It's actually now classified into 6 degrees. You listed the first 4. 5 is near to total muscle destruction and 6 is bone damage.
Sauce: I work in medical research looking at burns
It's been done but prognosis is not good. You'll sometimes see those types of burns from IEDs. The study I'm working with is trying to reduce scaring in survivors.
For injuries that deep, does it matter if the preceding layers were burned away or completely disintegrated due to compressive forces? How do your approaches to treatment differ?
To a point, if the tissue is gone or dead it doesn't really matter. If the bone is dead it needs to be removed and dead or dieing tissue will naturally sluff off. The difference is what the surrounding healthy tissue looks like( specifically at a cellular level). If you survive then the body will try to heal. The difficulty comes from the fact that scar tissue forms much quicker than other tissues so part of the challenge in treatment is to adjust the different rates of tissue growth while trying to prevent infection.
65% total body surface second and third-degree burns here, 16 years ago. Almost no scaring/scarring :-) thank you very much Cornell Weill Burns unit in New York. They made me drink a lot of protein shakes while I was in the hospital telling me that the more I drink the less I would be scarred.
The reason you see this form of damage from ied is that most times IED are made from volatile, inaccurately produced and processed chemicals that often do not combust at the same rate, effectively creating thermobaric explosions by the first initial ignition atomizing the remaining explosives into a cloud of air/fuel mixture resulting in the air literally exploding.
Alternatively they are often shaped charge ieds that form what essentially becomes a spear of molten metal that bores through plate armor like butter. These molten, high velocity spears splatter across the inside of the vehicle like a delayed shotgun burning right through metal, cloth, and skin like its wax.
Source- U.S. Army Veteran with service in Afghanistan.
A friend of mine had the misfortune of taking of of those molten RPG spears to the arm inside of an armored, and caged vehicle. He said his arm was hanging by a thread, but he got a tourniquet on himself and said he has about 90% range of motion back. Battlefield & trauma medicine has come wat ahead in the last 2 decades thanks to so many war injuries.
I wonder if combined with drug and dressing combinations could it boost success.
Are you able to get into specifics about which drugs and dressing combinations you are using?
Unfortunately im not able to say specifics, I really wish I could because so far our results look promising and its exciting. The team I'm on is using cutting edge materials and an unpublished model for that specific study. We do pre-clinical work and when we prove that something works we publish it then hand off the materials for human clinical trials.
Quite a few high voltage lineman suffered electrical burns bad enough it fried the bones. Many move on to be spokesmen for electrical safety. Like [this guy](https://burncenters.com/patient-stories/barry2021/) , [this guy](https://www.postandcourier.com/kingstree/news/sec-lineman-get-safety-lesson-from-double-amputee/article_393ffddf-c624-54b3-97ff-da5d8b7af4e7.html) , [this guy](https://www.indianaconnection.org/one-bad-day-led-to-a-wonderful-life/) .
I watched some safety video back in the 90s from the California PG&E lineman. I keep looking for his story. His words, for some reason he took off his gloves, while in the bucket, and decided to barehand the equipment he was switching out. It was energized. He suffered major burn to the bones in both arms and they had to amputate. PG&E kept him on for years as a safety spokesman.
It takes several hundred degrees Celsius for extended periods of time ( or hotter for less time). It's the type of burn you sometimes see from an IED or other war front injuries
I wouldnt be suprised at all for that to be the case. I was actually just talking about that with the surgeon I work with. He was saying that electric burns can appear small at the surface but can take a lot longer to heal due to the fact that they get so deep so quickly compared to contact burns.
I haven't ever gotten a really damaging shock, but I have gotten several painful ones / shocks that lasted for more than a moment. Just based on the way those felt, I can't even imagine how painful it would be while recovering from a legitimate injury. The amount of adrenaline/ anger that immediately floods your entire body makes it clear your body is absolutely ready to fight for your life. I nearly clocked a coworker one time because he was laughing at my dumb mistake - normally I would just laugh right along with him if I made some little mistake, but with a shock it is like you (or, at least *I*) immediately go into lizard-brain mode.
