Burn Basics
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