BURNS ● Often requires surgical intervention,

-are injuries to the skin and underlying tissues including amputation, and leads to severe
caused by heat, chemicals, electricity, radiation, or scarring and deformity.:
friction.
- The severity of a burn is classified by the depth of Management and Treatment:
the damage to the skin and tissues ● When managing burn injuries, calculating
the extent of the burn and the necessary
Classification of Burns: fluid replacement is critical for both pediatric
-First-Degree Burns (Superficial Burns): and adult patients.
● Affects only the outer layer of the skin ● This is commonly done using the Total Body
(epidermis). Surface Area (TBSA) percentage affected
● Redness, mild swelling, pain, and no by burns and the Parkland formula for fluid
blisters.The skin is dry and sensitive to resuscitation.
touch.
● Usually heals within a few days to a week Total Body Surface Area (TBSA):
without scarring. -The "Rule of Nines" is commonly used for adults
● Head and Neck: 9%
-Second-Degree Burns (Partial-Thickness Burns): ● Each Arm: 9%
● Involves both the epidermis and the dermis ● Each Leg: 18%
(the second layer of skin). ● Anterior Torso: 18%
● Blisters, severe pain, swelling, and red or ● Posterior Torso: 18%
splotchy skin. The burn may appear wet or ● Perineum: 1%
shiny.
● Takes weeks to heal and may result in -The "Rule of Nines" is commonly used for adults
scarring or changes in skin color.
Total Body Surface Area (TBSA):
-Second-Degree Burns (Partial-Thickness Burns): -Lund and Browder Chart (for Pediatrics): This
chart provides a more accurate assessment of
-Third-Degree Burns (Full-Thickness Burns): TSA for children by adjusting percentages based
● Extends through the entire dermis and on the child's age.
affects deeper tissues, including muscles,
bones, and nerves. Infants (0-1 year):
● The burn site may appear white, ● Head: 18%
blackened, or charred, and the skin may be ● Each Arm: 9%
numb due to nerve damage. ● Anterior Torso: 18%
● Requires medical intervention, such as skin ● Posterior Torso: 13%
grafting. Healing is slow, and scarring is ● Each Leg: 14%
inevitable. ● Gluteal Region: 5%

-Third-Degree Burns (Full-Thickness Burns) 5-year-olds:

● Head: 14%
-Fourth-Degree Burns: ● Each Arm: 9%
● The most severe, extending beyond the skin ● Anterior Torso: 18%
and subcutaneous fat to involve muscles, ● Posterior Torso: 18%
tendons, and bones. ● Each Leg: 16%
● The affected area is usually blackened, and
there may be a complete loss of sensation
due to extensive nerve damage.
Fluid Resuscitation: The Parkland Formula of Nines or the Lund and Browder chart for
● The Parkland formula calculates the amount more accuracy, especially in children.
of fluid required in the first 24 hours
post-burn. Management:
-Fluid Resuscitation:
Fluid Requirement (mL)=4xTBSA (%)xBody Weight Parkland Formula: Used for burns involving
(kg) more than 20% TBSA to estimate fluid
● Half of the fluid is administered in the first 8 requirements within the first 24 hours.
hours.
● The remaining half is administered over the NOTE: Urine output is the best indicator of
next 16 hours. adequate fluid resuscitation. Aim for a urine output
of 0.5-1 mL/kg/hr in adults and 1-1.5 mL/kg/hr in
Fluid Resuscitation: The Parkland Formula children.

NOTE: Continuous monitoring of urine output, vital Management:

signs, and electrolytes is essential to ensure Wound Care:
adequate resuscitation and to adjust fluid 1. Cleansing and Debridement:
administration as needed. ● Clean the wound with saline or mild
NOTE: Children are more vulnerable to fluid antiseptic solutions.
overload, so careful monitoring and sometimes the ● Debride necrotic tissue to prevent infection
use of colloids (like albumin) are necessary in the and promote healing.
latter half of fluid resuscitation 2. Cleansing and Debridement:
● Apply a non-adherent dressing or a topical
Management: antimicrobial agent (e.g., silver sulfadiazine,
-Initial Assessment and Stabilization: bacitracin).
1. Primary Survey (ABCDE Approach): ● Dressings should be changed daily or as
● A - Airway with cervical spine protection: needed based on the wound's condition.
Ensure the airway is patent. Consider the 3. Escharotomy:
possibility of inhalation injury, especially with ● Required if circumferential burns cause
burns involving the face, neck, or chest. constriction, compromising circulation or
● B - Breathing: Assess breathing and breathing.
oxygenation. Administer 100% oxygen via a ● Escharotomies relieve pressure and restore
non-rebreather mask if inhalation injury or blood flow.
carbon monoxide poisoning is suspected. 4. Pain Management:
● C - Circulation: Establish IV access with ● Analgesics: Administer pain relief with
large-bore cannulas and begin fluid medications like acetaminophen, NSAIDs,
resuscitation based on the burn's severity. or opioids depending on pain severity.
● D - Disability: Assess neurological status, ● Sedation: For more extensive burns,
including Glasgow Coma Scale (GCS). especially during dressing changes,
● E - Exposure: Remove all clothing and sedation may be necessary
jewelry to fully assess the extent of the 5. Infection Control:
burns and prevent further injury. Keep the ● Prophylactic Antibiotics: Not routinely
patient warm to prevent hypothermia. recommended but may be used in cases of
suspected infection or following a confirmed
2. Secondary Survey: positive culture
● Complete a full head-to-toe examination to ● Tetanus Prophylaxis: Administer tetanus
identify any additional injuries. immunization if the patient's vaccination
● Calculate the Total Body Surface Area status is not up-to-date.
(TBSA) affected by the burn using the Rule