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■ Estimation of burn depth may be difficult on initial evaluation.

■ For this reason, burns should be reevaluated in 24 hours as usually true

depth and extent of tissue damage are not initially apparent.

TREATMENT

■ Treatment for inhalational injury:

■ Humidified 100% O 2

■ Intubation for:

■ Full-thickness face or perioral burns

■ Circumferential neck burns

■ Supraglottic edema and inflammation on bronchoscopy

■ Tachypnea, hypoxia, or AMS

■ The Parkland Formula provides a guide for fluid resuscitation for patients

with significant burns:

4 mL ×%burn×weight (kg) = fluid requirement (mL) over first 24 hrs

■ Use only area of second- and third-degree burns to determine TBSA for

resuscitation.

■ Give half over first 8 hours. Multiply by 3 mL instead of 4 mL in children

and add maintenance fluids. The Parkland Formula is merely a guide,

and adequate fluid must be given to maintain urine output.

■ Circumferential burnsto extremities run the risk of circulatory compromise

due to pressure from burn/swelling. Circumferential burns to the torso may

interfere with breathing via constriction. Consider early escharotomy for both.

■ Blisters that are large or across joints should be ruptured, while smaller

immobile ones may be left alone.

■ Silvadene to body but not to face because of scarring risk. Use topical

agent like bacitracin to face.

■ Keep wounds out of sun to prevent scarring, and follow up in 24 hours.

DISPOSITION

■ Major: Burn center (see Table 3.13)

■ Moderate: Hospitalization

TRAUMA

TABLE 3.13. Criteria for Transfer to Burn Unit

Partial-thickness burns greater than 10% total body surface area (BSA)

Burns that involve the face, hand, feet, genitalia, perineum, or major joints

Third-degree burns in any age group

Electrical burns, including lightning injury

Chemical burns

Inhalation injury

Burn injury in patients with preexisting medical disorders that could complicate management,

prolong recovery, or affect mortality

Any patients with burns and concomitant trauma (such as fractures) in which the burn injury

poses the greatest risk of morbidity or mortality

Burned children in hospitals without qualified personnel or equipment for the care of children

Burn injury in patients who will require special social, emotional, or long-term rehabilitative

intervention

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency Medicine:

A Comprehensive Study Guide,6th ed. New York: McGraw-Hill, 2004:1222.)