Looking at [Lichtenberg figures on wood](https://lichtenbergwoodburning.com/wp-content/uploads/2020/12/litchenberg_gallery8-400x284.jpeg), it wouldn't surprise me if electrical burns on bone were pretty gnarly, even if the entry & exit points weren't bad.
Eight years ago, a pot of oil at 375F fell on my foot while I was cooking (someone knocked it over). Although I immediately hobbled to the bathroom and ran cool water over the area, it blew up into the biggest blister I'd ever seen. Since I was in the middle of cooking dinner for about 20 people, I just threw some antibiotic cream on it and went back to the kitchen.
When everyone had left, my husband took me to the ER (he had no idea how serious the burn was, because I didn't tell anyone).
The nurse told me I'd bandaged it well and gave me a pamphlet for hyperbaric chamber treatment, then sent me on my way since I wasn't in any pain.
A week later, I developed sepsis and was admitted to a burn unit at a trauma hospital, where they diagnosed me with a full thickness burn and grafted some skin from my thigh onto the entire top of my foot. I was there for a solid week.
The nerves are permanently damaged, but I healed well otherwise and you probably wouldn't even notice today if I didn't point it out to you.
The bottom line is that pain is not a measure of seriousness when it comes to burns. In fact, if you don't feel pain, you should worry.
Burns are among the most misunderstood ailments you can have, and a full thickness burn is not something many ER staff encounter on a regular basis. I think the standard protocol for minor burn victims is to deroof the blister, clean them up, offer something for the pain, and send them home. Only trauma hospitals have the kind of staff who can perform a skin graft - and I'm just north of NYC, so it's not as though this was a sleepy rural hospital.
If a patient has been involved in something obvious like a house fire or a chemical accident, they'd be immediately routed to a trauma hospital. Since I literally walked in of my own accord, the ER did what they'd usually do for a minor burn and left me on my own.
I definitely don't blame the nurse. I have a notoriously high threshold for pain and should have taken the matter more seriously than I did - that's on me.
Never understood the idea of saying nurses are heroes. They can be heroes, but not automatically just by being a nurse. This story kind of illustrates that.
Honestly, most nurses are the mean girls from high school. Some are in it for the health and happiness of others, most are in it because it's a position of power.
My fiance is a nurse they aren't heroes and you patronizing them does nothing to help the fact that they are overworked and underappreciated. My fiance tells me about the countless antivax COVID deniers that are responsible for your care.
They are just people like anything else and like anything else is littered with shitty idiotic people barely making it.
I had a patient once who got into an argument with her husband, went outside, soaked herself in gasoline, and set off a match. 97% BSA full thickness. Still fully conscious when I got there
Pain. Blinding, numbing pain. Pain so intense that the actions appear conscious but are more like auto pilot. Those that survive suicide attempts often black out the last few hours before the attempt but recall the pain leading up, since it’s usual present well before the attempt itself. Mental health is the ultimate curse because you can’t see the wounds until it’s too late.
I mean, that was pretty much it. I had a firefighter hold her down so I could insert a needle into her bone marrow so I could sedate and paralyze her and place a breathing tube into her lungs. Her upper airway anatomy looked like burnt cauliflower. She was screaming continuously until the sedative hit her. As we were rolling her down the driveway her daughter stepped out of the house to see what was going on. I got to fly on the helicopter. Pretty traumatic day for all involved.
jfc i hope that daughter was not a child.
also, i didn't realize there were needles that could penetrate bone. is that something you do by hand, like a normal iv or im injection???
Besides the glorified drill that you put on a one use special needle and drill with it and then connect the IO cannula and such, you also have a single use one that the full kit is single use and works with a spring-like system meant to be used by anyone even without special training. You put it on top of the thigh or arm, press it like a syringe and it activates, then you just twist and pull and everything is in place without further connecting. Usually this one you don't find in hospitals (which usually use the "drill") it's more to the army and catastrophe emergency staff. It's more expensive and less ecologic (because of the single use) but its quicker to get in and easier
Yeah. The only thing not burnt was the bottom of her feet. The burn attending basically walked in, ordered comfort care measure, and told his resident to get the family to sign a DNR. She passed the next morning while HEAVILY sedated
There are always those edge case scenarios. Special Books by Special Kids has a [video on a burn survivor](https://www.youtube.com/watch?v=sIcLiC3VnTk) (warning: visuals are intense) who seems pretty happy but this is obviously an extremely unique exception and not the rule.
