Disease and Condition

A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A second-degree burn injures the top layers of skin, called the epidermis, and extends down to the deeper layers of skin, called the dermis.


Anyone can get a second-degree burn. Children and the elderly are more likely to experience complications from burns. 

Causes of Second Degree Burns

Most second-degree burns are caused by contact with flames, hot liquids, or chemicals, or by severe sunburns. Burns caused by heat are called thermal burns. Burns caused by hot liquids or steam are called scalds.

Symptoms Second Degree  Burns

Skin with a second-degree burn is extremely red and blistered, and may look wet because of fluid loss. Second degree burns are very painful, and the victim’s pulse rate usually increases in response to the pain. Small second-degree burns usually heal without scarring. Larger second-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, rapid pulse and breathing, nausea and vomiting, a blue tinge to the lips and finger nails, and pale, cold, moist skin. See a doctor immediately if a second-degree burn is on the face, hands, feet, or genitals; is caused by an electrical source; or covers an area larger than two to three inches.

 Diagnosed Second Degree Burns

Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. The doctor will check for other conditions related to burn injuries, such as smoke inhalation, carbon monoxide poisoning, or other injuries. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. Second-degree burns that cover less than 15% of an adult's body or less than 10% of a child's body are considered minor. Second-degree burns that cover 15 to 25% of an adult's body, or 10 to 20% of a child's body, are considered moderate burns. Those that cover more than 25% of an adult's body or more than 20% of a child's body, as well as those on the face, hands, feet, or genitals, are critical.

 Treatment Second Degree Burns

Minor burns are treated at home, while moderate and critical burns require hospital treatment. The goal of treatment for second-degree burns is to reduce pain and prevent infection. If the burn was caused by fire, and the victim’s clothing is on fire, smother any flames with a blanket or water, if available, or have the victim use the “stop, drop, and roll” method. If the burn has blisters that are not open, first remove any clothing or jewelry from the injured area. Then, hold the burned area under cool running water for around 10 minutes to stop the burning process. You can also use a clean towel or wash cloth moistened with cold water. However, don’t use ice or ice water because they will further damage the tissue. Do not break open the blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.

Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.

Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.

Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If the area of the burn is larger than two to three inches, you should get immediate medical treatment. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. If your doctor thinks there will be a great deal of scarring, he or she may recommend a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted to the burned area. This is called an autograft.

For smaller burns that can be treated at home, gently wash the area with an antiseptic cleanser, loosely bandage the burn, then leave it alone for at least 24 hours. You can apply an aloe-based cream to relieve pain before bandaging it. Pain relievers such as acetaminophen, ibuprofen, or aspirin can help with inflammation and pain, and should be used according to directions. Never give aspirin to a child under the age of 18 because of the risk of a serious illness called Reye’s syndrome. If you have seen a doctor, follow his or her instructions for changing the bandages. Make sure you wash your hands with soap and water. Be sure to remove the bandage slowly and carefully. You will need to soak it before removing if it is sticking to the burn. Gently wash the burn, check for signs of infection, apply a thin layer of antibiotic cream, then cover it with a clean bandage.

Signs of infection include increased swelling or redness, blisters filled with greenish or brownish fluid, oozing pus in the burned area, or red streaks spreading away from the burn, and are a reason to call your doctor. Also call your doctor if you have a fever, swollen lymph nodes, or notice numbness or a cold feeling in the arms or legs. A second-degree burn can take anywhere from 10 days to 3 weeks to heal. Call your doctor if it doesn’t heal within that time. Vitamins C and E, and zinc may help the burn to heal, but should be taken only in safe amounts.

Prevented Mangment


Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest.

A hernia is the protrusion of an organ through the wall that normally contains it. With a hiatal hernia, part of the stomach protrudes upward through the opening (hiatus) at the esophagus and the diaphragm. The stomach is normally located in the abdomen. The esophagus connects the throat to the stomach, and the diaphragm is a group of muscles used for breathing, located between the abdomen and the lungs.


Hiatal hernias are more likely to occur in females than males, and are very common during middle age. People who are obese or have had abdominal surgery are at higher risk for hernias. The risk also increases with age. Hiatal hernias can occur in children and adults.

Causes of Hiatal Hernia

Hiatal hernias are caused by a weakness in the muscle tissue at the opening in the diaphragm where the esophagus passes through to the stomach. In some people, this weakness is congenital, which means it is present at birth. In others, it develops over time, as a result of excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, heavy lifting, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing. Because the muscle is weak, the hernia occurs during abdominal strain.

 Symptoms of Hiatal Hernia

A hiatal hernia cannot be seen on the outside of the body, and may not cause any symptoms at all. Patients who do experience symptoms usually feel a burning sensation in the chest and throat a short time after eating. This is called gastroesophageal reflux and is caused by stomach acids being pushed up into the esophagus. Other symptoms include heartburn, an uncomfortably full feeling after eating, and the frequent need to belch. A serious complication of a hiatal hernia can occur if the part of the stomach that is herniated becomes twisted or pinched by the diaphragm. This is called a strangulated hiatal hernia. If this happens, that portion of the stomach can lose its blood supply. Symptoms include severe chest pain, bloating, and difficulty swallowing. Very large hiatal hernias can develop lesions that bleed and cause anemia from the blood loss.

Diagnosed of Hiatal Hernia

To diagnose a hiatal hernia, your doctor will rely upon your description of symptoms and a series of diagnostic tests. These may include endoscopy or a barium swallow. With endoscopy, a flexible viewing tube is inserted through the mouth and down to the stomach so the doctor can check for the hiatal hernia between the esophagus and the stomach. You will be given a mild sedative during the procedure so you will feel no discomfort. With a barium swallow, x-rays are taken after you drink a special barium solution. The barium helps reveal the bulge of a hiatal hernia on the x-ray. Both tests can be done on an outpatient basis.

Treatment of Hiatal Hernia

The treatment for hiatal hernias is focused on diet and surgery is rarely necessary. Doctors recommend restricting your intake of spicy and acidic foods and beverages, caffeinated beverages, and chocolate; elevating your head when lying down to prevent gastroesophageal reflux; remaining in an upright position after eating; and using antacids and acid-reducing medications. Patients with hiatal hernias find that symptoms are reduced if they eat frequent small meals throughout the day. Surgery is necessary for a strangulated hiatal hernia and very large hiatal hernias that cause severe gastroesophageal reflux. This procedure may be performed through laparoscopic surgery, in which the surgeon uses a special viewing instrument called a laparoscope, inserted through a small incision in the chest or abdomen. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to pull the stomach back down into the abdomen and repair the weak muscle or make a smaller opening between the diaphragm and the esophagus.

Prevented Managment

Although there is no way to prevent hernias due to a congenital weakness, you can help reduce your risk for a hiatal hernia. Follow a healthy diet that is high in fiber and drink plenty of fluids to prevent constipation, maintain a healthy weight through diet and exercise, and avoid cigarette smoking, which can cause chronic coughs. If your job requires heavy lifting, learn the proper way to lift and wear a support garment. Certain medications can aggravate a hiatal hernia. Your doctor can recommend which medications to avoid if you have this condition.