As world practice shows, 4 degree burns of a local nature are mainly obtained by a flame or a hot object, being in a state of alcoholic or drug intoxication. Such burns with chemical compounds of an acidic or alkaline nature are possible. Electric trauma to the extremities often takes the form of 4th degree hand and forearm burns, manifested by complete charring of the fingers.
In morphological terms, this type of damage is deep. All layers of the skin and underlying tissues can be destroyed: the subcutaneous fatty base, muscles, ligaments and tendons, bone formations, blood vessels and nerves. Circular spread of these changes around the affected limb is possible, which leads to the formation of a dense crust of necrotic tissues and becomes the cause of compression of the preserved elements and a violation of adequate blood supply.
In terms of clinical manifestations, these burns cannot be confused with anything. In place of the destroyed tissues, a dense thick-walled scab of black or brown color is determined. The general condition of patients is disturbed up to shock and cerebral coma. If the area of the burn is large, then there is very little time to save a life. Circular damage is especially dangerous. A dense scab, which forms a frame, with a progressive increase in tissue edema, becomes a barrier to their stretching, which leads to their compression and loss of chances of salvation. The most urgent is chest compression, which leads to disruption of vital functions and rapid death of victims in case of failure to provide specialized care.
In terms of the development of burn disease, with burns of the 4th degree, its manifestations can be traced from the first hours after they were received. If such burns are limited to small areas, the prognosis for a complete cure is favorable. This process can take several months. With extensive burns, if the victim survives, recovery lasts for many months or even years, since it requires numerous plastic surgeries to replace the formed defects.
The most important thing to remember is that you should not first of all look for an answer to the question about the degree of the burn received. It is necessary to quickly and efficiently organize the provision of urgent measures and the transportation of the patient to a medical institution, on which not only the extent of the lesion, but also the life of a person often depends. Everything else should be entrusted to specialists in this matter, who know the intricacies of a complex problem.
How to help the victim?
In a domestic environment. The first step is to cool the skin. To do this, it is enough to lower the burned area of the body in cool water for 10-15 minutes. During this time, the pain will go away, and the redness will decrease. Just don't use ice! You just need cool water. After that, it is necessary to treat the skin with a special agent.
The following tools are also used:
- Panthenol (or any product that contains panthenol). The drug has an anti-inflammatory effect, improves tissue regeneration, is quickly absorbed (absorbed) by the skin.
- Bepanten ointment
- Dermozin ointment
- Solcoseryl gel
- Sulfargin
These funds can significantly reduce the force of burning, accelerate the regeneration of the skin and quickly heal the burn itself. If these funds are not at home, then the burnt area of the body can be lubricated with raw egg white, aloe juice. Or you can make a compress with raw potatoes or pumpkin. Do not use such a popular method as oil and greasy creams. This method really relieves the primary pain, but it only gets worse later.
Home remedies are recommended to be used as a temporary measure, and treatment is necessary with special ointments, which are listed above.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
