Author:
Kai Knudsen
Updated:
16 January, 2025
The most common injury mechanisms among burn injuries requiring hospital care are hot liquid (43%), open flame (15%), and electricity (9%). Children are overrepresented, accounting for 36% of all hospital-treated burns, most of them involving scald injuries. The depth of a burn depends primarily on the total amount of heat energy transferred to the skin. The amount of energy is in turn dependent on both temperature and exposure time.
Burn injuries
The most common injury mechanisms among burn injuries requiring hospital care are hot liquid (43%), open flame (15%), and electricity (9%). Children are overrepresented, accounting for 36% of all hospital-treated burns, most of them involving scald injuries. The depth of a burn depends primarily on the total amount of heat energy transferred to the skin. The amount of energy is in turn dependent on both temperature and exposure time.
Fluid therapy constitutes an important foundation in the treatment of severe burns. Crystalloid fluid is usually administered according to the Parkland formula. Albumin is generally withheld during the first 24 hours.
Start infusion with warmed Ringer’s Acetate. Estimate daily fluid requirements as 4 ml/kg x % burned surface area/24 hours. Half of this volume is given in the first eight hours, and the remainder over the following 16 hours. Use an infusion pump (see Parkland formula). Insert a Foley catheter with continuous temperature monitoring. Adjust the infusion rate so that urine output is 0.5 ml/kg/h in adults and approximately 1 ml/kg/h in children.
Parkland Formula
- (2)-4 ml x body weight (kg) x percentage of burned body surface area
- Crystalloid fluids for the first 24 hours
- Half of the volume in the first 8 hours, the remainder over the following 16 hours
- Children have smaller glycogen reserves and therefore require maintenance treatment with 5% glucose in addition to crystalloids:
- 100 ml/kg/day for 0-10 kg
- 50 ml/kg/day for each kg between 11-20 kg
- 20 ml/kg/day for each kg over 20 kg
- Fluid therapy is monitored with hourly urine output; Adults: 0.5 ml/kg/h
- Children up to 30 kg: 1.0 ml/kg/h.
Burn Injury Surface Estimation
Burn-Surface-Area-Percentage
| Body Part | 0-1 years | 1-4 years | 5-9 years | 10-15 years | Adult |
|---|---|---|---|---|---|
| Head | 19.0 | 17.0 | 13.0 | 10.0 | 7.0 |
| Neck | 2.0 | 2.0 | 2.0 | 2.0 | 2.0 |
| Trunk front | 13.0 | 13.0 | 13.0 | 13.0 | 13.0 |
| Trunk back | 13.0 | 13.0 | 13.0 | 13.0 | 13.0 |
| Right gluteus | 2.5 | 2.5 | 2.5 | 2.5 | 2.5 |
| Left gluteus | 2.5 | 2.5 | 2.5 | 2.5 | 2.5 |
| Genitalia | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
| Right upper arm | 4.0 | 4.0 | 4.0 | 4.0 | 4.0 |
| Left upper arm | 4.0 | 4.0 | 4.0 | 4.0 | 4.0 |
| Right lower arm | 3.0 | 3.0 | 3.0 | 3.0 | 3.0 |
| Left lower arm | 3.0 | 3.0 | 3.0 | 3.0 | 3.0 |
| Right hand | 2.5 | 2.5 | 2.5 | 2.5 | 2.5 |
| Left hand | 2.5 | 2.5 | 2.5 | 2.5 | 2.5 |
| Right thigh | 5.5 | 6.5 | 8.5 | 8.5 | 9.5 |
| Left thigh | 5.5 | 6.5 | 8.5 | 8.5 | 9.5 |
| Right lower leg | 5.0 | 5.0 | 5.5 | 6.0 | 7.0 |
| Left lower leg | 5.0 | 5.0 | 5.5 | 6.0 | 7.0 |
| Right foot | 3.5 | 3.5 | 3.5 | 3.5 | 3.5 |
| Left foot | 3.5 | 3.5 | 3.5 | 3.5 | 3.5 |
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