Emergency Care of the Burn Patient

Extent of Injury

An easy way to determine the extent of a burn injury is by using a tool called the rule of nines. You simply divide the body up into sections which equal nine. For instance each arm is nine percent, each leg is two nines which equals eighteen. There are two limitations to this tool. One is that this is not how people get burned. For example, a typical burn injury may involve a hand, part of the lower arm, a spot on the abdomen and 25% of the back. One good rule to remember is that the area of the palm of the patient's hand is equal to one percent. But remember it's the patient's hand not your hand. The other limitation with the rule of nines is that it is not the same for children.

Kids have relatively big heads and relatively small legs compared to adults. Therefore when a little kid pulls cups of hot coffee onto themselves (a very typical cause of injury) they may have a much more severe injury than an adult with a similar type of injury. Therefore, the infant will require more treatment as a result.

The Land and Browder chart is another tool that has been in use for a long time. This tool divides the body up into much smaller areas and also gives you the sizes that are associated with different aged patients. When we first see a burn victim, we completely debride all of the burn tissue, then we draw the burned areas on the diagram. We use blue for second degree and red for third degree burns. Then you add up all of the areas and the total gives an accurate size of burn injury. The two points two remember when you are estimating the size of the injury are:

1. Debride all of the blisters first before you estimate the size, and
2. First degree burns do not count.

As you can see by this chart the survival of a particular patient relies heavily on the size of the burn. These are statistics from our own burn center but they are very similar to statistics published nationally. As you can see, for groups two and three, which are young adults, survival can be very good even with very large burns. Even a patient with a 70% burn has a 50% chance of survival. For very young people and very old people those figures are considerably different. The survival rates of the very old or very young person with a much smaller burn, are very poor. Therefore the age of the patient is also very important when determining the severity of the injury.

Patients with serious burn injuries should be referred to a burn center according to the Referral Criteria established by the American Burn Association.

Now you know everything you need to know about the depth of burn injuries, the extent of burn injuries and when you should consider referring a burn patient to a burn center. Now we need to talk about the actual treatment of the burn patient.

*DISCLAIMER This site is designed as an introduction to thermal injury for emergency medical technicians, medical students and physicians in training. It is not a comprehensive guide to thermal injury. As such the information may not be sufficient to address specific patient problems and these should be handled by physicians familiar with the specific clinical details pertinent to the individual patient. We invite comments from all users of this site.