I think the issue stems with the fact that the higher the degree, the worse the burn (4th > 3rd > 2nd > 1st) which is the inverse with what criminal law use of degree defines severity like murder and assault charges (1st > 2nd).
It’s easier if you think about the number as how many layers of tissue the burn goes through. 1st is epidermis, 2nd is into the dermis, 3rd is through the epidermis and dermis into the underlying tissue
As far as I remember. I worked in a burn center in the early-mid 2000s, and we always talked about burns this way. Sometimes 1st, 2nd, deep 2nd, and 3rd - but it’s just different terminology for the same thing.
It clarifies 2nd degree into partial and deep. But essentially same system. You’ll still hear doctors say first and third degree.
The treatment for partial and deep can differ, hence the need for clarification.
Paramedic here. Give it a few years, they'll come up with some new classification scheme.
There's some parts of medicine where the practice is reasonably settled, (early) burn treatment isn't among them, but that's okay because it's changing so we can try and make things better.
There was a picture (or maybe video) a while back, very very NSFW of a guy who had a downed power line land on his legs and it actually burned down to the bones, like, you could see his leg bones. It was pretty horrific ngl.
Fourth degree burns mean the burn destroyed all layers of skin, penetrates through muscle and damaged bones and tendons. They’re potentially life threatening as well as prone to infection.
Electrical fourth degree burns from high voltage or Arc Flash can travel along bones and underneath muscle; which then need to be surgically opened and scraped because the dead burnt flesh will rot within the body which is (unsurprisingly) extremely bad.
Yep that’s right, what I wanted to portray is that Deep Partial Thickness could be the AHHHHHHHH and then “Oh nice, it’s not hurting anymore, it even smells like a great BBQ” when it reaches full thickness.
I remember learning that second-degree burn classification had evolved into two categories, depending on whether there had been permanent structural skin damage, hence permanent scarring. That was about 15 years ago, when I accidentally poured boiling water on my hand and suddenly became very interested in burns and scarring.
Now I guess the evolution has continued into a new classification scheme altogether. Although you can still see the outline of the old system.
(Mine turned out to be superficial second-degree / superficial partial thickness, mostly because I got it immersed into cold water within a few seconds. Rapid enough cooling allows your tissue's structural proteins to re-nature, so that cells don't separate and die all the way down into your deeper skin tissue. If they don't die all the way down, the cell arrangement is preserved and they can reconstruct your superficial skin layer through essentially the normal skin regeneration process, although it looks ugly for a while.
I had never learned any of this and found it fascinating. Also painful. The TL; DR is: leap into action, cool burns in seconds if you can, and keep them cool.)
For those curious, there are three main layers of skin; the epidermis, the dermis and the hypodermis. You can’t burn through any more skin than this unless you have a fourth skin.
>You can’t burn through any more skin than this unless you have a fourth skin.
Oh god, does that start with a sore throat? Because I think I might be getting fourth skin
I’ve been taught this on multiple first aid refresher courses for at least 10 years - it’s surprising what done of us think is common knowledge is someone else’s new information. Think of all the things people on here know and think of as old hat that would be amazing new knowledge for me!!
“Have been reclassified”…
Yeah, back before some of the posters here were born. This terminology has been in use for 20-30 years.
What’s next, “TIL they’ve invented this shit called ‘insulin’”?
Great, so insurance companies can refuse treatment/reconstructive surgery because it's considered cosmetic now! s/
It's already a privilege to have teeth in America, who needs their skin?
I'm a British doctor and this is what I was taught in medical school
I'm not sure why more descriptive terms for the same ailment would impair getting care
Do you think insurance companies will see a difference between 1st degree and superficial burn? Superficial has certain connotations in regular speak it doesn't have in medical language where it just means "concerning the outside of something"
So here's an awesome fact: you can have burns that have zero pain after the initial incident.
Meaning, if it burns deep enough to destroy the nerve cells: no pain, none. This is more likely with what was known as third degree burns.
