Burn Wounds

Gomez, Cancio. EM Clinics of NA 2007. 25:135-46.

st

1 degree burn: EPIDERMIS depth only; painful

nd

2 degree (partial thickness)

* Superficial - EPIDERMIS +
SHALLOW DERMIS; moist,
blistering; skin blanches;
very painful; heals within 3
weeks
* Deep EPIDERMIS + DEEP
DERMIS; heals in >3
weeks; looks between
superficial partial thickness
rd
and 3 degree burn; may
need skin graft
rd

3 degree: EPIDERMIS + ENTIRE DERMIS; dark brown, charred, skin does not
blanch, site insensate because burned nerve fibers; needs skin graft
Total body surface area (TBSA) Rule of 9s
Patients palm and fingers = 1%
TBSA
In calculating TBSA % burn, do
st
not include 1 degree burns
Burn unit referral
Partial thickness >10% TBSA
Burns of face, hands, feet,
genitalia, perineum, major joints
rd
3 degree burn
Electrical or chemical burn
Inhalational injury
Patient with co-morbidities
Special considerations: social,
emotional, or long-term rehab
intervention
Fluid resuscitation= 4 cc/kg/% TBSA of LR over 24 hrs with half given in first 8 hrs
Titrate to UOP of 30-50 cc/hr (adults),1 cc/kg/hr (children < 30 kg), 0.5-1 cc/kg/hr
(age >2 yr), 1-2 cc/kg/hr (age <2 yr)
Start if >20% TBSA involvement
Minor burns tetanus immunization update, pain meds, debride dead skin, +/- unroof
blisters >2 cm diameter, apply topical antimicrobial and dressing, 24 hr followup.
Large burns apply silver sulfadiazine or mafenide acetate as topical antimicrobial
agent (gram negative coverage)
What is high-voltage electrical injury? >1000 volts