Will a second degree burn blanch with pressure at the 14 hour mark post burn?

Second Degree Burns and Blanching at 14 Hours Post-Burn

Second degree burns typically do not blanch with pressure at the 14-hour mark post-burn due to the significant edema formation that peaks between 12-18 hours after injury. 1

Burn Wound Edema Timeline

• In deep second-degree burns, edema formation reaches its maximum between 12 and 18 hours post-burn, with approximately 80% of maximum edema already present by 4 hours 1
• By the 14-hour mark, the burn wound would be in the peak phase of edema formation, making blanching unlikely due to the accumulated fluid in the tissues 1
• The initial inflammatory response has already occurred by 20 hours post-burn, altering the tissue's ability to demonstrate normal capillary refill 2

Pathophysiology Affecting Blanching Response

• Second-degree burns involve damage to both the epidermis and part of the dermis, disrupting normal microcirculation 2
• Burn injuries induce early hypovolaemic shock due to inflammation, capillary leak syndrome, and alterations in the microcirculation 3
• The severity of this inflammatory response and resulting edema would prevent normal blanching at the 14-hour mark 1

Clinical Assessment of Second-Degree Burns

• Burn depth assessment typically includes evaluation of:
  • Appearance (color, texture)
  • Sensation
  • Capillary refill/blanching
  • Presence of blisters 2
• At 14 hours post-burn, the significant edema would impair the normal blanching response that might be seen in healthy tissue 1

Implications for Treatment

• By 14 hours post-burn, the wound would be in a state where:
  • Fluid resuscitation formulas may need adjustment as the initial phase of fluid loss has already occurred 2
  • The burn wound would likely appear edematous and non-blanching 1
  • Assessment for potential compartment syndrome becomes important, especially in circumferential burns 3

Monitoring Considerations

• For second-degree burns at the 14-hour mark, clinicians should monitor for:
  • Signs of infection, as the protective barrier is compromised 3
  • Adequate pain control, as the inflammatory response is significant at this timepoint 2
  • Potential progression of burn depth, as the full extent may not be apparent until 24-48 hours post-burn 2

Caution

• The absence of blanching at 14 hours post-burn should not be used as the sole determinant of burn depth, as the normal physiological response to thermal injury includes significant edema that peaks around this time 1
• Complete resorption of edema typically takes about 1 week in second-degree burns, while it is significantly delayed in third-degree burns 1