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10. Medical and minor surgical procedures
T his table help s to accurately calculate the % o f B S A invo lved acco rd ing to p atient‟s
age:
e.g. burn o f the face, anterio r trunk , inner surface o f the lo wer arm and circum ferential
burn o f left up p er arm in a child 2 y ears o f age: 8 .5 + 1 3 + 1 .5 + 4 = 2 7 % B S A .
Depth of burns
A p art fro m first-d egree burns (p ainful ery them a o f the sk in and absence o f blisters) and
very d eep burns ( th ird - d egree burns, carbo niz atio n) , it is no t p o ssible, up o n initial
exam inatio n, to d eterm ine the d ep th o f burns. D ifferentiatio n is p o ssible after D 8 -D 1 0 .
Superficial burn on D8-D10 Deep burn on D8-D10
S ensatio n N o rm al o r p ain Insensitive o r d im inished sensatio n
C o lo ur P ink , blanches with p ressure W hite, red , bro wn o r black
D o es no t blanch with p ressure
T exture S m o o th and sup p le F irm and leathery
A p p earance M inim al fibrino us exud ate C o vered with fibrino us exud ate
G ranulatio n tissue evid ent L ittle o r no bleed ing when incised
B leed s when incised
H ealing H eals sp o ntaneo usly within 5 -1 5 d ay s – V ery d eep burn: alw ay s requires
surgery (no sp o ntaneo us healing)
– Interm ed iate burn: m ay heal sp o nta -
neo usly in 3 to 5 week s; high risk o f
infectio n and p erm anent sequelae
Evaluation for the presence of inhalation injury
D y sp no ea with ch est wall ind raw ing, bro nch o sp asm , so o t in th e nares o r m o uth ,
p ro d uctive co ugh, carbo naceo us sp utum , ho arseness, etc.
Treatment of severe burns (in hospital)
I. Initial management
On admission
– E nsure airway is p 2 aO is no rm al.
atent; high-flo w o xy gen, even when S
– E stablish intraveno us access, thro ugh unburned sk in if p o ssible (intrao sseo us access 10
if veno us access is no t p o ssible).
– Ringer lactate (RL ): 2 0 m l/ k g d uring the first ho ur, even if the p atient is stable.
– Morphine S C : 0 .2 m g/ k g (S tep 1 and S tep 2 analgesics are no t effective).
– In the event o f chem ical burns: flush with co p io us am o unts o f water fo r 1 5 to 3 0 m in,
avo id ing co ntam inatio n o f healthy sk in; d o no t attem p t to neutraliz e the chem ical
agent.
Once the patient is stabilized
– Rem o ve clo thes if they are no t ad herent to the burn.
– T ak e histo ry o f the burn injury : m echanism , causative agent, tim e, etc.
– A ssess the burn injury : extent, d ep th, carbo niz atio n; o cular burns, burns at risk o f
seco nd ary functio nal d eficits; circum ferential burns o f the extrem ities, chest o r neck .
W ear face m ask and sterile glo ves d uring the exam inatio n.
267
T his table help s to accurately calculate the % o f B S A invo lved acco rd ing to p atient‟s
age:
e.g. burn o f the face, anterio r trunk , inner surface o f the lo wer arm and circum ferential
burn o f left up p er arm in a child 2 y ears o f age: 8 .5 + 1 3 + 1 .5 + 4 = 2 7 % B S A .
Depth of burns
A p art fro m first-d egree burns (p ainful ery them a o f the sk in and absence o f blisters) and
very d eep burns ( th ird - d egree burns, carbo niz atio n) , it is no t p o ssible, up o n initial
exam inatio n, to d eterm ine the d ep th o f burns. D ifferentiatio n is p o ssible after D 8 -D 1 0 .
Superficial burn on D8-D10 Deep burn on D8-D10
S ensatio n N o rm al o r p ain Insensitive o r d im inished sensatio n
C o lo ur P ink , blanches with p ressure W hite, red , bro wn o r black
D o es no t blanch with p ressure
T exture S m o o th and sup p le F irm and leathery
A p p earance M inim al fibrino us exud ate C o vered with fibrino us exud ate
G ranulatio n tissue evid ent L ittle o r no bleed ing when incised
B leed s when incised
H ealing H eals sp o ntaneo usly within 5 -1 5 d ay s – V ery d eep burn: alw ay s requires
surgery (no sp o ntaneo us healing)
– Interm ed iate burn: m ay heal sp o nta -
neo usly in 3 to 5 week s; high risk o f
infectio n and p erm anent sequelae
Evaluation for the presence of inhalation injury
D y sp no ea with ch est wall ind raw ing, bro nch o sp asm , so o t in th e nares o r m o uth ,
p ro d uctive co ugh, carbo naceo us sp utum , ho arseness, etc.
Treatment of severe burns (in hospital)
I. Initial management
On admission
– E nsure airway is p 2 aO is no rm al.
atent; high-flo w o xy gen, even when S
– E stablish intraveno us access, thro ugh unburned sk in if p o ssible (intrao sseo us access 10
if veno us access is no t p o ssible).
– Ringer lactate (RL ): 2 0 m l/ k g d uring the first ho ur, even if the p atient is stable.
– Morphine S C : 0 .2 m g/ k g (S tep 1 and S tep 2 analgesics are no t effective).
– In the event o f chem ical burns: flush with co p io us am o unts o f water fo r 1 5 to 3 0 m in,
avo id ing co ntam inatio n o f healthy sk in; d o no t attem p t to neutraliz e the chem ical
agent.
Once the patient is stabilized
– Rem o ve clo thes if they are no t ad herent to the burn.
– T ak e histo ry o f the burn injury : m echanism , causative agent, tim e, etc.
– A ssess the burn injury : extent, d ep th, carbo niz atio n; o cular burns, burns at risk o f
seco nd ary functio nal d eficits; circum ferential burns o f the extrem ities, chest o r neck .
W ear face m ask and sterile glo ves d uring the exam inatio n.
267
