Thermal Burn Assessment: Second vs Third Degree Classification

Case at a Glance

A 37-year-old female with multiple sclerosis, ADHD, and asthma presented with concerns about burn severity after sustaining a thermal injury from contact with a hot oven element.

Patient's Story

The patient accidentally contacted the heating element of her oven while cooking, immediately hearing a characteristic sizzling sound. She reported minimal pain following the initial injury, experiencing only mild stinging sensations around the burn perimeter. Despite the thermal contact, she maintained sensation to temperature and pressure in the affected area, which differed from her expectations of typical burn symptoms.

Initial Assessment

The patient contacted a telephone advice nurse who recommended immediate emergency department evaluation, expressing concern for possible third-degree burn injury. This recommendation prompted the patient to seek urgent medical care despite her uncertainty about the severity.

The Diagnostic Journey

Upon emergency department presentation, the attending physicians conducted a brief visual and physical examination of the burn site. The clinical assessment revealed evidence of blister formation, which serves as a key diagnostic indicator for burn depth classification. The presence of intact sensation to temperature and pressure further supported the clinical findings.

Final Diagnosis

Second-degree thermal burn with partial-thickness skin involvement, evidenced by blister formation and preserved sensation.

Treatment Plan

Conservative wound management was recommended with outpatient follow-up care. Standard burn care protocols including wound cleaning, appropriate dressing application, and pain management as needed.

Outcome and Follow-up

The patient was discharged home with wound care instructions. The discrepancy between initial telephone triage assessment and emergency department evaluation was explained by the clinical finding of blister formation, which definitively indicates second-degree rather than third-degree burn classification.