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11.03 Partial Thickness (Second-Degree) Burns and Tar Burns


Small, (<6% total body surface) partial thickness (second degree) burns can occur in a variety of ways. Spilled or splattered hot water and grease are among the most common causes, along with hot objects, explosive fumes, and burning (volatile) liquids. The patient will complain of excruciating pain and the burn will appear erythematous with vesicle formation. Some of these vesicles or bullae, may have ruptured prior to the patient's arrival, while others may not develop for 24 hours. Tar burns are special in that tar adheres aggressively to the burned skin.

What to do:

What not to do:


Simple partial thickness burns will do well with nothing more than clensing, debridement, and a sterile dressing. All other therapy, therefore, should be directed at making the patient more comfortable. Silvadene cream is not always necessary, but it is soothing and may reduce the risk of infection. When it is possible to leave vesicles intact, the patient will have a shorter period of disability and will require fewer dressing changes and follow up visits. If the wound must be debriede, the closed dressing techique may be more convenient and less of a mess than the open technique of washings and cream applications.

Some physicans believe it is important to remove all traces of tar from a burn. Removal can be accomplished relatively easily by using a petroleum of petroleum-based antibiotic ointment such as Bacitracin, which will dissolve the tar. Others have found the citrus and petroleum distillate industrial cleanser, De-Solv-It, very effective as well as non-toxic and non-irritating.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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