Classification: 

1.   Superficial - epidermis, red burn ----- Red, painful, no blisters 

2.   Superficial partial thickness - epidermis + superficial dermis ----- Painful blisters 

2.   Deep partial thickness - epidermis + dermis ----- Can have blisters, if open can be pale yellow-white, absent cap refill 

4.   Full thickness - epidermis + full thickness of dermis ----- Pale and leathery, painless 

Determining Body surface area:

Rule of 9’s

     Head = 9% 

     Chest + Abdomen = 18% 

     Back = 18% 

     Arm = 9% each 

     Leg = 18% each 

     GU area = 1% 

* palmar surface of hand roughly 1%

* note superficial burns do not count in calculation 

Management: 

     - Update tetanus for all burns 

     - Pain Control - use of opioids generally required for major burns 

            - Can consider benzodiazepines or ketamine 

     - Wound Management of Major Burns 

            - Cover with sterile drape or clean sheet it transferring 

            - If smaller, can cover with saline soaked gauze (careful with hypothermia in large surface area burns) 

     - Management of Minor Burns 

            - Irrigate +/- debridement 

            - Consider aspiration of blisters if large or over joint, palmar surface of hand, etc. 

            - Apply topical agent of choice - bacitracin or triple antibiotic ointment generally recommended

            - Silver sulfadiazine not generally recommended, contraindicated if sulfa allergic, G6PD deficiency, or for burns to face as can cause grey discoloration 

     - Dispo planning  

            - Pain control agents for home 

            - Dressing changes - BID while weeping → once daily until healed 

            - Follow up in 24-48 hours, possibly with burn specialist

Fluid Resuscitation for Major Burns 

     - Parkland formula: 4 x weight (kg) x total body surface area burned → ½ in first 8 hours, remainder in next 16 hours

            - Some burn centers prefer using 2 instead of 4 as 4 tends to overshoot 

     - Titrate to urine output of 0.5-1cc/kg/h for adults 

When to Transfer to a Burn Center 

     - Partial thickness >20-25% TBSA 

     - Full thickness >10% TBSA 

     - Burns involving hands, feet, perineum, crossing major joints, circumferential around an extremity      

     - high risk due to comorbid conditions or social factors prohibiting follow up

     - Associated inhalation injury, other traumatic injury

References:  

Guthrie, A. Minor Burn Management. Life in the Fastlane. https://litfl.com/ 

    minor-burn-management/ 

Tintinalli, Judith E. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Edition. Ch 204, 216, 222.  

Tolles, Juliana. “Emergency Department Management of Patients with Thermal Burns.” Emergency medicine practice (Online) : an evidence-based approach to emergency medicine. 20.2 (2018): 1–24. Print. 

Volino, A. An Interesting Case of Smoke Inhalation. EM Daily. https://emdaily.cooperhealth.org/content/interesting-case-smoke-inhalation