Environmental Exposures Answers 479become necessary to account for losses. This is done using the Parkland
formula:4 mL/kg/%TBSA (total BSA),one-half to be given over first 8 hours
and the remaining half to be given over the next 16 hours. Ringer lactate is
the fluid of choice. It is also important to protect against hypothermia and
provide adequate analgesia. Depending on the extent and area of the burn,
some patients may need transfer to a burn facility where further escharo-
tomy and debridement may be performed.
First-degree burns (a)are characterized primarily by erythema, having
the appearance of a simple sunburn. It involves the epidermis only and usually
heals without scar formation. Second-degree burns (b and c)are superficial
partial thickness burns involving the epidermis and part of the dermis
resulting in painful erythema and blister formation. Follicles and glands
may or may not be involved. These blisters are best left intact. Third-degree
burns (d and e)are full thickness burns involving the epidermis, dermis,
and subcutaneous fat that results in pale, charred skin. Surgical debridement
and grafting is necessary in these cases. Fourth-degree burns extend through
the skin, fat, muscle, and bone and are often limb and life-threatening.
(Reproduced, with permission, from Tierney LM, McPhee SJ, Papadakis MA.Current Medical
Diagnosis & Treatment. New York, NY: McGraw-Hill, 2006.)