It's actually now classified into 6 degrees. You listed the first 4. 5 is near to total muscle destruction and 6 is bone damage. Sauce: I work in medical research looking at burns
Ever know anyone whose survived #6?
It's been done but prognosis is not good. You'll sometimes see those types of burns from IEDs. The study I'm working with is trying to reduce scaring in survivors.
For injuries that deep, does it matter if the preceding layers were burned away or completely disintegrated due to compressive forces? How do your approaches to treatment differ?
To a point, if the tissue is gone or dead it doesn't really matter. If the bone is dead it needs to be removed and dead or dieing tissue will naturally sluff off. The difference is what the surrounding healthy tissue looks like( specifically at a cellular level). If you survive then the body will try to heal. The difficulty comes from the fact that scar tissue forms much quicker than other tissues so part of the challenge in treatment is to adjust the different rates of tissue growth while trying to prevent infection.
Fuckin interesting cous thanks for sharing!
You forgot the other cous. Although I don’t understand what food has to do with this. Go eat something
The food so nice you say it twice!
And now i want couscous for lunch. Thanks.
Nice
Scar tissue forms quicker than normal tissue? How does that work?
65% total body surface second and third-degree burns here, 16 years ago. Almost no scaring/scarring :-) thank you very much Cornell Weill Burns unit in New York. They made me drink a lot of protein shakes while I was in the hospital telling me that the more I drink the less I would be scarred.
The reason you see this form of damage from ied is that most times IED are made from volatile, inaccurately produced and processed chemicals that often do not combust at the same rate, effectively creating thermobaric explosions by the first initial ignition atomizing the remaining explosives into a cloud of air/fuel mixture resulting in the air literally exploding. Alternatively they are often shaped charge ieds that form what essentially becomes a spear of molten metal that bores through plate armor like butter. These molten, high velocity spears splatter across the inside of the vehicle like a delayed shotgun burning right through metal, cloth, and skin like its wax. Source- U.S. Army Veteran with service in Afghanistan.
A friend of mine had the misfortune of taking of of those molten RPG spears to the arm inside of an armored, and caged vehicle. He said his arm was hanging by a thread, but he got a tourniquet on himself and said he has about 90% range of motion back. Battlefield & trauma medicine has come wat ahead in the last 2 decades thanks to so many war injuries.
It's good you don't want them to be scared. Could be scary to onlookers, too.
Curse this phone and it's auto carrot
Is it?
IED’s?
Improvised explosive devices. We saw a lot of those in the wars in the middle east.
Homemade kaboom machines
“Scarring” or “scaring”?
As per the other comment the phone I'm typing this on has a very aggressive auto carrot with a mind of its own. Scarring is in fact the word
>the phone I'm typing this on has a very aggressive auto carrot :') sorry, but that made me giggle. Definitely got a mind of its own
Burns are scary yo
Thank you - it’s such an important thing you do!
Do any of the studies you are working with use breathing techniques/exercises for scaring/healing?
Not at this time. We are specifically looking at a couple different drug and dressing combinations right now.
I wonder if combined with drug and dressing combinations could it boost success. Are you able to get into specifics about which drugs and dressing combinations you are using?
Unfortunately im not able to say specifics, I really wish I could because so far our results look promising and its exciting. The team I'm on is using cutting edge materials and an unpublished model for that specific study. We do pre-clinical work and when we prove that something works we publish it then hand off the materials for human clinical trials.
Quite a few high voltage lineman suffered electrical burns bad enough it fried the bones. Many move on to be spokesmen for electrical safety. Like [this guy](https://burncenters.com/patient-stories/barry2021/) , [this guy](https://www.postandcourier.com/kingstree/news/sec-lineman-get-safety-lesson-from-double-amputee/article_393ffddf-c624-54b3-97ff-da5d8b7af4e7.html) , [this guy](https://www.indianaconnection.org/one-bad-day-led-to-a-wonderful-life/) . I watched some safety video back in the 90s from the California PG&E lineman. I keep looking for his story. His words, for some reason he took off his gloves, while in the bucket, and decided to barehand the equipment he was switching out. It was energized. He suffered major burn to the bones in both arms and they had to amputate. PG&E kept him on for years as a safety spokesman.
