What are second degree burns?
Second degree burns, also known as partial thickness burns, affect both the outer and underlying layer of skin (the dermis). These burns lead to pain, redness, swelling, and blistering of the skin. Second degree burns can be caused by brief contact with flames, hot liquids, steam, or heated objects. Treatment for second degree burns depends on the extent and location of the burn, but generally includes cleaning and dressing the wound, medication for pain management, and prevention of infection. In some cases, skin grafting may be necessary.
What happens when you go to the emergency room with a second degree burn?
If you have a second degree burn, you should go to the emergency room or urgent care center for evaluation and treatment. Here is what you can expect:
- Triage – When you arrive, a nurse will assess the burn, ask about what caused it, and check your vital signs. This helps determine the severity and prioritize treatment.
- Pain management – You will likely receive medications like ibuprofen or stronger prescription painkillers if needed. This helps make cleaning and dressing changes more tolerable.
- Cleaning the wound – The burned area must be very gently cleaned to remove loose dead skin and debris. This prevents infection.
- Applying dressing – Sterile gauze and bandages are placed over the wound to protect it. These may have antibiotic ointment to prevent bacterial growth.
- Tests – Blood work, wound cultures, IV fluids, and tetanus shots may be ordered depending on the extent of the burn.
- Referral to burn unit – For large or severe second degree burns, you may need to be admitted or transferred to a specialized burn care unit.
- Wound care instructions – At discharge you will receive instructions on changing dressings, watching for signs of infection, and when to follow up.
So in summary, emergency second degree burn care focuses on pain management, cleaning, protecting the wound, and preventing complications. Prompt and proper treatment can help minimize scarring.
How do doctors assess the severity of a second degree burn?
Doctors use several factors to determine the severity of a second degree burn:
- Surface area – The size of the burned region is estimated by the “rule of nines,” which divides the body into sections that equal roughly 9% of the total body surface area each. Larger surface areas indicate more serious burns.
- Depth – Second degree burns penetrate into the dermis layer of skin. Third degree burns go deeper into fat, muscle, and bone.
- Location – Burns on the face, hands, feet, genitals, or joints can be more problematic than areas with looser skin that swell less.
- Cause – The cause of the burn can hint at its severity. For example, chemical or electrical burns tend to go deeper.
- Age and health – Younger and healthier people tend to heal better than older adults or those with chronic illnesses.
- Appearance – Reddened, blistered skin that is sensitive and painful indicates a superficial or mild second degree burn. White, waxy, numb skin suggests a deep second degree burn.
Doctors will also watch for signs of shock, dehydration, and infection, which signal a major burn. They may order tests like wound biopsies or CT scans for further information.
How do doctors treat second degree burns?
Here are the main components of treatment for second degree burns:
Fluid resuscitation
Burn victims are at risk for dehydration and fluid shifts due to plasma loss through damaged skin. IV fluids are given to maintain circulation and kidney function.
Wound care
The burn must be cleaned, debrided (removing dead tissue), and monitored for infection. Antibiotic creams and dressings help prevent bacterial growth.
Pain management
Oral or intravenous medications like ibuprofen, novacaine, morphine, or fentanyl are used to control burn pain during procedures.
Nutritional support
A high-calorie, protein-rich diet provides nutrients for healing. Tube feeding may be used if oral intake is inadequate.
Skin grafts
For deep second degree burns, a graft using a thin layer of the patient’s own skin may be placed over the wound to encourage healing and reduce scarring.
Physical therapy
Stretching, exercises, and massage help prevent contractures and maintain mobility if joints or tendons are affected.
Emotional support
Burn survivors often experience psychological distress. Counselors help patients and families cope with pain, grief, body image changes, and PTSD.
What medications are used to treat second degree burn pain?
Several types of medications in various forms can provide pain relief for second degree burns:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Oral non-opioid medications like ibuprofen (Advil, Motrin), naproxen (Aleve), or indomethacin work by reducing inflammation. Topical NSAID creams can also treat localized pain.
Acetaminophen
Tylenol or other acetaminophen tablets help mild background burn pain but are not very potent.
