Burn: Assessment and Management
Burns compromise all the functions of the Skin, which explains the systemic consequences.
1. Classification
| Level | Layer | Appearance | Sensation | Healing |
| –— + -----------–— + ----------------–— + -------------–— + ------------------- | ||||
| 1st | Epidermal | Red, dry | Painful | 3-7 days |
| 2a | Papillary dermis | Blisters, pink, wet | Painful | 7-21 days |
| 2b | Reticular dermis | Mottled white | Dull pressure only | 3-8 weeks |
| 3rd | Subcutaneous | Leathery, black/brown | No sensation | Needs graft |
| 4th | Muscle/bone | Charred, black | No sensation | May need amputation |
2. Pathophysiology
• Immediate: direct tissue destruction • Early (0-24h): capillary leak → fluid loss → hypovolaemia • Systemic: SIRS → organ dysfunction • Late: loss of barrier → infection → sepsis
3. Critical areas to consider
• Face — airway compromise, eyes, cosmetic concerns • Hands/feet — functional importance • Perineum — high infection risk • Circumferential burns — eschar constriction → compartment syndrome These are all criteria for referral to a burns centre.
4. Assessment
As per EMST principles.
A, B, C, D
Rule of 9s: • Head: 9% • Each arm: 9% (total 18%) • Each leg: 18% (total 36%) • Anterior trunk: 18% • Posterior trunk: 18% • Perineum: 1% Your palm (including fingers) = ~1% TBSA — useful for small/patchy burns.