To Burn or Not to Burn, the second Degree

Last week we talked about first degree burns, which were defined as burns that produced redness, swelling and pain, the most common of which is the sunburn.

Today we are going to talk about second degree burns. The easiest definition of second degree burns is those burns that produce Blisters, pain, redness and swelling around the blisters. These are some of the most painful burns there are. They also can be dangerous in that they can produce open wounds that can be slow to heal. If large areas of the body are burned, they can be fatal. So, second degree burns are nothing to be taken lightly.

Again, any burn (thermal, chemical, electrical) can cause second degree burns. The time of exposure often is the difference between the degree of burn. If you put your hand in the fire for a second and pull it right back out, you will probably have a first degree burn. Now, if you have a hot pot handle on the fire and try to pick it up to move it and don’t want to drop it, you don’t let it go right away. This contact burn will often produce blisters and render the hand almost useless. You also can get second degree burns from sunburns. They usually get blisters on the most exposed portions of the body and produce extreme nausea, often vomiting, fever, weakness and other flu-like symptoms. Some have called this “sun Poisoning” which is again an extreme sunburn. Chemical burns that are second degree are often from caustic solutions, like battery acid, lye or other very basic or alkaline solutions. Second degree burns from electrical sources are less likely to happen or at least recognized unless the current passes over the outside of the body as happens when you are sweating very heavily.

I like to blacksmith as a hobby and do historical reenactments. As a blacksmith, I tended to get a lot of small second degree burns from the hot metal. The good news is the longer you smith the less burns you tend to get. I think it is called learning that things are hot. Some of us are just a little harder to teach. Now, treatment for small second degree burns is simple. First, remove what is causing the burn, drop the hot pot, wash the chemical off with copious amounts of water. (I like that phrase copious amounts… why can’t they just say take a hose and run a bunch of water on it. BTW make sure it is the white hose and not the one at the dump station unless you have no other choice!) If the person’s clothes are on fire have them STOP, DROP TO THE GROUND, AND ROLL UNTIL THE FIRE IS OUT. Electrical burns drop the wires or turn off the power. Second, DO NOT BREAK THE BLISTERS, but clean the area with soap and water and put a dry sterile dressing over the burn. If the blisters are broken, place an antibiotic ointment over the burn and apply a sterile dressing. That is it for small second degree burns; they should heal in about two weeks, if kept clean and covered.

Now the tricky question, medium sized burns… do you go to the hospital or treat yourself? This is going to have to be up to you. Just let me say this, if you do try to treat a medium sized second degree burn yourself and if there is any sign of infection, go seek medical care. Treatment is the same as for small burns just be prepared with larger dressings and bandages.

Now, large second degree burns are different. When I say large, I mean something like a burn covering about 18% of the body surface (check the rule of nines for burns), but basically something like both arms, the whole chest or whole back or a whole leg. Anything approaching this size means the patient should be taken to an emergency room to be evaluated and, if the patient is a child or elderly, even less of a burn area should be cause for alarm, err on the side of caution. Something this size can happen from trying to start a fire, often with gasoline, or falling in a fire, catching clothes on fire when trying to get warm around a fire, or immersion in very hot water (again turn your water heater temperature below 115 at the very most). Until you can get the person to treatment, wrap them in a clean sheet and, if conscious, keep hydrated.

Also, needing treatment in the Emergency Department are second degree burns that involve the head/face, the complete surface of the hands and feet and the genitals. Pain relief in the form of Aleve are not out of the question but will not usually be strong enough to control the pain.

Prevention is the best course for second degree burns. Keep a close eye on people around fires and other open flames. Be very careful with strong chemicals, and wear glove and goggles and protective clothing. Turn electrical circuits or equipment off before attempting to service them.

These burns can cause disfiguring scars to large areas of the body. Don’t let that happen to your friends or family. Used with caution these devices or substances are tools that can help people, and, as such, you are responsible to use them with caution.

Your Obedient Servant,

Gary Smith, Jr.