is there any long-term tissue damage and it usually results in an increase or
decrease in the skin color.
Treatment involves placing a cold, wet compress on the burned area in order
to constrict blood vessels and reduce swelling and pain. Less tissue damage
occurs if the burned area is cooled quickly. Remove clothing immediately and
flush the burned area with water if a chemical agent caused the burn.
Don’t apply greasy ointments, butter, or a dressing to the burned area. This
inhibits heat loss and increases tissue damage. Bacitracin with polymyxin B
(Polysporin) and similar over-the-counter antibiotics should be used.
Second-degree (partial thickness) burns
Second-degree burns expose the epidermis and part of the dermis layer of skin.
The burn site appears red, blistered, and may be swollen and painful.
These burns can be quite painful and can become infected easily. They should
be cleaned with a non-abrasive solution, treated with antibiotic ointment such
as silver sulfadiazine (Silvadine), protected with a non-stick dressing, and the
patient should be given an analgesic based on the amount of area burned and
the pain experienced.
Third-degree (full thickness) burns
Third-degree burns destroy the epidermis and dermis and may also damage
underlying nerve, bones, muscles, and tendons. The burn site appears white or
charred and the patient has no sensation in the area since the nerve endings
are destroyed.
Third-degree burns can be very painful because they are generally mixed
(that is, second- and third-degree). Analgesics are used to manage the pain (see
Chapter 16). Burn patients are susceptible to infection. With the skin gone, the
patient is exposed to infection.
Third-degree burns are treated by first removing the charred skin (eschar)
which is called debridement. This is a painful procedure. The patient is then
given multiple antibiotics to prevent infections. The patient is also at risk for
fluid and electrolyte imbalances (see Chapter 10) and at high risk for stress
ulcers (see Chapter 18). Burn patients must be assessed for possible smoke
inhalation. If it exists, the patient is treated with respiratory medications (see
Chapter 14).
Burned areas must be cleansed with sterile saline solutions and an antiseptic
such as povidone-iodine (Betadine). Broad-spectrum topical antibiotics are then
applied to burn areas. These include antibacterials such as mafenide acetate
CHAPTER 20 Skin Disorders^381