Burn Classification: Partial-Thickness (Second Degree)
This patient has partial-thickness (second degree) burns, as burns extending through the epidermis into the dermis define second-degree injury. The correct answer is B. Partial-thickness (second degree).
Burn Depth Classification
The classification of burn depth is based on which anatomical layers are affected:
- First-degree (superficial) burns involve only the epidermis and present with erythema without blistering 1
- Second-degree (partial-thickness) burns disrupt the epidermis and extend into part of the dermis, which matches this patient's presentation 1, 2
- Third-degree (full-thickness) burns extend through the epidermis, dermis, and into subcutaneous fat 2
- Fourth-degree burns expose bone, tendons, and muscles 3
Clinical Significance of This Patient's Burns
This patient requires immediate specialist referral for several critical reasons:
High-Risk Anatomical Locations
- Burns involving the face and bilateral hands automatically require burn specialist consultation regardless of total body surface area, as these are considered special areas with high risk of functional impairment 4, 5
- Hand burns with partial-thickness depth require specialized care beyond first aid to prevent permanent functional disability 5
- Facial burns carry risks of inhalation injury and require specialized assessment 6
Workplace Explosion Context
- The mechanism (explosion) raises concern for inhalation injury, which should be assessed by looking for soot around the nose/mouth and monitoring for respiratory difficulty 6
- This mechanism may also indicate deeper burns than initially apparent, as the burn wound is dynamic and can progress without proper treatment 2
Immediate Management Priorities
While arranging urgent transfer to a burn center:
- Cool the burns with clean running water for 5-20 minutes to limit tissue damage 4, 5, 6
- Provide adequate analgesia with titrated intravenous opioids or ketamine, as burn pain is often intense and difficult to control 5
- Cover burns loosely with clean, non-adherent dressings while arranging immediate transfer 5
- Monitor for compartment syndrome in the hands by watching for blue, purple, or pale extremities indicating poor perfusion 5
Critical Pitfall to Avoid
Do not delay specialist referral for any partial-thickness hand or facial burn, as undertriage increases morbidity and mortality 5. Direct admission to a burn center, rather than sequential transfers, improves survival and functional outcomes 5.