## Clinical Assessment of Burn Depth The clinical presentation describes a **partial-thickness (second-degree) burn**: - Erythema with intact blisters - Blanching on pressure (indicates viable capillary bed) - Brisk capillary refill - Severe pain (nerve endings intact) ### Burn Depth Classification | Feature | Superficial (1st) | Partial-Thickness (2nd) | Full-Thickness (3rd) | Deep Full-Thickness (4th) | |---------|-------------------|------------------------|----------------------|---------------------------| | **Appearance** | Erythema only | Blisters, moist, red | Charred, leathery, white | Carbonized, brown | | **Blanching** | Yes | Yes | No | No | | **Capillary Refill** | Brisk | Brisk | Absent | Absent | | **Pain** | Severe | Severe | Absent/minimal | Absent | | **Healing** | 3–7 days | 2–3 weeks | Requires grafting | Requires grafting | **Key Point:** The presence of blanching and brisk capillary refill confirms viable dermis — this is a partial-thickness burn, NOT full-thickness. ## Management Priority **High-Yield:** Partial-thickness burns covering >15% TBSA in adults (or >10% in children/elderly) require: 1. **Fluid resuscitation** using Parkland formula: `$4 \times \text{TBSA (%) } \times \text{Body weight (kg)} \text{ mL of LR over 24 hrs}$` - Half given in first 8 hours - Titrate to urine output (0.5 mL/kg/hr adults) 2. **Transfer to a burn centre** (specialized care for optimal wound management and prevention of contractures) **Clinical Pearl:** Escharotomy is reserved for **circumferential full-thickness burns** causing compartment syndrome or respiratory compromise — not indicated here. **Warning:** Do NOT delay fluid resuscitation or transfer awaiting topical agents. Systemic fluid balance is the priority in the acute phase.
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