1st- and superficial 2nd-degree burns heal by epithelialization (primarily from hair follicles)
Extremely deep burns, electrical burns, or compartment syndrome can cause rhabdomyolysis with myoglobinuria (Tx: hydration, alkalinize urine)
![](https://i0.wp.com/basicmedicalkey.com/wp-content/uploads/2017/06/image00541.gif?w=960)
ADMISSION CRITERIA1
2nd- and 3rd-degree burns > 10% BSA in patients aged < 10 or > 50 years
2nd- and 3rd-degree burns > 20% BSA in all other patients
2nd- and 3rd-degree burns to significant portions of hands, face, feet, genitalia, perineum, or skin overlying major joints
3rd-degree burns > 5% in any age group
Electrical and chemical burns
Concomitant inhalational injury, mechanical traumas, preexisting medical conditions
Injuries in patients with special social, emotional, or long-term rehabilitation needs
Suspected child abuse or neglect
BURN ASSESSMENT
Deaths highest in children and elderly (trouble getting away)
Scald burns – most common
Flame burns – more likely to come to hospital and be admitted
Assessing percentage of body surface burned (rule of 9s)
• Head = 9, arms = 18, chest = 18, back = 18, legs = 36, perineum = 1
• Can also use patient’s palm to estimate injury (palm = 1%)
Parkland formula
• Use for burns ≥ 20% only – give 4 cc/kg × % burn in first 24 hours; give ½ the volume in the first 8 hours
• Use lactated Ringer’s solution (LR) in first 24 hours
• Urine output best measure of resuscitation (0.5–1.0 cc/kg/h in adults, 2–4 cc/kg/h in children < 6 months)
• Parkland formula can grossly underestimate volume requirements with inhalational injury, ETOH, electrical injury, post-escharotomy
• Important to use LR in first 24 hours
• Colloid (albumin) in 1st 24 hours causes ↑ pulmonary/respiratory complications → can use colloid after 24 hours
![](https://i0.wp.com/basicmedicalkey.com/wp-content/uploads/2017/06/image00542.gif?w=960)
Escharotomy indications (perform within 4–6 hours):
• Circumferential deep burns
• Low temperature, weak pulse, ↓ capillary refill, ↓ pain sensation, or ↓ neurologic function in extremity
• Problems ventilating patient with significant chest torso burns
• May need fasciotomy if compartment syndrome suspected after escharotomy
Risk factors for burn injuries – alcohol or drug use, age (very young/very old), smoking, low socioeconomic status, violence, epilepsy
CHILD ABUSE
Accounts for 15% of burn injuries in children
History and exam findings that suggest abuse:
• History – delayed presentation for care, conflicting histories, previous injuries
• Exam – sharply demarcated margins, uniform depth, absence of splash marks, stocking or glove patterns, flexor sparing, dorsal location on hands, very deep localized contact injury
LUNG INJURY
Caused primarily by carbonaceous materials and smoke, not heat
Risk factors for airway injury – ETOH, trauma, closed space, rapid combustion, extremes of age, delayed extrication
Signs and symptoms of possible airway injury – facial burns, wheezing, carbonaceous sputum
Indications for intubation – upper airway stridor or obstruction, worsening hypoxemia, massive volume resuscitation can worsen symptoms
Pneumonia – most common infection in patients with > 30% BSA burns
• Also most common cause of death after > 30% BSA burns
UNUSUAL BURNS
Acid and alkali burns – copious water irrigation
• Alkalis produce deeper burns than acid due to liquefaction necrosis
• Acid burns produce coagulation necrosis
Hydrofluoric acid burns – spread calcium on wound
Powder burns – wipe away before irrigation
Tar burns – cool, then wipe away with a lipophilic solvent (adhesive remover)
![](https://freepngimg.com/download/social_media/63059-media-icons-telegram-twitter-blog-computer-social.png)
Stay updated, free articles. Join our Telegram channel
![](https://clinicalpub.com/wp-content/uploads/2023/09/256.png)
Full access? Get Clinical Tree
![](https://videdental.com/wp-content/uploads/2023/09/appstore.png)
![](https://videdental.com/wp-content/uploads/2023/09/google-play.png)