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Ch. 4 Skin and Body Membranes
Marieb - Essentials of Human Anatomy & Physiology 13th Edition
Marieb13th EditionEssentials of Human Anatomy & PhysiologyISBN: 9780135624340Not the one you use?Change textbook
All textbooksMarieb 13th EditionCh. 4 Skin and Body MembranesProblem 22
Chapter 4, Problem 22

A burn victim exhibits a red and swollen arm with blistering; a hand that has been charred black, exposing bone; and a cheek that appears blanched. How serious is each burn, and is this patient critical? Explain.

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Step 1: Understand the classification of burns. Burns are categorized into three degrees based on their severity: (1) First-degree burns affect only the epidermis, causing redness and swelling. (2) Second-degree burns extend into the dermis, causing blistering. (3) Third-degree burns destroy the full thickness of the skin and may expose underlying tissues such as muscle or bone, often appearing charred or white.
Step 2: Assess the arm with redness, swelling, and blistering. The presence of blistering indicates a second-degree burn, which involves damage to both the epidermis and dermis. This type of burn is painful and may require medical attention to prevent infection and promote healing.
Step 3: Evaluate the hand that is charred black and exposes bone. This description matches a third-degree burn, which is the most severe type of burn. Third-degree burns destroy the full thickness of the skin and underlying tissues, often resulting in nerve damage (which may reduce pain sensation in the area). This is a critical injury requiring immediate medical intervention, including possible surgery or skin grafting.
Step 4: Examine the cheek that appears blanched. A blanched appearance suggests compromised blood flow, which could indicate a severe burn. Depending on the depth of tissue damage, this could be a second-degree or third-degree burn. Further assessment by a medical professional is necessary to determine the extent of the injury.
Step 5: Determine the overall criticality of the patient. The presence of third-degree burns (especially on the hand, exposing bone) and burns on multiple body regions (arm, hand, cheek) makes this patient critical. Immediate medical attention is required to manage fluid loss, prevent infection, and address potential complications such as shock or organ failure.

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Key Concepts

Here are the essential concepts you must grasp in order to answer the question correctly.

Burn Classification

Burns are classified into three main categories: first-degree, second-degree, and third-degree. First-degree burns affect only the outer layer of skin, causing redness and minor pain. Second-degree burns involve deeper layers, resulting in blisters and swelling. Third-degree burns penetrate all skin layers, potentially damaging underlying tissues and nerves, often appearing charred or white.
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Assessment of Burn Severity

The severity of burns is assessed based on depth, extent, and location. The 'Rule of Nines' is commonly used to estimate the total body surface area affected. Burns covering a significant percentage of the body, especially third-degree burns, indicate a critical condition. Additionally, burns on the face, hands, feet, or over major joints are considered more serious due to functional and cosmetic implications.
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Critical Condition Indicators

A patient is considered critical if they exhibit signs of shock, respiratory distress, or extensive burns. In this case, the charred hand indicates a third-degree burn, which is life-threatening, while the swollen arm and blanched cheek suggest second-degree burns. The combination of these injuries, especially if extensive, can lead to complications such as infection, fluid loss, and systemic shock, necessitating immediate medical intervention.
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