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The first half of the fluid is given within eight hours from the burn incident, and the remaining over the next 16 hours. Only area covered by second-degree burns or greater is taken into consideration, as first-degree burns do not cause hemodynamically significant fluid shift to warrant fluid replacement.
The Wallace rule of nines is a tool used in pre-hospital and emergency medicine to estimate the total body surface area (BSA) affected by a burn.In addition to determining burn severity, the measurement of burn surface area is important for estimating patients' fluid requirements and determining hospital admission criteria.
The Lund and Browder chart is a tool useful in the management of burns for estimating the total body surface area affected. It was created by Dr. Charles Lund, Senior Surgeon at Boston City Hospital, and Dr. Newton Browder, based on their experiences in treating over 300 burn victims injured at the Cocoanut Grove fire in Boston in 1942.
Burns that affect only the superficial skin layers are known as superficial or first-degree burns. [ 2 ] [ 11 ] They appear red without blisters, and pain typically lasts around three days. [ 2 ] [ 11 ] When the injury extends into some of the underlying skin layer, it is a partial-thickness or second-degree burn . [ 2 ]
Burn scar contracture is the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area. This is mediated by myofibroblasts. [1]
The original Baux score was the addition of two factors, the first being the total body surface area affected by burning (usually estimated using the Wallace rule of nines, or calculated using a Lund and Browder chart) and the second being the age of the patient. The score is expressed as:
Friction burn caused by a treadmill. Example of a third-degree friction burn. A friction burn is a form of abrasion caused by the friction of skin rubbing against a surface. A friction burn may also be referred to as skinning, chafing, or a term named for the surface causing the burn such as rope burn, carpet burn or rug burn.
A burn center needs a team approach for the management of critically burnt patients. Usually, the burns management team consists of a plastic surgeon, intensivist, chest physician, general surgeon, Anesthesiologist, Respiratory Therapist, pediatrician, nurses and technicians, microbiologist, psychiatrist, nutritionist, physiotherapist, and social worker.