Third-Degree Burn

A third-degree burn affects all layers of the skin. The outer layer (epidermis) and the layer underneath it (dermis) are both burned. A third-degree burn may also injure the nerves, blood vessels, and muscles under the skin. Another name for this type of burn is a full thickness burn. A third-degree burn is the worst type of burn. Third-degree burns are always medical emergencies.

A third-degree burn must be treated properly. If the burn is not treated, your body can lose important fluids. This type of burn can also cause infection and lasting injury. Very bad third-degree burns may need to be treated at a hospital that has a burn unit. This is an area of a hospital that specializes in treating serious burns.

CAUSES

  • Heat (thermal) injury. This happens when skin comes in contact with something very hot. It could be a flame, a hot object, hot liquid, or steam.

  • Chemicals. Many chemicals can burn the skin. The burn should be flushed with cool water and checked by an emergency caregiver.

SYMPTOMS

  • Numbness or only a little pain. This happens because the nerve endings have been destroyed. The area around the burn may hurt more than the burned area of skin.

  • Skin that looks and feels thick, dry, and leather-like.

  • Color changes in the skin. The skin might look white or yellow, brown, purple, or black.

  • Swelling.

  • Dehydration. You might feel very thirsty, dizzy, weak, or have trouble urinating.

  • The skin may feel clammy. Lips and fingernails may turn blue. Breathing may be very fast, and you could faint.

TREATMENT

The first thing emergency caregivers will do is make sure you can breathe normally. Then they will start to treat your burn. Long-term care will also be needed for a third-degree burn. The goal will be to replace lost fluid, prevent infection, and prevent scarring.

Emergency care

  • You may be given oxygen to help you breathe. A breathing tube (endotracheal tube) may be used. This is a tube that is placed in your windpipe to keep the airway open.

  • Third-degree burns may cover large areas. This can cause your body to lose a lot of fluids. The fluids must be replaced. To do this, an intravenous line (IV) is used. Fluid can flow directly into your body through the IV.

  • Parts of the body that are burned will be wrapped in dry bandages (dressings) to keep them as clean as possible.

  • Dead skin will be cut, removed, or both. This is called debridement.

Other treatments may include:

  • Applying an antibiotic cream to fight infection.

  • Protecting the burn with a germ-free (sterile), nonstick bandage.

  • Taking pain medicine. You may need very large doses of pain medicine.

  • Getting a tetanus shot.

If you were treated in a hospital that does not have a burn unit, you may be taken to one that does. This could be needed if:

  • Burns cover more than 15% of your body.

  • Burned areas include your face, hands, feet, genitals, or joints.

  • Burns are around the chest or neck. This may cause breathing problems.

  • Burns caused a lung injury from breathing flames or smoke.

  • Burns were caused by electricity or lightning.

  • The person who was burned is a child.

  • The person who was burned is an older person with other medical problems.

Long-term burn care may include:

  • Breathing support. This could mean use of oxygen for a while or using a machine to help you breathe (ventilator).

  • Taking antibiotic medicine to prevent or treat infection.

  • Surgery. This may be needed:

  • To remove dead tissue.

  • To cover the burned area with skin grafts.

  • To repair areas of the body that were damaged by the burn.

  • Hyperbaric oxygen. This involves breathing pure oxygen in a pressurized room. This may be used if you were exposed to a large amount of smoke or carbon monoxide.

  • Physical therapy. This will help you be able to do your regular activities. It can also help prevent scarring.

HOME CARE INSTRUCTIONS

Medicine

  • Take any medicine prescribed by your caregiver. Follow the directions carefully.

  • Ask your caregiver if you can take over-the-counter medicine to relieve pain and swelling. Do not give aspirin to children.

  • Make sure your caregiver knows about all other medicines you take. This includes over-the-counter medicines.

Burn care

  • You may need to change the bandage on your burn as often as 2 or 3 times each day. Your caregiver will give you directions. It is important to use only the materials your caregiver prescribes.

  • Keep the burned or grafted area dry. Ask your caregiver when you can take a shower or tub bath again.

  • Drink enough fluids to keep your urine clear or pale yellow. Eat a well-balanced diet with lots of protein. This helps promote healing.

Follow up

  • Keep all follow-up appointments. This is important. This is how your caregiver can tell if your treatment is working.

  • Protect your burn from sunlight. Use sunscreen whenever you go outside. Burned areas may be sensitive to sun exposure.

SEEK MEDICAL CARE IF:

  • You have any questions about your medicines.

  • You have any questions about your treatment.

  • You wonder if it is okay to do a particular activity.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your burn changes color, becomes red, leaks fluid, swells, or smells bad.

  • You have a fever.