Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Introduction to burns
- How are burns classified?
- What is the significance of the amount of body area burned?
- How important is the location of a burn?
- What about electrical burns?
- What about chemical burns?
- First aid for burns
What is the significance of the amount of body area burned?
In addition to the depth of the burn, the total area of the burn is significant. Burns are measured as a percentage of total body area affected. The "rule of nines" is often used, though this measurement is adjusted for infants and children. This calculation is based upon the fact that the surface area of the following parts of an adult body each correspond to approximately 9% of total (and the total body area of 100% is achieved):
- Head = 9%
- Chest (front) = 9%
- Abdomen (front) = 9%
- Upper/mid/low back and buttocks = 18%
- Each arm = 9%
- Each palm = 1%
- Groin = 1%
- Each leg = 18% total (front = 9%, back = 9%)
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
Only second and third degree burn areas are added together to measure total body burn area. While first degree burns are painful, the skin integrity is intact and it is able to do its job with fluid and temperature maintenance.
If more than15%-20% of the body is involved in a burn, significant fluid may be lost. Shock may occur if inadequate fluid is not provided intravenously. The Parkland formula (named for the trauma hospital in Dallas) estimates the amount of fluid required in the first few hours of care following a burn:
- 4cc/ kg of weight/% burn = initial fluid requirement in the first 24 hours,
with half given in the first 8 hours.
- As an example: A 175lb (or 80kg) patient with 25% burn will need 4cc x 80kg x 25%, or 8000cc of fluid in the first 24 hours, or more than 7 pounds of fluid.
As the percentage of burn surface area increases, the risk of death increases as well. Patients with burns involving less than 20% of their body should do well, but those with burns involving greater than 50% have a significant mortality risk, depending upon a variety of factors, including underlying medical conditions and age.
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