the skin contains three main layers the epidermis dermis and hypodermis or subcutaneous Burns our tissue injuries caused by heat chemicals electricity radiation extreme cold or friction that disrupt the Skin's framework and function superficial Burns affect the epidermis only causing aemma or redness and pain partial thickness burns are either superficial or deep superficial partial thickness Burns involve the epidermis and the upper or papillary dermis causing immediate blistering and intense pain and sensitivity deep partial thickness burns destroy the papillary dermis epidermis and most of the lower or reticular dermis sparing some cutaneous nerve endings capillaries and dermal appendages full thickness burns destroy the entire epidermis dermis and portions of the hypodermis the burned area is white brown dry and charred has no sensation and cannot heal without surgical intervention Burns can also be evaluated by determining the percentage of body surface area they cover this percentage can be estimated quickly using the rule of nines a formula in which each body part is assigned a value of 9% or a multiple of 9 severe burns involving a large surface area increase capillary permeability and lead to two stages of shock in hypovolemic shock water electrolytes and plasma proteins leak from the bloodstream into interstitial spaces creating widespread edema in Burn shock the lowered intravascular volume increases blood viscosity and Vascular resistance to compensate the heart rate speeds up as a result organs and tissues do not receive adequate blood supply resulting in tissue and organ death from a lack of oxygen burn treatment aims to restore fluid balance through administration of intravenous fluids electrolytes and proteins which increases intravascular volume wound care reduces complications by preventing infection and promoting healing of damaged tissues analgesics control the pain and inflammation of superficial Burns superficial partial thickness burns are cleansed covered with a sterile dressing and monitored regularly for infection in deep partial thickness Burns dead skin or escar is routinely detached or debrided to a healthy level the wound bed is kept clean and moist to allow epithelial regeneration and to except transplanted tissue called a skin graft full thickness burns are excised and regularly debrided to prevent esea and infection and to create a viable base for grafting