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Management of paediatric burns

BMJ 2010; 341 doi: (Published 25 August 2010) Cite this as: BMJ 2010;341:c4485
  1. A W N Reid, core trainee year 2, plastic surgery,
  2. J Akhtar, foundation year 2, plastic surgery,
  3. O P Shelley, consultant plastic surgeon
  1. Correspondence to: A W N Reid awnr2{at}

    An 11 year old girl presented to an accident and emergency department with an injury to her right foot. She had splashed hot oil from a pan on to her socks while preparing food in the kitchen. Her mother had immediately placed the affected foot in cold water for 15 minutes and dressed the injury with cling film. Her mother had then taken her without delay to the hospital. The girl had no other injuries and non-accidental injury was not suspected. She was otherwise fit and well, she was not taking any regular drugs, and she had no allergies.

    On arrival, she was given oral paracetamol and intranasal diamorphine analgesia. On initial examination, the affected area on the right foot measured 4×5 cm; some of the area appeared pink, the rest of the area was covered with blisters. After deroofing of the blisters using plastic forceps (figure), all the affected skin was moist, blanched on gentle pressure, and was sensate. Routine general examination was otherwise unremarkable.


    • 1 What is the per cent total body surface area of the burn and how is this determined?

    • 2 What is the probable depth of this burn?

    • 3 Would you use intravenous fluids to resuscitate this child?

    • 4 Would you discuss this burn with the specialist burn centre? Justify your decision

    • 5 What are the potential complications of this particular burn?


    1 What is the per cent total body surface area of the burn? How is this determined?

    Short answer

    The total body surface area is less than 1% using the palmar method for small burns: the area of patient’s palm and fingers corresponds to about 0.8% total body surface area in …

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