Tiền sử bệnh
A brief, accurate history must be obtained from the guardian upon presentation of the patient. Determine the time of injury, causative agent, and type of burn; any first aid measures done; the patient’s associated medical problems; and vaccination status.
Khám thực thể
Burns - Initial Management_Initial Assesment
Assess the degree, site, and extent (size and depth) of the burn.
Lund and Browder Classification
The relative percentage of body surface area (BSA) is affected by growth.
| Body Part | 0 years | 1 year | 5 years | 10 years | ≥15 years |
| A = one-half of head | 9.5% | 8.5% | 6.5% | 5.5% | 4.5% |
| B = one-half of one thigh | 2.75% | 3.25% | 4% | 4.5% | 4.5% |
| C = one-half of one lower leg | 2.5% | 2.5% | 2.75% | 3% | 3.25% |
This is the most reliable method for estimating total BSA (TBSA) in both adults and children. This classification is widely regarded as the gold standard due to its strong validity and its usefulness for consistent comparison throughout treatment and is applied across all age groups, as it accounts for changes in TBSA proportions as a person grows.
Screening
Alarm Signs
The following are alarm signs and necessitate admission:
- Burns >10-15% of the total BSA
- Burns associated with smoke inhalation
- Burns involving hands, feet, face, perineum and joint surfaces
- Burns resulting from high-tension electrical injuries
- Circumferential full-thickness burns
Indications for Referral to a Burn Unit
Burn patients who require referral to a burn unit include those at the extremes of age (<5 or >60 years) or those with burns involving the face, hands, perineum, feet (with dermal or full-thickness loss), flexural regions (particularly the neck or axilla), and circumferential dermal or full-thickness burns of the limbs, torso, or neck. Patients with inhalational injuries, including carbon monoxide (CO) poisoning, and those with burns caused by mechanisms such as chemical injuries involving >5% of the total body surface area (TBSA), exposure to ionizing radiation, high-pressure steam injury, high-tension electrical injuries, hydrofluoric acid burns affecting >1% TBSA, lightning injuries, or suspected non-accidental trauma should likewise be admitted.
Partial-thickness burns involving 10% TBSA and large dermal or full-thickness burns >5% TBSA in children <16 years old or >10% TBSA in individuals >16 years old require inpatient management. Admission is also indicated for patients with serious coexisting medical conditions associated with them or those requiring social, emotional, or rehabilitation intervention. Patients with burns, with or without trauma, who are at high risk for morbidity and mortality, and those with worsening wounds within the past 72 hours with evidence of scarring and the presence of any degree of contracture should also be referred to the burn unit. All patients with significant burn injuries should be referred to surgery for proper wound debridement.
American Burn Association Burn Center Transfer Criteria
- Partial-thickness thermal burns ≥10% TBSA
- Full thickness thermal burns
- Any deep partial or full thickness thermal burns involving the face, hands, genitalia, feet, perineum or over any joints
- All pediatric patients ≤14 years old or <30kg
- High-voltage electrical burns (≥1,000 volts) and lightning injury
- Chemical burns
- Inhalation injury
- Burn injury in patients with pre-existing medical conditions
- Any patients with concomitant trauma (eg fractures)
- Burn injury in patients who require special social/emotional and/or long-term rehabilitative support, including suspected child abuse or substance abuse
- Poorly controlled pain
European Burns Association Burn Centre Transfer Criteria
- Superficial dermal burns on more than:
- 5% BSA in children <2 years old
- 10% BSA in children 3-10 years old
- 15% BSA in children 10-15 years old
- 20% BSA in adults of age
- 10% BSA in seniors >65 years old
- Patients needing burn shock resuscitation
- Patients with burns on the face, hands, genitalia or major joints
- Deep partial-thickness burns and full-thickness burns in any age group and extent
- Circumferential burns in any age group
- Burns of any size with concomitant trauma
- Burns with suspicion of inhalation injury
- Major electrical burns
- Major chemical burns
- Diseases associated to burns such as toxic epidermal necrolysis, necrotizing fasciitis, staphylococcal scalded child syndrome if the involved area is 10% in children and 15% for adults
- Burn patients needing special social, emotional or long-term rehabilitation