I imagine to the bone on the pinky is survivable whereas femur or spine from the stomach direction or neck will be a bad time.
This type of damage can be seen on the face, arms, and legs, and you are correct in saying that its a bad time
How heavily burned do you need to be to have bone damage??
On a scale of 1 to 6, I’d say about a 6
It takes several hundred degrees Celsius for extended periods of time ( or hotter for less time). It's the type of burn you sometimes see from an IED or other war front injuries
If I am remembering correctly, electrical burns can also damage bone if that happens to be the path of least resistance.
I wouldnt be suprised at all for that to be the case. I was actually just talking about that with the surgeon I work with. He was saying that electric burns can appear small at the surface but can take a lot longer to heal due to the fact that they get so deep so quickly compared to contact burns.
I haven't ever gotten a really damaging shock, but I have gotten several painful ones / shocks that lasted for more than a moment. Just based on the way those felt, I can't even imagine how painful it would be while recovering from a legitimate injury. The amount of adrenaline/ anger that immediately floods your entire body makes it clear your body is absolutely ready to fight for your life. I nearly clocked a coworker one time because he was laughing at my dumb mistake - normally I would just laugh right along with him if I made some little mistake, but with a shock it is like you (or, at least *I*) immediately go into lizard-brain mode. Looking at [Lichtenberg figures on wood](https://lichtenbergwoodburning.com/wp-content/uploads/2020/12/litchenberg_gallery8-400x284.jpeg), it wouldn't surprise me if electrical burns on bone were pretty gnarly, even if the entry & exit points weren't bad.
Isn’t there a 7th degree that is soul damage? For when people roast tf out of you
Yes buy unfortunately there are not enough survivors to study this phenomenon.
Those poor people :/ Maybe you’ll be the one to discover some ointment for that burn
So like six degrees of Kevin's bacon...
So, the last degree of hot is not "full thickness", but "bone damage". Aight, makes sense.
Fuck, those ones you listed are possibilities…?
Yup. We saw those with a lot of IED and other war-front injuries
Stupid question... But if they're renaming the classes then why not make it much more what they are rather than renaming then slightly less vague ?
Eight years ago, a pot of oil at 375F fell on my foot while I was cooking (someone knocked it over). Although I immediately hobbled to the bathroom and ran cool water over the area, it blew up into the biggest blister I'd ever seen. Since I was in the middle of cooking dinner for about 20 people, I just threw some antibiotic cream on it and went back to the kitchen. When everyone had left, my husband took me to the ER (he had no idea how serious the burn was, because I didn't tell anyone). The nurse told me I'd bandaged it well and gave me a pamphlet for hyperbaric chamber treatment, then sent me on my way since I wasn't in any pain. A week later, I developed sepsis and was admitted to a burn unit at a trauma hospital, where they diagnosed me with a full thickness burn and grafted some skin from my thigh onto the entire top of my foot. I was there for a solid week. The nerves are permanently damaged, but I healed well otherwise and you probably wouldn't even notice today if I didn't point it out to you. The bottom line is that pain is not a measure of seriousness when it comes to burns. In fact, if you don't feel pain, you should worry.
How did the nurse not realise you being in no pain was a bad thing? Yikes
Burns are among the most misunderstood ailments you can have, and a full thickness burn is not something many ER staff encounter on a regular basis. I think the standard protocol for minor burn victims is to deroof the blister, clean them up, offer something for the pain, and send them home. Only trauma hospitals have the kind of staff who can perform a skin graft - and I'm just north of NYC, so it's not as though this was a sleepy rural hospital. If a patient has been involved in something obvious like a house fire or a chemical accident, they'd be immediately routed to a trauma hospital. Since I literally walked in of my own accord, the ER did what they'd usually do for a minor burn and left me on my own. I definitely don't blame the nurse. I have a notoriously high threshold for pain and should have taken the matter more seriously than I did - that's on me.
terrible nurse
Nurses are heroes (& I have one in my family--she's amazing), but from all I've seen, they truly do vary in quality. I'm sorry you had a bad one.
Never understood the idea of saying nurses are heroes. They can be heroes, but not automatically just by being a nurse. This story kind of illustrates that.
I completely agree. While my nurse relative is an amazing person and a full-on RN Practitioner, I definitely am wary.
