UMEM Educational Pearls

Pediatric Burns

• Burn Depth:
  • Avoid the traditional classification of 1st, 2nd, 3rd, and 4th degrees – they are imprecise.
  • Use modern classification:
    • Superficial, superficial partial thickness, deep partial thickness, full thickness, and Deep full thickness.
• Estimation of burn %:
  • Rules of 9 is NOT useful in pediatrics
  • Use the Lund-Browder Chart, which accounts for varying surface area percentiles by age.
  • If Lund-Browder Chart not available, use the area from the patient’s wrist to the tips of the fingers as being equivalent to 1% of his/her BSA.
  • Don’t include superficial burns in calculation of %TBSA burned.
  • Burn depth will often progress… anticipate this, as this will have implications on fluid management.
• Fluid Resuscitation
  • Parkland: Weight (kg) x %TBSA burned x 4ml = 24 hr total volume of Ringer’s Lactate
  • First ½ over the first 8 hours SINCE THE TIME OF THE BURN (not the arrival in the ED)
  • Second ½ over the next 16 hrs.
  • IF THE PT WEIGHS <30kg, this volume needs to be IN ADDITION to the child’s Maintenance fluids
  • Parkland gives you an estimate of the starting fluid requirements, but assessment of the Urine Output allows you to adjust it according to the pt’s needs:
    • Goal Urine Output = 1ml/kg/hr for pts <30kg; 0.5ml/kg/hr for pts >30kgs
    • Be careful not to fluid overload pt: decrease or increase IVF rate accordingly.
       

References

Duffy BJ, McLaughlin PM, Eichelberger MR. Assessment, Triage, and Early Management of Burns in Children. Clinical Pediatric Emergency Medicine. 2006; 7:82-93.

Burn Service Manual, Children’s National Medical Center.  Emergency, Trauma and Burn Services, Children’s National Medical Center, Washington, DC.