1. Identify the Depth of Third-Degree Burns
Third-degree burns are the most serious level of burns. All layers of the skin (epidermis, dermis and hypodermis) are involved, and the damage can go so deep as to include fat, muscle and bone. Third-degree burns will present with redness and swelling quite similar to first- and second-degree burns, but will not blanch when touched. The skin will appear waxy white, charred or leathery. In addition, coagulated blood vessels are visible below the burned skin surface
2. Evaluate the Level of Pain
Because of the depth of the damage, the burn victim might not feel pain immediately. In the initial symptoms the amount of pain indicates the level of burn. The nerve endings are destroyed when the damage passes the dermis. The area may even feel numb initially. If pain is present at the onset of injury, it is most likely coming from areas of second-degree burns or the surrounding tissue.
3. The Assessment in the Emergency Room
Doctors in the emergency room will assess the burn site and evaluate the cause of the burn to determine whether other injuries may be present. For instance, if the source of the burn is identified as a house fire, the potential for damage caused by smoke inhalation is very high. Likewise, they will check for possible carbon monoxide poisoning, if the situation warrants.
Another part of the assessment includes rating the severity by the amount of total body surface area (BSA) that is affected. A standardized "rule of nines" is used to evaluate the third-degree burn rating. For example, each leg and foot together is considered 18 percent of BSA; the genital area is 1 percent; the head and neck are 9 percent. Third-degree burns are considered minor if the BSA is less than 2 percent, 2 to 10 percent are moderate and any BSA greater than 10 percent is critical. Third-degree burns on the hands, feet, face or genitals are automatically considered in the critical category.
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