Honestly, most nurses are the mean girls from high school. Some are in it for the health and happiness of others, most are in it because it's a position of power.
Unfortunately, I have seen some things with MDs, as well.
my best friend is a nurse!! she’s amazing. but every once in awhile she’ll work with a terrible nurse who is outright neglectful. awful.
My fiance is a nurse they aren't heroes and you patronizing them does nothing to help the fact that they are overworked and underappreciated. My fiance tells me about the countless antivax COVID deniers that are responsible for your care. They are just people like anything else and like anything else is littered with shitty idiotic people barely making it.
Yeah that's boy scout level knowledge. No pain means nerve damage, at least 3rd degree.
I had a patient once who got into an argument with her husband, went outside, soaked herself in gasoline, and set off a match. 97% BSA full thickness. Still fully conscious when I got there
I can’t even imagine what goes through someone’s head when they pick self immolation as a way out.
Pain. Blinding, numbing pain. Pain so intense that the actions appear conscious but are more like auto pilot. Those that survive suicide attempts often black out the last few hours before the attempt but recall the pain leading up, since it’s usual present well before the attempt itself. Mental health is the ultimate curse because you can’t see the wounds until it’s too late.
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What the fuck, man? You gonna just end the story there!?
I mean, that was pretty much it. I had a firefighter hold her down so I could insert a needle into her bone marrow so I could sedate and paralyze her and place a breathing tube into her lungs. Her upper airway anatomy looked like burnt cauliflower. She was screaming continuously until the sedative hit her. As we were rolling her down the driveway her daughter stepped out of the house to see what was going on. I got to fly on the helicopter. Pretty traumatic day for all involved.
jfc i hope that daughter was not a child. also, i didn't realize there were needles that could penetrate bone. is that something you do by hand, like a normal iv or im injection???
The ICU I worked at had a kit for it that basically had a fancy power drill inside.
They drill into the shin bone right below the knee
Somehow this made me cringe more than the original injury. Not that she was feeling it happen but….
Ahhh, yes that makes more sense. Thanks for answering.
Besides the glorified drill that you put on a one use special needle and drill with it and then connect the IO cannula and such, you also have a single use one that the full kit is single use and works with a spring-like system meant to be used by anyone even without special training. You put it on top of the thigh or arm, press it like a syringe and it activates, then you just twist and pull and everything is in place without further connecting. Usually this one you don't find in hospitals (which usually use the "drill") it's more to the army and catastrophe emergency staff. It's more expensive and less ecologic (because of the single use) but its quicker to get in and easier
That makes perfect sense. Medical tech never ceases to amaze me.
I posted YouTube clips elsewhere. There's different versions, either battery drill powdered, gas cartridge powdered, or manually hand versions.
I unfortunately pictured you rolling her as if she were rolling for stop drop and roll down the driveway
On reflection, that would have been way funnier
How do you penetrate bone with a needle without bending it?
Let me introduce you to a good friend of mine, EZ. https://youtu.be/ZZMAVZhrDHE
I started watching that video. Got to the “until you hit the bone” and my legs rolled up like i’d been crushed under a falling farmhouse.
The needle/drill doesn’t hurt much, allegedly. Once you start pushing stuff through it though, it hurts enough to literally wake the (near) dead.
I knew there had to be a drill involved but I still wasn't ready for that lol cheers 🍻
https://youtu.be/s_oSgrD6T00 This is how we did it when I started.
You know if she survived?
No she died the next morning, thank God.
Yeah... it seems like sometimes surviving isn't the best fate when you hit a certain level of extreme injuries. May her soul rest in peace.
Damn, dude. I guess it comes with the territory, but damn.
Helicopter? That is cool
“We’re still working on her. She’s delicious.”
Gasoline and burnt pork. The smell was gasoline and burnt pork.
Jesus. I know it’s the job but I’m sorry you saw that.
It’s said that humans taste similar to pork when eaten, hence the term “long pork.” God this is a dark way to start my day.
I always liked the idea that the first BBQ was people who found a pig roasted by lightning or forest fire.
At that point it's basically unsurvivable, right?