Narcotics
Opioids like morphine, oxycodone, fentanyl, and hydromorphone given intravenously or orally treat more intense pain. Potential side effects include sedation, nausea, and constipation.
Anesthetics
Numbing medications like lidocaine injections, sprays, or ointments placed over the skin provide short-term pain relief, especially for wound care procedures. They help reduce opioid needs.
Antidepressants
Tricyclic antidepressants like amitriptyline may treat neuropathic aspects of burn pain through effects on brain chemicals.
Anti-anxiety drugs
Medications such as lorazepam or diazepam reduce anxiety and muscle spasms, complementing other pain drugs.
Ketamine
Low doses of IV ketamine, an anesthetic, can relieve severe burn pain that is unresponsive to other medications. Close monitoring for psychedelic side effects is needed.
Doctors combine therapies based on the individual patient’s level and type of pain. The goal is to use the lowest doses of medications necessary to keep the patient comfortable.
What techniques are used for cleaning and dressing second degree burns?
Proper cleaning and dressing of second degree burns is vital to prevent infection and optimize healing. Here are some techniques that hospitals use:
Cleaning
– Irrigating with saline solution to remove debris
– Gently washing with mild soap and water
– Removing blister fluid and dead tissue (debridement)
Antiseptic application
– Solutions like chlorhexidine, iodine, silver sulfadiazine
– Minimize bacteria but don’t damage healing tissue
Occlusive dressings
– Petrolatum gauze to keep wound moist
– Hydrogel sheets to cool surface
– Avoid dry scabs which impair healing
Absorptive dressings
– Multi-layer pads to wick away exudate
– Change when strike-through is present
Compression bandages
– Elastic wraps help reduce swelling
– Must avoid restricting circulation
Topical agents
– Antibiotic ointments (bacitracin, mupirocin)
– Honey, silver, plant extracts
The technique depends on the location and extent of the injury. Doctors tailor wound care to each patient while following sterile procedure to prevent complications like infection and delayed wound closure.
When are skin grafts needed for treatment of second degree burns?
Skin grafting may be recommended for deep second degree burns if:
- The burn has not shown signs of healing after 2-3 weeks with conservative treatment
- It covers a large surface area, usually greater than 20% total body surface area
- It is located on the hands, feet, face, joints, or genitals
- The blood supply to the area is compromised, slowing natural healing
- Scarring would limit movement or function such as over joints
- The burn edges cannot be pulled together for closure with sutures or staples
Grafts involve taking a thin layer of undamaged skin from another part of the patient’s body, like their back or thighs, and placing it over the injured area. This healthy skin encourages faster regrowth and reduces contraction that leads to scarring.
Skin grafts require surgery in an operating room under anesthesia. The patient must be healthy enough to undergo the procedure and will need immobilization during recovery to ensure the grafts integrate.
What factors promote healing and recovery from second degree burns?
Healing of second degree burns depends on the patient’s overall health and several key treatment factors:
Infection prevention
Preventing wound infections through careful cleaning, dressings, and antibiotic therapy allows natural healing processes to work optimally. Signs of infection that disrupt healing include increasing pain, redness, heat, swelling, oozing, and fever.
Good circulation
Adequate blood flow is necessary to deliver nutrients, oxygen, and healing factors to the wound. Compression garments may help improve circulation.
Proper nutrition
Eating a protein and calorie-dense diet with vitamins and minerals provides the body with needed resources for repairing damaged tissue and fighting infections.
Moist wound environment
Keeping the wound area slightly moist, such as with hydrogel dressings, and avoiding desiccation promotes new tissue growth rather than just scab formation.
Physical therapy
Gentle range-of-motion exercises and massage keep joints flexible and prevent restrictive scar contracture during healing.
Stress reduction
Anxiety and excess stress hormones inhibit healing. Relaxation, social support, counseling, and medications can modulate the stress response.
Effective treatment combines meticulous wound care with optimizing the patient’s overall health to aid the body’s regenerative capacities. Prompt healing reduces scarring and improves function.
What types of complications can occur during recovery from a second degree burn?
