Treating Young Children Injured by Third Degree Burns and How to Recognize 6 Degrees of Burns

An extensive burn injury is one of the most painful pieces of damage that the human body can suffer and in children, it is heartbreaking. In a house fire, the screams of a burning child that cannot be found are haunting. The screams of agony from a child in a hospital burn unit undergoing the scrubbing away of dead and burned skin with metal brushes is nerve shattering. The skin grafting surgeries are lengthy and entail months or years. Not all grafts are successful. Not all plastic surgery can save a 2-year-old's twisted, scarred face that may no longer have a nose or ears. Fingers heal together or are burned off. Feet sometimes become charred stumps. Limb amputation sometimes becomes necessary, even in the truth of all this, the public hopes for the newest technologies to come to the rescue in these cases.

Fire prevention in the 2010s is still many times more effective than treatment of third degree burns.

Young Ally was just three years old.

On the Friday before Palm Sunday, her teen brother was watching her, her four-year-old sister, and the dogs. Mom, Dad, and a middle-school sister were away. Suddenly, fire broke out upstairs in the two-story home. Brother saved the 4-year-old and dogs, but was cut off from the youngest child by the fire.

He stood on the sidewalk screaming for help. A passerby jumped from his car and entered the house, heard screams, but could not navigate through the flames.

The fire department arrived; one of the men was burned himself as he extracted Ally from the second floor inferno. She was rushed to the children's hospital 100 miles away, where she was diagnosed with 3rd Degree burns over 60% of her body. Her mom, dad, and sisters moved into Ronald McDonald House next door, but sat by her bedside most of the time. Brother went to another city to stay with a friend.

What caused the fire on the second floor? No answers are available in this case yet, but it could be an electrical wiring problem in rental property that had an unfinished basement with only a dirt floor. Building codes may not have been met. When the burned child is released from the hospital after two months, the struggling family of six must find a new residence as well.

Lanlords that own rental properties such as houses, apartments and other residences have the responsibility to provide safe living arangements according to the law. Smoke detectors must be installed in these residences, checked at least yearly, and maintained in workable condition. Electrical wiring in these residences must be up to code according to legal standards.

Sixty percent body coverage by 3rd Degree burns in a three-year-old is serious. All layers of skin are burned across more than half of the body, leaving her open to infection and dehydration, shock, possible loss of limbs or face, and the need for a tetanus shot. Fat, muscle, and under elements beneath the skin may be involved (see the Mayo Clinic link).

A 4th Degree burn includes fire damage below all layers of skin to muscle, tendons and ligaments at least, creating a rather carbonized appearance. Persons struck by trains have been carbonized throughout their bodies with these burns and were the subject of the old Traffic Safety film Signal 30. Some students in most classes that viewed the old movie suddenly left the room in horror and nausea, a reaction similar among today's audiences that view the bodily torture in The Passion of the Christ.

Fifth and Sixth Degree burns are not mentioned widely among the general public. They are reportedly specific medical pathology terms used in connection with autopsies of burned bodies, the last being akin to cremation. Attorneys speak of these burn level as used in autopsy reports applied for legal actions (see references). Anecdotal denials of these degree levels on the Internet may stem from posters' lack of knowledge of pathology -- At the same time, Degrees 5 and 6 may have been previously limited to and even un-named among the victims of Hiroshima and Nagasaki nuclear attacks in the 1940s and the radiation events of Soviet submarines like K-19 in the 1960s and later, in the Chernobyl disaster. Further, advances in 21st Century war and spacefaring technologies may, in fact, require these final two burn degrees to be more officially defined and more widely used. The fact that the terms were used on a sci-fi TV series does not mean that they do not exist -- after all, we do now have the artificial skin that was first given to us by Star Trek® imaginations.

Generally, by the time a body part continues to burn to the 6th Degree, all tissue from the outer skin layer (epidermis) completely down through all tissues to the bone is irrevocably damaged and the bone itself is charred. The 5th Degree burn does not include charred bone. In the 3rd and 4th Degrees, bones may be damaged without charring, however - enough to cripple a patient, if not causing death.

Third Degree burns are cleaned and dressedwhen the patient reaches a hospital. Since burns cause fluid loss from the body, especially with 60% of the body burned as mentioned ablove, IV solutions are required to replace lost fluids and reduce the possibilities of complications. In 3rd Degree burns, some tissue under the skin is also lost. Children's hospitals often maintain Burn Units in which burn victims can receive the needed round-the-clock care by specialists.

Debridement after the initial treatment is the scrubbing away of dead skin from a burned body and usually causes severe pain and much screaming on the part of injured youngsters as well as adults. New methodologies are on the market that are said to reduce this level of pain, but they are not yet mainstream. One method uses super-oxidized water and hydrotherapy (water action) to remove dead tissue and was developed in a clinic in Mexico. Some specialists recommend hyperbaric oxygen treatment as an adjunct to speed healing. This can be expensive and not covered by all insurance programs.

Some burn cases require surgical removal of dead skin, using excision (cutting). Often, this is followed by skin grafting, another surgical procedure in which skin is removed from, for example, a thigh or buttock and sewn over a cleaned burn elsewhere.

THE PIG MATRIX

Interestingly, Star Trek® fictitious medical procedures resulted in stimulating research that produced an artificial skin. Today that artifice can be laid over well-cleaned burn areas instead of using bandages and the body heals around it, after which it dissolves - much like dissolving dental sutures. In the sci-fi series, the skin-like material was sprayed on with an aerosol can, but we do not have that capability. In some cases, pig skin has been used in the same way.

Another technique involves the use of pig-tissue matrix made into powder; it can be laid beside human tissues with the result that new human tissues grow at the site - muscle, bone, an esophagus, skin, many types of tissue. In still other methods, a patient's own stem cells have been used to grow some amounts of new skin.

DRESSINGS

Dressings and bandages are used to cover burns in order to help the body maintain its normal heat and to resist infection. In the 1980s, a child in our Cincinnati children's hospital Burn Unit was hypnotised to raise his 2nd Degree-burned arms shoulder high in front of him and maintain them there without tiring. This technique worked for him for two important weeks, with the result that he needed fewer bandages, his arms did not rub against his body to do more damage, and he felt less pain. Overall healing was also quicker.

EXTREME CARE

With 3rd Degree burns, skin grafting and more extensive plastic surgery are often needed. These surgeries may take up to several years to complete. Infections can be a long-standing problem. Amputationsare still sometimes necessary and the fitting of protheses can take prolonged periods of time and require help with funding. Severely burned children are often supported in their home communities with fund raising events sponsored to provide money in the absence of adequate insurance coverage.

NOTE:This Hub does not cover all possible required treatments in 3rd Degree burns or the appropriate First Aid measures to use. Reference the Mayo Clinic link above for First Aid measures and discussion. Call your local Red Cross for additional information and First Aid Training. Call or visit your healthcare professional or hospital in case of burns above 1st Degree and for even 1st Degree covering a large area of the body. Be safe.

American Red Cross:www.redcross.org