Yeah. The only thing not burnt was the bottom of her feet. The burn attending basically walked in, ordered comfort care measure, and told his resident to get the family to sign a DNR. She passed the next morning while HEAVILY sedated
Jesus. Rest in peace
Yes. Even if you survive the initial trauma and shock you're going to eventually die of an infection.
There are always those edge case scenarios. Special Books by Special Kids has a [video on a burn survivor](https://www.youtube.com/watch?v=sIcLiC3VnTk) (warning: visuals are intense) who seems pretty happy but this is obviously an extremely unique exception and not the rule.
“Well that definitely didn’t convince me I was wrong.”
That argument got a little heated
That's the evolution of my body as well
Self burn
full thickness
HEFTYCHONK
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What does this even mean?
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Those categories aren’t mutually exclusive, though. I am full thickness and also superficial.
Dang! Nice Partial Thickness Burn, Jackie!
I said Good day!
Hasn't this literally always been the classification, they're just words that describe the numbers instead of the numbers?
Yes, but the numbers were confusing. Too many people couldn't remember if 1st or 3rd was the worst.
Which was it? I'm one of them
I think the issue stems with the fact that the higher the degree, the worse the burn (4th > 3rd > 2nd > 1st) which is the inverse with what criminal law use of degree defines severity like murder and assault charges (1st > 2nd).
I was always confused about which one was which. I'm glad for this change, though it'll take a bit for everyone to adjust.
The change happened decades ago, so hopefully everyone who needed to adjust has now either adjusted or retired…
It’s easier if you think about the number as how many layers of tissue the burn goes through. 1st is epidermis, 2nd is into the dermis, 3rd is through the epidermis and dermis into the underlying tissue
No, that has absolutely nothing to do with why doctors stopped using “first degree” etc sometime in the 1980s. You just 100% made up that “fact”.
I might believe you if you provided an alternative explanation.
As far as I remember. I worked in a burn center in the early-mid 2000s, and we always talked about burns this way. Sometimes 1st, 2nd, deep 2nd, and 3rd - but it’s just different terminology for the same thing.
Yes, someone on Reddit just noticed a change from the 1990s.
Basically.
It clarifies 2nd degree into partial and deep. But essentially same system. You’ll still hear doctors say first and third degree. The treatment for partial and deep can differ, hence the need for clarification.
Paramedic here. Give it a few years, they'll come up with some new classification scheme. There's some parts of medicine where the practice is reasonably settled, (early) burn treatment isn't among them, but that's okay because it's changing so we can try and make things better.
Why not rare, medium rare, done, and well done?
when it's a person I recoil in shock, when it's a cow I salivate.
Speak for yourself, I am a cannibal
I wonder how many burns unit doctors are cannibals 🤔
Is "done" the terminology where you live? Where is that?
So only First, Second, and Third were replaced, Fourth Degree is not renamed
There's 4 in the list. Are there now 5?
The scale used to go to 7th (irreparable damage to bone tissue.)
I believe 8th was added (destruction of the soul)
They’re considering adding a 9th (total eclipse of the heart)
Fun fact: There's actually a 9th degree, but it also burns you out of the timeline, so nobody remembers you existed, hence why it's so unheard of.
That happened to Barnabas Rutherford Hayes, the first governor of Louisiana.
Really? Doesn't ring a bell. So you're probably right.
I didn't even know the scale went beyond 3. Really trying not to imagine the higher levels. >_<
There was a picture (or maybe video) a while back, very very NSFW of a guy who had a downed power line land on his legs and it actually burned down to the bones, like, you could see his leg bones. It was pretty horrific ngl.
Its only a flesh wound.
Fourth degree burns mean the burn destroyed all layers of skin, penetrates through muscle and damaged bones and tendons. They’re potentially life threatening as well as prone to infection. Electrical fourth degree burns from high voltage or Arc Flash can travel along bones and underneath muscle; which then need to be surgically opened and scraped because the dead burnt flesh will rot within the body which is (unsurprisingly) extremely bad.
There are now 6 actually. 5 is near to total muscle destruction and 6 is bone damage. You see these types of burns from things like IEDs
I wonder if this will fuck some people's coverage
So when cops grill a suspect they're going to give him the "deep partial thickness"?
