Intended for healthcare professionals

Clinical Review ABC of burns

Initial management of a major burn: II—assessment and resuscitation

BMJ 2004; 329 doi: (Published 08 July 2004) Cite this as: BMJ 2004;329:101
  1. Shehan Hettiaratchy,
  2. Remo Papini

    Assessment of burn area

    Assessment of burn area tends to be done badly, even by those who are expert at it. There are three commonly used methods of estimating burn area, and each has a role in different scenarios. When calculating burn area, erythema should not be included. This may take a few hours to fade, so some overestimation is inevitable if the burn is estimated acutely.

    Wallace rule of nines

    Palmar surface—The surface area of a patient's palm (including fingers) is roughly 0.8% of total body surface area. Palmar surface are can be used to estimate relatively small burns (< 15% of total surface area) or very large burns (> 85%, when unburnt skin is counted). For medium sized burns, it is inaccurate.

    Wallace rule of nines—This is a good, quick way of estimating medium to large burns in adults. The body is divided into areas of 9%, and the total burn area can be calculated. It is not accurate in children.

    Lund and Browder chart—This chart, if used correctly, is the most accurate method. It compensates for the variation in body shape with age and therefore can give an accurate assessment of burns area in children.

    It is important that all of the burn is exposed and assessed. During assessment, the environment should be kept warm, and small segments of skin exposed sequentially to reduce heat loss. Pigmented skin can be difficult to assess, and in such cases it may be necessary to remove all the loose epidermal layers to calculate burn size.

    Resuscitation regimens

    Fluid losses from the injury must be replaced to maintain homoeostasis. There is no ideal resuscitation regimen, and many are in use. All the fluid formulas are only guidelines, and their success relies on adjusting the amount of resuscitation fluid against monitored physiological parameters. The main …

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