BURNS
CALCULATION
| BODY SURFACE AREA | |||||
| AREA INDICATED | 0 YEAR | 1YEAR | 5 YEAR | 10 YR | 15 YR |
| A | 9.5 | 8.5 | 6.5 | 5.5 | 4.5 |
| B | 2.75 | 3.25 | 4.0 | 4.5 | 4.5 |
| C | 2.5 | 2.5 | 2.75 | 3.0 | 3.25 |
MAJOR BURNS.
- >5% BSA involved
- Burns involving airway
- Deep burns in especially important areas (e.g. hands or eyes)
TREATMENT
ALGORITHM FOR PRIMARY SURVEY OF MAJOR BURN INJURY: BMJ, 2004
- Remove all clothing.
- Cool burnt areas with wet soaks
- Look for inhalational injury.
- Measure ABG and carboxy-haemoglobin.
- Consider intubation if burns >30% of total body surface area.
From- paediatric advanced life support St Louis: Mosby 1996:460
CIRCULATION
- Treat shock( Normal saline bolus -20 ml/kg)
- 2 large bore IV cannula.
- Consider Central venous access if burns >25%.
FLUIDS
- Start Normal Saline as formula below
- Avoid potassium for first 48 hours
- IV Opiates. (MORPHINE- 100 microgram /kg IV).
- Consider tetanus vaccination.
Percentage of burn x weight (kg) x 4
· Half of this in first 8 hours
· Next half over 16 hours.
TOPICAL AGENTS USED IN BURNS DRESSING
- Silver Sulfadiazine- Broad spectrum
- Silvadene Cream- Good sound penetration
- Mafenide- Broad spectrum including Pseudomonas
- 0.5% Silver nitrate- Bacteriostatic including fungi
- Accuzyme ointment- enzymatic debridement
MEASURING EXTENT OF BURNS
Wallace’s rule of 9s
The rule of 9s is relatively accurate for adults and less accurate in children.
The following are the respective percentages of the TBSA:
• Head and neck total for front and back: 9%
• Each upper limb total for front and back: 9%
• Thorax and abdomen front: 18%
• Thorax and abdomen back: 18%
• Perineum: 1%
• Each lower limb total for front and back: 18%.
Using Palmar surface to estimate burns
- The surface area of a patient’s palm (including fingers) is roughly 0.8% of total body surface area.
- Palmar surface can be used to estimate relatively small burns (<15% of total surface area) or very large burns (>85%, when unburnt skin is counted).