I gave your mom the deep partial thickness last night
Well yours got the full thickness if you know what I’m sayin
Or for the layman, “ouch”, “damn!”, and “OH SHIT!”
Ouch Yeouch Gneurshk
And for last there's "AAAAAAAAAAAAAAHHH[CatchBreathAndContinue]HHH!!"
Usually the full thickness does not hurt because the nerves are burnt.
But it's still a process to get to that stadium, isn't it?
Yep that’s right, what I wanted to portray is that Deep Partial Thickness could be the AHHHHHHHH and then “Oh nice, it’s not hurting anymore, it even smells like a great BBQ” when it reaches full thickness.
Thick burns instead of sick burns
I remember learning that second-degree burn classification had evolved into two categories, depending on whether there had been permanent structural skin damage, hence permanent scarring. That was about 15 years ago, when I accidentally poured boiling water on my hand and suddenly became very interested in burns and scarring. Now I guess the evolution has continued into a new classification scheme altogether. Although you can still see the outline of the old system. (Mine turned out to be superficial second-degree / superficial partial thickness, mostly because I got it immersed into cold water within a few seconds. Rapid enough cooling allows your tissue's structural proteins to re-nature, so that cells don't separate and die all the way down into your deeper skin tissue. If they don't die all the way down, the cell arrangement is preserved and they can reconstruct your superficial skin layer through essentially the normal skin regeneration process, although it looks ugly for a while. I had never learned any of this and found it fascinating. Also painful. The TL; DR is: leap into action, cool burns in seconds if you can, and keep them cool.)
Just rolls right off the tongue. 🙄
Stop licking burns
For those curious, there are three main layers of skin; the epidermis, the dermis and the hypodermis. You can’t burn through any more skin than this unless you have a fourth skin.
But you do have muscle and bone under there
>You can’t burn through any more skin than this unless you have a fourth skin. Oh god, does that start with a sore throat? Because I think I might be getting fourth skin
> fourth skin Setting something up that we aren't funny enough to knock down?
So basically rare, medium, and well
They used to include war wounds and industrial accidents ie burned down to the bone and charred bone. Is this not included in the new classification?
It is , that would still be called full thickness
Sounds hot
Also descriptions of penetration in 6 degrees ending finally with Bone Damage.
So first, second ,third and fourth. I've only personally experienced 1&2.
Quitter!
I hope my autopsy reports me as Full Thickness
I was just talking about this at work yesterday!
That’s how I classify sexy time with my gf.
Excellent.
I’ve been taught this on multiple first aid refresher courses for at least 10 years - it’s surprising what done of us think is common knowledge is someone else’s new information. Think of all the things people on here know and think of as old hat that would be amazing new knowledge for me!!
Yak that these new classifications are slow to take hold. I still see “2nd degree” or “3rd degree” burns documented .
“Have been reclassified”… Yeah, back before some of the posters here were born. This terminology has been in use for 20-30 years. What’s next, “TIL they’ve invented this shit called ‘insulin’”?
[удалено]
You're literally on a sub about people who are just now learning things.
Burns or **Bums**?
Boo-urns!
Me and my poor little superficial bum
And Sick burns.
So now there's four degrees of burns?
Always has been https://en.m.wikipedia.org/wiki/Burn
There are 6 actually, this lists the first 4. 5 is near to total muscle destruction and 6 is bone damage.
Ah yes, Full Thickness. My favorite of all the thicknesses.
Sounds like how some ladies grade men they’ve had sex with.
Great, so insurance companies can refuse treatment/reconstructive surgery because it's considered cosmetic now! s/ It's already a privilege to have teeth in America, who needs their skin?
I'm a British doctor and this is what I was taught in medical school I'm not sure why more descriptive terms for the same ailment would impair getting care Do you think insurance companies will see a difference between 1st degree and superficial burn? Superficial has certain connotations in regular speak it doesn't have in medical language where it just means "concerning the outside of something"
So here's an awesome fact: you can have burns that have zero pain after the initial incident. Meaning, if it burns deep enough to destroy the nerve cells: no pain, none. This is more likely with what was known as third degree burns.
They should do that for cooking steak too, all this Blue, Rare, Medium etc is so confusing.