title: "Burns"
Burns
Burns cause local tissue injury plus systemic inflammatory response. Fluid resuscitation is critical in the first 24-48 hours to prevent burn shock.
Classification by Depth
| Depth | Appearance | Sensation | Healing |
|---|---|---|---|
| Superficial (1st) | Red, dry, no blisters | Painful | 3-5 days, no scar |
| Partial thickness (2nd) | Blistered, moist, pink | Very painful | 2-3 weeks if superficial |
| Full thickness (3rd) | White/brown, leathery, dry | Painless | Requires grafting |
| 4th degree | Extends to muscle/bone | Painless | Requires surgery |
TBSA Estimation
Wallace Rule of Nines (Adults)
| Body Part | TBSA |
|---|---|
| Head | 9% |
| Each arm | 9% |
| Each leg | 18% |
| Anterior trunk | 18% |
| Posterior trunk | 18% |
| Perineum | 1% |
Palm method: Patient's palm (including fingers) = 1% TBSA. Useful for scattered burns.
Source: local burns service guideline / ATLS.
Paediatric Modification
- Children have proportionally larger heads
- Infants: Head = 18%, each leg = 14%
- Use Lund-Browder chart for accuracy
Fluid Resuscitation
Parkland Formula: 4 mL × weight (kg) × %TBSA over 24 hours. Give half in first 8 hours (from time of burn, not arrival).
Source: local burns service guideline / ATLS.
Example: 70 kg patient with 30% TBSA burn:
- Total: 4 × 70 × 30 = 8400 mL in 24h
- First 8h: 4200 mL
- Next 16h: 4200 mL
Use crystalloid (Hartmann's or normal saline)
Monitoring Adequacy
Target urine output 0.5-1 mL/kg/hr (adults) or 1 mL/kg/hr (children). Adjust fluid rate to achieve this.
Source: local burns service guideline / ATLS.
Airway Burns
Suspect airway burns if: facial burns, singed nasal hairs, carbonaceous sputum, hoarse voice, stridor, history of enclosed space fire.
Intubate early - airway oedema worsens over 24-48 hours.
Indications for Early Intubation
- Stridor or hoarseness
- Respiratory distress
- Large TBSA burn (>40%)
- Significant facial/neck burns
- Declining GCS
Carbon Monoxide Poisoning
Consider in all enclosed-space fires:
- SpO₂ unreliable (carboxyhaemoglobin reads as normal)
- Symptoms: Headache, confusion, cherry-red skin (late)
- Treatment: 100% oxygen (half-life COHb: 4h on room air → 1h on 100% O₂)
- Consider hyperbaric oxygen if severe
Circumferential Burns
Circumferential full-thickness burns of limbs or chest may cause compartment syndrome or respiratory compromise. May need escharotomy.
Transfer Criteria (Burns Centre)
-
10% TBSA in adults, >5% in children/elderly
- Full thickness >5% TBSA
- Burns to face, hands, feet, genitalia, joints
- Inhalation injury
- Electrical or chemical burns
- Circumferential burns
- Significant co-morbidities