Rule of Nines (Adult)

Head: 9%. Each Arm: 9%. Anterior Trunk: 18%. Posterior Trunk: 18%. Each Leg: 18%. Perineum: 1%.

1st Degree (Superficial)

Epidermis only. Red, dry, painful, blanches. Heals in ~1 week. No scarring. (Sunburn).

2nd Degree (Partial Thickness)

Epidermis & part of dermis. Red, moist, blistered, VERY painful. Heals in 2-3 weeks, may scar.

3rd Degree (Full Thickness)

Destroys entire dermis & epidermis. Dry, leathery eschar (white/black), painless. Requires grafting.

Extends into muscle, bone, tendon. Charred appearance. Requires complex reconstruction, often amputation.

Parkland Formula (Fluid Resuscitation)

4 mL LR x kg x % TBSA burned. Give 1/2 in first 8h post-burn, 2nd half over next 16h.

Emergent Phase (0-48h)

Fluid shifts from intravascular to interstitial (third-spacing). Priorities: Airway, Breathing, Circulation (Fluids).

Acute Phase (After 48h)

Fluid remobilization (shifts back), diuresis begins. Priorities: Infection control, wound care, nutrition, pain.

Massive increase in metabolic rate and caloric need (up to 5000 kcal/day). High protein required for healing.

Early enteral feeding (within 24h) is preferred. High-protein, high-calorie diet. May need TPN if gut not functional.

Singed nasal hairs, soot in sputum, hoarseness, stridor, facial burns. Requires early intubation.

Treated with 100% Oxygen. CO binds to hemoglobin 200x more than O2, causing tissue hypoxia.

Silver Sulfadiazine (Silvadene)

Broad-spectrum topical antimicrobial cream. Used for partial/full-thickness burns. Can cause leukopenia.

Mafenide Acetate (Sulfamylon)

Penetrates eschar. Used for ear/cartilage burns and electrical burns. Can cause metabolic acidosis.

Used for facial burns. Petrolatum-based, good for moistening.

Incision through constricting circumferential eschar on chest or limbs to restore circulation and ventilation. Bedside procedure.

Incision through eschar AND fascia for deeper compartment syndrome. Often follows escharotomy if perfusion doesn't improve.

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (coolness).

Major cause of mortality. Loss of skin barrier. Use strict aseptic technique, protective isolation, monitor for sepsis.

IV opioids (morphine, fentanyl) are mainstay. Give prior to dressing changes and therapy. PCA pumps are common.

Contracture Prevention

Early and aggressive physical/occupational therapy. Splinting, positioning, range of motion exercises.

Address PTSD, body image issues, depression. Involve social work and psychiatric support early.

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Burns

Question	Answer
Rule of Nines (Adult)	Head: 9%. Each Arm: 9%. Anterior Trunk: 18%. Posterior Trunk: 18%. Each Leg: 18%. Perineum: 1%.
1st Degree (Superficial)	Epidermis only. Red, dry, painful, blanches. Heals in ~1 week. No scarring. (Sunburn).
2nd Degree (Partial Thickness)	Epidermis & part of dermis. Red, moist, blistered, VERY painful. Heals in 2-3 weeks, may scar.
3rd Degree (Full Thickness)	Destroys entire dermis & epidermis. Dry, leathery eschar (white/black), painless. Requires grafting.
4th Degree	Extends into muscle, bone, tendon. Charred appearance. Requires complex reconstruction, often amputation.
Parkland Formula (Fluid Resuscitation)	4 mL LR x kg x % TBSA burned. Give 1/2 in first 8h post-burn, 2nd half over next 16h.
Emergent Phase (0-48h)	Fluid shifts from intravascular to interstitial (third-spacing). Priorities: Airway, Breathing, Circulation (Fluids).
Acute Phase (After 48h)	Fluid remobilization (shifts back), diuresis begins. Priorities: Infection control, wound care, nutrition, pain.
Hypermetabolic State	Massive increase in metabolic rate and caloric need (up to 5000 kcal/day). High protein required for healing.
Diet	Early enteral feeding (within 24h) is preferred. High-protein, high-calorie diet. May need TPN if gut not functional.
Inhalation Injury	Singed nasal hairs, soot in sputum, hoarseness, stridor, facial burns. Requires early intubation.
Carbon Poisoning	Treated with 100% Oxygen. CO binds to hemoglobin 200x more than O2, causing tissue hypoxia.
Silver Sulfadiazine (Silvadene)	Broad-spectrum topical antimicrobial cream. Used for partial/full-thickness burns. Can cause leukopenia.
Mafenide Acetate (Sulfamylon)	Penetrates eschar. Used for ear/cartilage burns and electrical burns. Can cause metabolic acidosis.
Bacitracin	Used for facial burns. Petrolatum-based, good for moistening.
Escharotomy	Incision through constricting circumferential eschar on chest or limbs to restore circulation and ventilation. Bedside procedure.
Fasciotomy	Incision through eschar AND fascia for deeper compartment syndrome. Often follows escharotomy if perfusion doesn't improve.
6 Ps	Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (coolness).
Infection Risk	Major cause of mortality. Loss of skin barrier. Use strict aseptic technique, protective isolation, monitor for sepsis.
Pain Management	IV opioids (morphine, fentanyl) are mainstay. Give prior to dressing changes and therapy. PCA pumps are common.
Contracture Prevention	Early and aggressive physical/occupational therapy. Splinting, positioning, range of motion exercises.
Psych Support	Address PTSD, body image issues, depression. Involve social work and psychiatric support early.

Created by: Wasurenboh

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