ASSESMENT OF BURN WOUNDS

AND
IMMEDIATE CARE
 BURN WOUND ASSESSMENT

• Classified according to depth of injury and extent of

body surface area involved

• Depending on the level of dermis and subcutaneous

tissue involved
1. Superficial partial thickness
2. Deep partial thickness
3. Full thickness
Depth of burn Characteristics

Superficial partial thickness • No deeper than papillary dermis

• Blisters
• Blanching on pressure
• Heals without scaring

Deep partial thickness

• Epidermis and dermis
• No blanching

Full thickness
• Dark and leathery
• Dry
• No pain
Calculation of Burned
Body Surface Area
 Total Body Surface Area

• A Patients hand ~ 1% of the

total body surface area

• Rule of nines divides the body – adequate for

initial assessment for adult burns
• Lund and Browder Chart is the most accurate
because it adjusts for age
Lund & Browder chart
 Immediate care
• Always start with ABC
Airway
Breathing
Circulation
Disability
Exposure with environment control
Fluid resuscitation
• Airway
Suspect airway injury if
– H/O being trapped in the presence of smoke or hot gases
– Burns on the palate or nasal mucosa, or loss of all the hairs
in the nose
– Deep burns around the mouth and neck

Initial management
– Secure the airway
– Early elective intubation is safest
– Delay can make intubation very difficult because of swelling
– Be ready to perform an emergency cricothyroidotomy, if
intubation is delayed
• Breathing ( increase in respiratory effort and
rate ,decreasing oxygen saturation )
– Nebulisers and warm humidified oxygen are useful
– Chest escharotomies if constrictive eschar
• Circulation: get vitals (HR & BP)
– 2 large bore IV
– Start burn resuscitation with Lactate Ringer’s
– Place patient on continuous EKG / monitor
• Disability– neurological status
• Exposure: remove all clothing
• Fluid resuscitation
(IV fluids is needed to maintain sufficient blood volume for
normal C.O. )
– In children with burns over 10% and
adults with burns over 15% TBSA
– If oral fluids are to be used, salt must be added

• Parkland formula (burn >20% TBSA)

– 4 x Wt(kg) x %TBSA = mL/24 hours
– Deliver 1/2 volume over 1st 8hrs
– Deliver 2nd half over next 16 hours
• Crystalloid resuscitation
- Ringer’s lactate commonly used
- maintenance fluid must be given in childrens
(dextrose-saline)
-100mL/kg for 24 hours for first 10 kg
- 50mL/kg for next 10 kg
-20 mL/kg for 24 hours for each kg over 20 kg body weight

• Hypertonic saline
• Colloid resuscitation
Muir and Barclay formula:
-0.5 x %age body surface area burnt x weight = one portion
- periods of 4/4/4, 6/6 and 12 hours, respectively
-1 portion to be given in each period
• Monitoring resuscitation
- key is to monitor urine output (b/w 0.5 and 1.0 mL/kg
body weight per hour)

- if below increase infusion rate by 50%

-if inadequate and patient shows sign of hypoperfusion

( tachycardia, cold peripheries & a high haematocrit)
give a bolus of 10 mL/kg body weight

-It is important that patients are not overresuscitated,

and urine output in excess of 2 mL/kg body weight per hour
should signal a decrease in the rate of infusion.
 Chemical Burns
• Speed is essential
• ABCDE – remove all clothing
• Irrigate with 15-20L of water( care should be
taken not to cause hypothermia)
– Brush off any dry powder before irrigation
• Alkalis generally cause worse damage
 Initial Assessment
• AMPLE history
– Allergies
– Medications
– Past medical history (CHF – careful w fluids)
– Last meal
– Events regarding the injury (how did the fire start,
how long was the exposure, what type of
exposure – flame, grease)
• Burn Resuscitation with Lactate Ringer’s

• Figure out burn size by “rule of nines”

• Parkland formula
– 4 x Wt(kg) x %TBSA = mL to give in 1 day
– Half over 1st 8hrs (subtract what was given)
– Give other Half over next 16 hours

• Do not give colloid in first 24 hrs

 Electrical Burns
• Most significant injury is within deep tissue
• Edema can compromise circulation
• Be ready to perform eschar-/fasciotomies
• Explore & debride necrotic tissue
• EKG
• Follow serial CPK & urine myoglobin due to
possibility of rhabdomyolysis