Burn Assessment and Treatment: Making The Call
In our first installment, we looked at how to determine the thickness of a burn and what that might mean for the patient. Now let’s talk about the things that will help us decide how to determine if our patient’s burn is minor, moderate of severe.
Our three considerations when deciding on burn criteria are:
burn surface area
We covered burn depth last time, this time we’ll cover estimating burn area and the particular locations that change our burn assessment.
Let’s look at two widely accepted guidelines for estimating the surface area of a burn. For smaller burns, the palm method can be useful. Look at the palm of your patient’s hand. The surface area of the palm (we’re not including the fingers here) is about 1% of the patients total body surface area. This can be useful if the burn involves 15% or less of the total body surface area.
Another rapid estimation tool is the rule of nines. This rule requires a bit of memorization on your part, but the effort is well worth it. In the rule of nines we divide major body regions into percentages. The head is 9%. The chest and back are both 18% respectively. Each leg is also 18%. Each arm is given 9% and the genitalia add the remaining 1% to total body area. From that foundation, large area burns can be estimated rapidly. One half of one arm is a 4.5% total body surface area burn (TBSA). One entire leg and the front of the other leg is a 27% TBSA burn.
For complex burn patterns, the two rules can be used together as well.
Calling the critical burn
With these tools we can now identify the thickness of the burn we are working with, recognize the body regions involved and rapidly estimate the TBSA of the burn. Now were ready to decide if our patient has sustained a critical burn.
Critical burn criteria:
Any full thickness burn greater than 10% of TBSA.
Any moderate thickness burn greater than 30% of TBSA.
Full thickness burns on hands, feet, genitalia or face.
Burns with swelling or deformity affecting a joint.
Burns affecting the airway.
Full or partial thickness circumferential burns. (encircling a limb or the torso)
Any moderate burn in a pediatric or elderly patient.
All of these burn criteria suggest the need for rapid transport to a local or regional burn center.
Moderate burn criteria:
Full thickness burns from 2 to 10 percent of TBSA*
Partial thickness burns from 15 to 30 percent of TBSA*
Superficial burns greater than 50 percent of TBSA
Patients who meet moderate burn criteria require transport to the hospital in a medic unit and careful monitoring for hemodynamic changes.
Minor burns are superficial burns involving less than half of the body, moderate burns involving less than 15 percent of the TBSA and full thickness burns under two percent of TBSA. While we give these burns a minor classification, we need to be cautious not to understate the importance of proper care and treatment to the patient.
Minor burns still carry immediate risks of dehydration and more long term risks such as infection and loss of mobility.
We also need to keep in mind that preexisting medical conditions can increase the severity of a burn. Patients with a history of renal failure, CHF and immuno-compromised patients may be at increased risk for complications from burns.
I know what you’re saying. “That all great Steve, but tell me what to do with these folks once I decide it’s time to start treating the burn.” Great idea. Let’s cover that in part three. See you then.