Brief essay on burn classification and treatment

I often am required as an urgent care physician to rate the severity of a burn.  What constitutes a 1st degree, 2nd degree and 3rd degree burn?   Are they treated differently, and what are the potential complications?

All burns should be treated immediately with cool water or compresses.  This will provide a small amount of pain relief.  Acetaminophen or ibuprofen can also help.  First degree burns such as red, non blistering sunburn usually do not require a physician evaluation.  Topical analgesic sprays such as Solarcaine can mildly numb the skin as it heals.  Second degree burns are more severe and blister, usually fairly quickly.  Blisters provide a protective barrier as new skin forms underneath, and should not be picked off.  Physician evaluation is recommended, because 2nd and 3rd degree burns often get infected, necessitating antibiotics ranging from topical preparations such as Neosporin to oral and intravenous medication, the latter usually reserved for the more severe 3rd degree burns.  A tetanus shot is also recommended if the patient is not up to date.  Second degree burns penetrate deeper than 1st degree burns, involving the dermis layer of skin, while 3rd degree burns go even deeper, down to the subcutaneous tissue.  Nerves are damaged in the deeper 3rd degree burn, making them not painful to touch, while 2nd degree burns are very sensitive.  Both, however, frequently require prescription pain medication.  As shown in the top photograph, skin grafting is usually required in a 3rd degree burn, as these do not heal on their own…Richard R Samuel, MD     Family Practice and Urgent Care