Question

37 year-old male presents after sustaining a burn from a pot of boiling water. He states that his skin started to blister a few hours after and it’s quite painful. What type of burn does he likely have? 

Answer

A non-circumferential, superficial partial-thickness burn; it was treated with Silvadene (silver sulfadiazine)

Burn Classification:

• The traditional 1st, 2nd, 3rd degree classification-system was replaced by:
  • Superficial: skin is dry, red, and blanches with pressure; painful sensation (e.g. sunburn)
  • Superficial partial-thickness: skin has blisters, red, moist, weeping, and blanches with pressure; painful sensation
  • Deep partial-thickness: skin has blisters, wet/waxy dry, variable color (patchy to yellow-white to red), and does not blanch with pressure; pressure-like sensation
  • Full-thickness: skin is waxy-white to leathery-gray to charred and black; dry, elastic, and does not blanch with pressure; deep-pressure sensation
  • Fourth-degree: Burn extends into fascia, muscle, bone; deep-pressure sensation
• Always be concerned with extremity burns because they can become edematous, causing superficial/deep partial-thickness to convert to full-thickness burns 
• Treat with:
  • Extremity elevation 
  • Topical antibiotic creams/ointments
  • Blister debridement is controversial
  • Observation for compartment syndrome if circumferential
  • Consult with burn center as necessary
• See image below demonstrating blisters after debridement

References

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Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine). New York: McGraw-Hill Companies. pp. 1374–1386.