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The Pediatric Burn Patient: A Simplified Approach

It is crucial to determine the percentage of total body surface area (%TBSA) of second and third degree burns to plan appropriate fluid resuscitation. Several techniques can assist in this estimation, including the hand technique (1%TBSA per patient palm size), Lund Browder chart, or the free online tool found at www.SageDiagram.com. In any pediatric patient with >10% TBSA, the classic teaching includes using the Parkland formula. This involves administration of 4 mL/kg x %TBSA burned, with 50% given in the first eight hours from the time of injury, and the second half given over the next 16 hours. The %TBSA is frequently overestimated outside of certified burn centers

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“If a child is burned, the first course of treatment should be 20 minutes of cool running water,” said Bronwyn R. Griffin, PhD, honorary senior fellow at the University of Queensland Child Health Research Centre and study co-author. “Cool running water is most effective immediately after a burn occurs, but evidence suggests it remains beneficial for up to three hours following an injury.”

Fire-related Injuries in Children

Palm Rule is a simple rule for burn size estimation in both children and adults with small surface area burns. The extent of the burn can be measured using the size of the patient’s entire hand (palm plus fingers) as 1% and adding up the burned areas.

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Parkland: Weight (kg) x %TBSA burned x 4ml = 24 hr total volume of Ringer’s Lactate. First ½ over the first 8 hours SINCE THE TIME OF THE BURN (not the arrival in the ED).

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In adolescents and adults, the modified Brook formula is employed: 3mL/kg/%TBSA.

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