Emergency Care Case

A 3-month-old girl is brought to the emergency department by ambulance for evaluation of hot water burns.

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A 3-month-old girl is brought to the emergency department by ambulance for evaluation of hot water burns. The child is sleepy but arousable. There are bright read burn marks from the umbilicus down with sparing of the buttocks and no splash marks above the umbilicus.

The most accurate method of estimating the total body surface area involved in a burn patient is:

A. The rule of 9s.

B. Palmar surface area.

C. Lund and Browder chart.

D. All of the above are equally accurate.

E.  None of the above.

The correct answer is “C.” The total body surface area (TBSA) involved can be estimated using the Wallace Rule of 9s (see Table 10–4); however, this is less accurate in young children. The surface area of a patient’s palm is approximately 1% TBSA and can be used to approximate small burns. The Lund and Browder chart is a more accurate method of estimation. This chart includes a diagram of the body with the measured area of the burn adjusted for age. (See Figure 10–6.) Only partial-thickness and full-thickness burns are included in the TBSA. Superficial burns are not included. Burns involving greater than 10% TBSA require fluid resuscitation, due to increased insensible losses and systemic inflammatory response. The Parkland formula is typically used to calculate additional fluid requirements. (See Table 10–5.)

Sources:

Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Chapter 116 Trauma, Burns, and Bites, Kline MW. Rudolph's Pediatrics, 23e; 2018

Leah Carton

Associate Editor - Pediatrics, Dermatology, Geriatrics , McGraw Hill