Estimating Percentage of Total Body Surface Area

Exclude erythema The Lund-Browder chart is the most accurate method for estimating burn extent, and must be used in the evaluation of all pediatric patients.

Relative Percentage of Body Surface Area Affected by Growth Age in years A-head (back or front) B-1 thigh (back or front) C-1 leg (back or front) 0 9½ 2¾ 2½ 1 8½ 3¼ 2½ 5 6½ 4 2¾ 10 5½ 4¼ 3 15 4½ 4½ 3¼ Adult 3½ 4¾ 3½

If you lose this book. use the “Rule of Nines” for adults: .

second or third degree.” Estimation of Burn Depth Burns are classified as either first.Use the patient’s palm size to represent approximately 1% TBSA. Superficial Burns First DegreeInjury involving only the outer epidermis layer. . Imagine a rectangle the width and length of your entire hand (from wrist to fingertips) and that is the size of “one palm. Resolves in 48-72 hours with comfort measures. Healing is uneventful.Palm trick. Erythema and mild discomfort.

Wounds are red with scattered deeper white areas throughout. Wounds are pink. Wound breakdown is common since the rete pegs have been destroyed. wound appears waxy and white. The wound is painless and will not heal unless very small (smaller than 2 X 2cm). Dermal necrosis with coagulated proteins turns the wound a white to yellow color (called coagulum). Topical antibiotics can add to this color change and make the wound difficult to differentiate from a third degree burn. in which case a leathery brown or black appearance is seen along with coagulated subcutaneous veins. wet. The entire epidermis and dermis are destroyed. Initially. Deep Burns Deep Second DegreeThe injury extends into the dermis.Superficial Second DegreeThe entire epidermis and upper third of the dermis are destroyed. The marked decrease in blood flow makes the wound very prone to conversion to a third degree wound. Dense scarring is seen if the wound heals primarily. Heals within two weeks via repopulation of epithelial cells present in skin appendages and the deep dermis. thus. Vessels leak plasma which lifts off the epidermis. . causing blister formation. Wounds require months to heal. leaving few viable epidermal cells. Blisters do not form because the dead tissue layer is thick and does not easily lift off the surface. Third DegreeA full thickness burn. No epidermal cells present for reepithelialization. and very painful. Reepithelialization is very slow. unless burn extends into the fat. what little epidermis is left is thin and not well adherent.

iii[iii] . Low voltage. Until proven otherwise. Acids cause protein coagulation. 2) arc burns occur when electrical current jumps from one part of the body to another. Electrical burns Electrical injuries are of three major types which may occur in combination: 1) true electrical injury exists when electricity passes through the body. SVT.. and other focal ectopic dysrhythmias. and T the duration of contact. which continues to injure the skin. along with significant deep-tissue destruction. and ECG changes may be present. where (J) is the heat produced. An entrance and exit wound is produced. low current (<1000volts and 5-60mA) cause less soft tissue damage but are noted to more commonly cause cardiac fibrillation. perhaps due to the low-resistance mesenteric vascular system. chemical burns should be considered deep. producing scattered spots of injury which may be deep 3) flame burns are caused by sparks sufficient to ignite clothing High-voltage.Other Burn Injuries Chemical Burns These burns cause progressive tissue damage until inactivated or flushed with water. Complications of electrical injuries include tetanic muscle contractions with resulting muscle fractures and dislocations. The quantity of heat produced is expressed in Joule’s Law: J=I2RT. Therefore when performing the history and physical examination. R is resistance. high-current source electrical injuries (>1000 volts and >5000mA) cause significant soft tissue damage. Intraperitoneal damage occurs. I is the current. or falls with crush injuries. whereas alkali burns combine with cutaneous lipids causing tissue saponification. limiting further penetration. record the voltage and duration of contact with the source.ii[ii] Electrical injuries may also cause delayed neurologic changes and cataract formation. Cardiac dysfunction may be seen initially in as many as one third of electrically injured patients.i[i] including RBBB.

marked by nausea. vomiting. This is followed by a latent period. GI. and then by hemopoietic. and headache within hours of exposure. fever. from an industrial accident (Chernobyl.Radiation burns Accidents involving ionizing radiation are not common. . Most frequently they are the result of a local accident (laboratory). and vascular complications. or from the detonation of a nuclear device. fatigue. diarrhea. Whole-body exposure of more than 100 rads causes acute radiation syndrome. Russia in 1986).

i ii iii .

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