UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Burns

Keywords: Burns, Parkland, Burn Percent, Burn Classification (PubMed Search)

Posted: 5/1/2008 by Sean Fox, MD (Updated: 7/17/2019)
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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.