The EM Burns section provides High Yield information for the Medical School, Residency, and in the future career as a Physician. Prepare and Learn Ahead! Educating, Preparing, and Proving high-yield content, quizzes, and medical resources. to students who are interested in the medical field.

First degree burn

  • Presentation:
    • only epidermis involved
    • area is painful and erythematous
    • No blisters
    • capillary refill intact
    • Looks like sunburn

Second degree burn

  • epidermis and partial thickness of the dermis are involved.
  • area is painful and blisters are present

Third degree burn

  • epidermis
  • full thickness of the dermis, and potentially deeper tissues are involved
  • area is painless, white, and charred
Craig0927 / Public domain

Circumferential Burns

  • Management: Consider escharotomy

Rule of 9s

AdultsEstimate % BSA in adults
Head & each Arm = 9%
Back and Chest each = 18%
Each Leg = 18%-
Perineum = 1%
ChildrenHead = 18%
Each Arm = 9%
Back and Chest each = 18%
Each Leg = 14%

Burn Work up and Tx

  • Parkland Formula:
    • Kg x % BSA x 3-4
    • Kg x % BSA x 2-4
    • Give ½ over the 1st 8hrs and the rest over next 16hrs
    • Ringers lactate or normal saline
  • NO PO or IV abx: Give topical. 
  • Doesn’t penetrate eschar and can cause leukopenia: Silver Sulfadiazine
  • Penetrates eschar but hurts like hell: Mafenide
  • Doesn’t penetrate eschar and causes hypo-K and HypoNa: Silver Nitrate

Burn Checklist

  • Singed nose hairs, wheezing, soot in mouth/nose = Low threshold for intubation
  • Patient w/ confusion, HA, cherry-red skin:
    • Best test: Check carboxyHb (pulse ox = worthless)
    • -Treatment: 100% O2 (hyperbaric if CO-Hb is ↑↑↑
  • Chemical burn: Irrigate >30min prior to ER
  • Electrical Burn, best 1st step: EKG!
  • If abnormal: 48 hours of telemetry (also if LOC)
  • If urine dipstick + for blood but microscopic exam is negative for RBCs? Myoglobinuria -> ATN
  • Then what do you check: K+! (When cells break)
  • If the affected extremity is extremely tender, numb, white, cold with barely dopplerable pulses: Compartment syndrome!!
    • –Criteria: 5 Ps or compartment pressure >30mmHg
    • –Treatment: May require fasciotomy. (at bedside!)

Urine Output

Burn Complications

Infectiouspseudomonal infection

Burn Management

Supportive Measurestetanus
stress ulcer prophy
IV narcotic analgesia
Monitor Count respirations for Opioid overdose
Antimicrobial Prophylaxistopical silver sulfadiazine and mafenide
MedicationIV route preferred – act quickly and act fast.
If IM injections are going to work, you need
adequate perfusion to the muscle.

Holds onto fluid in vascular space
▪ Vascular volume INCREASES.
▪ Kidney perfusion INCREASES.
▪ Cardiac output INCREASES.

By increasing the vascular volume by giving albumin – the workload of the heart will also increase.
Be careful of stressing the heart too much and throwing the client into a fluid volume EXCESS.

CVP to prevent fluid volume excess
CO output decrease and lung crackles – Fluid volume excess
Fluid Goal for Fluid Repletion1cc/kg/hr of UOP
Parkland FormulaFluids for first 24hrs =
4 (pt weight in kg x %BSA)

50% over 8hrs
50% over next 16hrs

Calculate what is needed for the first 24 hours,
and give half of the volume calculated during
the first 8 hours.
2nd 8 hours – 1/4 of the total volume
Same with the 3rd 8 hours.
Treatment for Burns
> 20-25% TBSA
1. Fluid Replacement.
2. Emergency Management.
3. Medication Management.
4. Pain Management.

Indications to Transfer Pt to Burn Center

– full thickness burn >5% of BSA
– partial thickness burn >10% BSA
– any full or partial burn over critical areas (face, hands, feet, genitals, perineum, major joints)
– circumferential burns; chemical, electrical, or lightning injury; inhalation injury
– any special psychosocial or rehabilitative care needs

Immunization for Burn patient

Airway Injury