Fourth Degree Burns: Causes, Symptoms, First-Aid and Treatment

The classification of burns includes: First, second, third and fourth degree burns and extends up to sixth degree burns.⁽²⁾ Though fourth-degree burns are uncommon, you must have probably heard that the third-degree burns are the severest, but the severity of the burns is much higher in subsequent degrees of burns. The consequences of the fourth degree burn can be serious and have had almost nearly 100 percent mortality rates if we look back at historical data. The advanced technology in medicine and clear comprehension of degree of burns has improved the survival chances of victims with deeper burns. Fourth degree burns extend deeper through the skin and begin to affect the ligaments and muscles.⁽¹⁾

The sources, which cause third degree burns also are responsible for the remaining fourth, fifth and sixth degree burns with the only difference being that the victim is exposed for a prolonged duration to the source of heat leading to deeper burns on the victim’s body.

While the accidents can happen anywhere, the causes at home for Fourth Degree Burns include: Accidents while cooking, house fires resulting from malfunction of electrical lines inside house or of any gadget utilizing electrical energy.

The major source of burns while cooking in kitchen is contacting a hot source like the cooking vessel on stove or spilling of hot liquid or hot oil over the victim’s body causing burns over a large body surface.

Care should be taken while handling electrical sockets and electrical appliances at home. The open/exposed electrical cords should be immediately repaired since they have the potential to emit large amounts of energy into an individual’s body when they come in contact and cause Fourth Degree Burns.

Occupational Hazards: The causes at work for Fourth Degree Burns include: personnel involved in cable, construction, electrical, emergency services, food services, research scholars and scientists working chemicals in laboratories and medical workers etc.

The fire fighters involved in emergency fire services sometimes while fighting the house fires get accidentally burnt. They are also sometimes exposed to high-voltage burns while fire fighting working with down power lines. Some personnel involved in fields like electric wiring, cable laying and construction field handle active power lines on daily basis and are at a great risk for fourth degree burns.

Rarely are the hazardous chemicals in industrial manufacturing or laboratories seen outside, but even a slight contact with any of the chemicals can be dangerous and result in fourth degree burns. One of the other possibilities for fourth degree burns is camp fires.

All the above causes listed may cause lesser-degree burns, but what categorises the burn into fourth-degree is the extent of the damage to the victim’s body. As discussed in third degree burns, they affect inner layer of skin and fatty tissues; while the fourth-degree burns go deeper affecting your tendons, nerves, muscles and tissues.

Fourth degree burns exhibit many similar symptoms to that of third degree burns, with a few additional features.

• Loss of Function & Charred/Whitish Appearance: Fourth degree burns result in loss of function of the affected body portion and charring. The first noticeable symptoms of fourth-degree burn are a charred-looking appearance of the affected body part. Sometimes the burnt area may even be white in color with exposed muscle tissues and bones.
• Less Pain Due to Nerve Damage in Fourth Degree Burns:⁽³⁾ The fourth degree burns are not that painful like the first and second degree burns and this is because the nerves, which send pain signals to our brain getting affected and this is why we do not feel the pain that much in fourth degree burns. Such nerve damage in fourth degree burns also makes the level of burn more dangerous since the damage could be very serious, but you cannot asses it since you can’t feel the pain.
• Charring in Fourth Degree Burns:⁽³⁾ Charring is the process where hydrogen and oxygen from the skin are burnt due to high exposure to heat, leaving behind carbon. The charred presence in a burn is an indication that the burns will leave scars and require grafting. Charring is also a characteristic in third degree burns sometimes, but it is more common in fourth degree burns that have had longer duration of exposure to the heat source.
• Muscle Damage Causing Loss of Function & Amputation in Fourth Degree Burns:^{(1, 3, 4)} Fourth degree burns completely destroy the skin’s upper layers of skin and start damaging the underlying muscle. Our body does not re-grow bone or muscle, as it re-grows the skin. Excision is required often if there is damage to the muscle and this leads to loss of function of the affected part. Generally the loss of function in fourth degree burns leads to amputation.⁽¹⁾

The exact treatment of fourth degree burn depends on the extent of the damage it has caused and the health condition after the accident. The following first aid activities may be undertaken while waiting for an ambulance:

• Cover the affected part with a loose cloth.
• Try raising the injured body part above the level of heart.⁽³⁾
• Due to reduced blood pressure, the patient may feel cold, so place a light sheet of blanket over the victim.
• For fourth degree burns caused by chemicals, flush the affected part with some water.⁽³⁾
• Do not apply creams or ice or ointments over the burns.⁽³⁾ Do not try removing the cloth stuck to the affected burnt part.⁽³⁾

The medical practitioner will initially clean the burn and remove dead tissues if any.

Medications: The options of treatment for fourth degree burns depend upon the extent to which an individual muscles, bones and nerves are affected. The doctor may prescribe medications to alleviate the pain, apply antibiotic ointments if the doctors suspect any infection on the affected part and prescribe tetanus injection after confirming from the victim that he hasn’t had the shot in the last 10 years.⁽³⁾

Depending on the location of the burn and patient’s condition, either antibiotics can be administered orally or intravenously; and topically at the site of the burn injury.

Intravenous Fluids: Intravenous fluids are given to the patient suffering from fourth degree burns to prevent low body temperature and dehydration.

Some patients may be in a state of shock, which may be due to the large inflammatory response from victim’s body.⁽²⁾ The major organs including heart can become susceptible to inflammation in fourth degree burns.

Excision of Burnt & Dead Skin/Tissue: The patient is often given pain medications since the treatment of the burns can be painful.^(3,4) Once stabilization of patient is achieved, the process of excision begins. The process of removing damaged and dead skin from the burn injury is referred to as excision. It is important to remove the dead skin, as it is highly susceptible to infection and many a times it prevents the body from healing.

Amputation of the Burnt Part:⁽⁴⁾ Amputation may be required for burns this deep.⁽¹⁾ The process of removing part or all of an extremity is called amputation.

Skin Grafting:⁽³⁾ As the fourth degree burns start healing, the doctor starts getting clarity on the overall extent of the damage to the victim’s body. If the skin doesn’t generate new tissues, then skin grafting, may be needed.

Lastly the skin grafting is carried out to begin the process of re-growing skin in the burnt/affected area. Since all the three layers of skin are destroyed, the body cannot replace the skin on its own, and for this reason surgical removal of healthy skin from other areas of the body is done to replace the burnt skin.⁽⁵⁾ If sufficient healthy skin is not available on the victim’s body, then other forms of skin grafting need to be explored and meanwhile the skin grafts of the patient are grown in a lab.

Physical Therapy:⁽⁶⁾ Other treatments, such as physical therapy may also be needed if the victim has lost feeling in the affected area. Further treatments for fourth degree burns may be necessary for lost muscles and joint.

The fourth degree burns are often fatal even if prompt treatment was made available to the victim. In order to increase the chances of survival of the patient, burns of this severity, such as fourth degree burns, require immediate medical treatment. The first priority of the medical practitioner will be rehydrating the patient and stabilising since lot of fluids are lost due to dehydration while sustaining fourth degree burns. Intravenous liquids are administered to the victim. Medical staffs also ensure proper circulation of blood and breathing and try to stabilize the patient.

While the patient is stabilized, antibiotics may be administered to prevent infection. Infection, if it is not treated, may lead to variety of other complications.

References:

Also Read:

• Do’s and Don’ts for Cases of Burns In Children
• First Aids & Home Remedies To Ease Burns At Home
• First-Degree Burns
• All You Need To Know About Third-Degree Burns