Some potential complications that may arise while recovering from a second degree burn include:
Infection
Bacteria can infect the open wound, causing increased pain, redness, fever, and pus. This delays healing and can enter the bloodstream. Topical antibiotics and early debridement help prevent infection.
Wound separation
Burn scabs and eschar may detach early before new skin has regrown underneath, creating persistent open wounds prone to infection. Surgical debridement and dressings are needed.
Hypertrophic scarring
Scars may become thick, raised, and discolored during the remodeling phase of healing. Steroid injections, special garments, and silicone sheets help prevent pathologic scarring.
Contractures
Burns over joints can cause surrounding skin to tighten as it heals, limiting mobility. Occupational therapy and splinting help maintain range of motion.
Itching
As nerve endings regenerate, severe itching may occur. Antihistamines and moisturizers provide relief. Scratching can disrupt the wound.
Fluid imbalances
Fluid shifts related to inflammation can lead to volume depletion or overload. Monitoring hydration status and providing IV fluids helps stabilize patients.
Psychological effects
Pain, scarring, grief, body image issues, anxiety, and post-traumatic stress are common. Counseling and support groups help patients cope.
Close monitoring and early treatment of complications improves recovery outcomes for second degree burn injuries. Preventing problems like infection and loss of joint mobility facilitates healing.
What is the typical recovery timeline for a second degree burn injury?
Healing times for second degree burns depend on several factors but generally follow this timeline:
Initial 72 hours:
– Plasma loss leads to fluid shifts and electrolyte imbalance
– Requirement for IV fluids and wound dressing changes
– Most painful period needing heavy pain medication
1-2 weeks:
– Soft scab formation over burn
– Inflammatory phase, risk of wound infection
– Superficial second degree may re-epithelialize if small area
2-6 weeks:
– Deeper burns require debridement of eschar
– Granulation tissue and epithelialization occur
– Daily wound care continues with topical agents
4-8 weeks:
– Most second degree areas fully re-epithelialized
– Scars remain pink and thickened
– Range of motion exercises preserve joint mobility
3-18 months:
– Scar maturation and remodeling finalize
– Pressure garments may minimize hypertrophic scars
– Symptoms like itching and tenderness gradually resolve
So while superficial second degree burns may heal within 2-4 weeks, deeper burns often take 1-2 months for complete closure. Maximum medical improvement with scar stabilization takes around 1 year. Proper wound care and physical therapy optimize healing.
What types of physical therapy are used after second degree burn injuries?
Physical therapy plays a critical role in restoring function after serious burns, including:
Range of motion exercises
Gentle stretching maintains flexibility and mobility in areas prone to contraction like joints and tendon sheaths. This prevents permanent disability from scar contracture.
Splinting and casting
Braces support joints in proper alignment and prevent involuntary movements that could disrupt delicate healing skin. Serial splinting stretches developing scar tissue.
Soft tissue mobilization
Massage techniques improve circulation and drainage, loosen adhesions, and help soften thickened scar tissue.
Strength training
Muscle strengthening exercises are incorporated once wounds close to rebuild deconditioned muscle loss from disuse.
Neuromuscular electrical stimulation
Electrical impulses applied to nerves and muscles re-educate damaged nerve pathways and prevent muscle atrophy.
Functional training
Activities focused on posture, balance, and coordination help patients regain control and confidence performing daily tasks with altered movement and sensation.
Scar management
Compression garments, custom orthotics, silicone gels, and stretching help control scar formation for best cosmetic and functional results.
Starting as soon as tolerated after a burn injury, skilled physical therapists tailor rehabilitation programs to each patient’s unique deficits with the goal of optimal recovery.
Conclusion
Treatment of second degree burns focuses on controlling pain, preventing infection, optimizing wound healing, and minimizing scarring and lasting impairments through proper wound care, medications, nutrition, skin grafts, and physical rehabilitation. Seeking prompt emergency care followed by consistent follow-up over months to years offers burn victims the best chances of making a full recovery and resuming their normal activities. While recovery is challenging and there is risk of complications, modern medical care can successfully restore form and function after serious burns.