## Assessment of Burn Severity and Resuscitation Priority **Key Point:** This patient has a deep partial-thickness (2nd degree) burn affecting approximately 36% TBSA (face 4.5%, neck 1%, anterior chest 9%, both upper limbs 4.5% × 2 = 9%, plus anterior forearms and hands 4.5% × 2 = 9%). Burns >15% TBSA in adults require formal fluid resuscitation. ### Burn Depth Classification | Depth | Appearance | Pain | Healing | Management | |-------|-----------|------|---------|-------------| | 1st degree (superficial) | Erythema only | Painful | Spontaneous (3–7 days) | Topical care | | 2nd degree (partial-thickness) | Blistering, moist, red | Extremely painful | Spontaneous (2–3 weeks) | Fluid resuscitation + wound care | | 3rd degree (full-thickness) | Charred, leathery, white | Painless | Requires grafting | Fluid resuscitation + surgical management | | 4th degree | Charred muscle/bone | Painless | Requires amputation | Fluid resuscitation + surgical management | **High-Yield:** The Parkland formula is the gold standard for initial fluid resuscitation in burns >15% TBSA: $$\text{Fluid (mL)} = 4 \times \text{TBSA (\%)} \times \text{Body weight (kg)}$$ Give half over the first 8 hours, half over the next 16 hours, starting from the time of injury (not arrival). ### Immediate Management Algorithm ```mermaid flowchart TD A[Burn injury >15% TBSA]:::outcome --> B{Airway patent?}:::decision B -->|No| C[Secure airway/intubate]:::action B -->|Yes| D[Initiate IV fluid resuscitation]:::action D --> E[Parkland formula: 4 mL × TBSA × weight]:::action E --> F[Insert urinary catheter]:::action F --> G[Monitor urine output]:::action G --> H{Urine output adequate?}:::decision H -->|Yes| I[Continue resuscitation]:::action H -->|No| J[Increase fluid rate]:::action A --> K[Assess for inhalation injury]:::action A --> L[Tetanus prophylaxis]:::action A --> M[Refer to burn centre]:::action ``` **Clinical Pearl:** The goal of fluid resuscitation is to maintain urine output of 0.5 mL/kg/hr in adults and 1 mL/kg/hr in children. Fluid rate should be titrated based on urine output, not by fixed schedule. **Warning:** Over-resuscitation causes "fluid creep" (excessive edema, compartment syndrome, acute kidney injury). Under-resuscitation leads to hypovolemic shock and organ failure. Titration to urine output is essential. **Mnemonic:** **ABCDE of burn management** — **A**irway (secure if needed), **B**reathing (assess for inhalation injury), **C**irculation (IV access, fluid resuscitation), **D**isability (neurological status), **E**xposure (remove clothing, prevent hypothermia). ## Why This Step First? In the first 24–48 hours post-burn, the priority is **systemic resuscitation**, not local wound care. The patient is at risk of hypovolemic shock due to massive fluid loss from the burned surface. Establishing IV access and initiating Parkland resuscitation takes absolute priority. Topical antibiotics and escharotomy are important but secondary interventions. 
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.