When you’re assessing burn wounds, there are two key principles that you need to consider.
- What is the depth/ severity of the burn wound? and
- What is the extent of the burn wound?
Depth of burns
1st degree
First degree burns ONLY involve injury to the epidermis. They are red, hyperemic and uncomfortable (if you’ve had a sunburn, you know this). Most importantly, first degree burn does NOT count in any calculations of extent of burn injury.
Superficial partial thickness/ Superficial 2nd degree
Superficial partial-thickness burns involve the epidermis and the papillary (superficial) dermis. These are burns that blister and that when debrided are moist, pink, and blanch with pressure. They are often quite painful and can have hyperesthesia.
Deep partial thickness / Deep 2nd degree
Deep partial-thickness burns involve the epidermis, papillary dermis, and various depths of reticular dermis. They typically have a pink-white and somewhat dry appearance, although dermal elements (including hair follicles) will still be visible in the base of the wound. They are relatively less painful than superficial partial thickness burns, and also take longer to heal.
Full thickness burns/ 3rd Degree
Full thickness burns extend into the subcutaneous tissues and will not heal spontaneously without wound contraction. They are often dry and leathery in appearance, and they may look charred with thrombosed vessels in the wound base. These typically result in little or no pain, at least in the area of the wound, and they have a high potential for infection.
Extent of burn injury
Calculating burn size is best done after debridement of the detached epidermis; it’s incredibly easy to be misled into thinking a burn is first degree that isn’t, or into thinking that a burn may be more extensive than it is. And remember when you’re calculating burn size that first degree burns don’t go into your calculations.
Quick and dirty estimate
If a patient has multiple areas with relatively limited burns or has just a small burn, the patient’s palm (including fingers) can be used to help estimate. Palm + fingers is approximately 1% TBSA
Semi-formal estimate
Using the “rule of 9s” to estimate burn size can be helpful for more extensive and contiguous burned areas. Remember to reduce your estimate if it’s not a whole arm, leg, etc.
Formal estimation
Lund & Browder diagrams are used for formal calculation of burn size and have a very granular breakdown of various parts of the body. A Lund calculation should be done on EVERY admission to the Buckeye Burn Service within the first 24 hours!
