Fig. 1
Estimating percent total body surface area in children affected by burns. (a) Rule of “nines” for the rapid estimation of total body surface area burned. In infants, relative surface area of the head is larger, and the lower extremities are smaller. (b) Lund-Browder diagram for more precise estimation of burn total body surface area (From U.S. Department of Health and Human Services. Downloaded from http://www.remm.nlm.gov;burns.htm. On 7 Dec 2013)
6.
Burn resuscitation formulas:
(a)
Parkland: four mL × kg × % TBSA burn.
(i)
Give one half of this volume over the first eight h.
(ii)
Give the second half of this volume over the following 16 h.
(iii)
Lactated Ringer’s is the solution of choice.
(iv)
For children <30 kg, give an additional volume of maintenance fluid each hour containing glucose to avoid hypoglycemia.
(b)
Brooke: two mL × kg × % TBSA burn, half given in the first eight h, half given in the following 16 h.
(c)
Initiation time for fluids is set at the time of injury (if starting fluids two h after injury, run the first half of fluid over six h.)
(d)
These formulas provide only estimation, and fluid resuscitation must be continually titrated to individual needs.
(e)
Titrate to ensure urine output of one mL/kg/h.
7.
Laboratory examination:
(a)
CBC.
(b)
Type and cross match 10 cc/kg packed cells.
(c)
Serum glucose.
(d)
Electrolytes.
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