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second degree burn
Classification:
- superficial partial thickness
- epidermis destroyed, partial dermal destruction
- blisters, weeping, sloughed skin, red
- painful to air & touch, blanches
- deep partial thickness
- epidermis & dermis destroyed
- wet or dry
- white, yellow or red
- painful to pressure
Etiology:
- see burn
Pathology:
- full thickness epidermal burn with the dermis remaining largely intact
Clinical manifestations:
1) 1st & second degree burns are hypersensitive & painful
2) erythema
2) tenderness
3) edema
4) 2nd degree burns
5) blisters
6) shiny appearance
7) weeping
Complications:
- see burn
Management:
1) debridement
a) intact blisters may be left for 3-4 days if no sign of infection
b) bulky blisters may be decompress & devitalized skin removed
2) gentle cleansing with antiseptic or mild soap
3) topical antibiotics
a) bacitracin for very limited 2nd degree burns
b) silver sulfadiazine (Silvadene) is preferred agent for larger or deeper burns
4) dressings
a) non-adherent gauze next to skin covered by bulky dressing
b) wounds of face & ears may be easier to treat without bandages
c) daily dressing changes (premedication may be required)
5) tetanus prophylaxis
a) tetanus toxoid 0.5 mL SC booster
b) tetanus immune globulin (Hyper-Tet) 25 U IM plus tetanus toxoid 0.5 mL SC if never immunized
6) 2nd degree burns heal spontaneously without scarring in 2-3 weeks
General
burn
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 18, 19.
American College of Physicians, Philadelphia 2012, 2018, 2022.