It presents as a white, black or mottled hard, dry wound, from which hairs are easily pulled out. No pain is present. Fourth Degree Fourth degree burns injure and expose muscle, bone, and tendons, and may require amputation of extremities. If left without surgical intervention the eschar will eventually separate by the formation of a layer of granulation tissue. Severe burns require emergency treatment to prevent life-threatening events such as shock and infection.
Shock is the first danger from a bad burn.
The first signs of shock are a fast pulse rate, restlessness, and thirst. Later signs are low blood pressure, a weak pulse, pale face, clammy hands and feet, and confusion. Treatment of a major burn first requires replacing fluids through transfusions of blood or another fluid such as plasma . The age of the individual is of great consequence, even when burns are small. In pediatric clients under age 2, the immunologic response to stress and trauma is not fully developed, and a burn injury can be overwhelming.