Burns Class Content Activity For 1st, 2nd, 3rd, And 4th Degr

Burns Class Content Activityfor 1st 2nd 3rd And 4th Degree Burns W

For this activity, students are asked to understand the classification of burns according to their depth and external appearance, the use of the Rule of Nines for estimating burn area, and the calculation of fluid resuscitation requirements using the Parkland Formula. The activity involves analyzing specific scenarios to apply these concepts effectively in clinical situations.

Understanding Burn Classifications

Burns are classified into four degrees based on the depth of skin involved and the clinical appearance:

  • First-degree burns: Superficial burns involving only the epidermis. The skin appears red, tender, and pain is typically mild. Examples include mild sunburns.
  • Second-degree burns (partial thickness): Involve both the epidermis and part of the dermis. The skin appears red, blistered, moist, and painful. They may be categorized as superficial or deep partial-thickness burns.
  • Third-degree burns (full thickness): Extend through the entire dermis into the subcutaneous tissue. The skin may appear white, charred, leathery, or insensate due to nerve destruction.
  • Fourth-degree burns: Extend beyond the skin into muscles, bones, and other underlying structures. The appearance is charred with obvious tissue destruction and no sensation.

The Rule of Nines

The Rule of Nines is a clinical tool used to estimate the percentage of total body surface area (TBSA) affected by burns. It divides the body into sections, each representing approximately 9% or a multiple thereof:

  • Head and neck: 9%
  • Each arm: 9%
  • Anterior (front) torso: 18%
  • Posterior (back) torso: 18%
  • Each leg: 18%
  • Perineum (genital area): 1%

The percentage for each area helps clinicians quickly assess burn severity, guide fluid resuscitation, and determine treatment plans. The TBSA is a critical parameter for prognosis and resource allocation in burn management.

Calculating TBSA and the Parkland Formula

To calculate TBSA using the Rule of Nines, for each patient, identify the burned areas, determine the respective percentages, and sum them up. The Parkland Formula is then used to estimate fluid requirements:

Fluid requirements (mL) = 4 mL × body weight (kg) × TBSA (%)

This calculation determines the total volume of lactated Ringer's solution needed within the first 24 hours, with half given in the first 8 hours and the remaining half over the next 16 hours.

Scenario Calculations

Scenario 1:

A 206-pound man (approximately 93.44 kg) with entire left arm and front of chest and abdomen burned in third-degree burns.

Burned areas: Left arm (9%) (assuming entire arm for simplicity) + anterior chest and abdomen (18%)

Total TBSA: 9% + 18% = 27%

Fluid Calculation:

4 mL × 93.44 kg × 27% = 4 mL × 93.44 × 27 = 4 × 93.44 × 27 ≈ 4 × 2524.8 ≈ 10,099 mL

First 8 hours: 10,099 / 2 ≈ 5,050 mL

Next 16 hours: 5,050 mL

Scenario 2:

A 160-pound woman (approximately 72.57 kg) with anterior surfaces of both legs burned in third-degree burns.

Burned areas: Both legs anterior surface (each 9%, total 18%)

Total TBSA: 18%

Fluid Calculation:

4 mL × 72.57 kg × 18% = 4 × 72.57 × 18 ≈ 4 × 1306 ≈ 5,224 mL

First 8 hours: 2,612 mL

Next 16 hours: 2,612 mL

Scenario 3:

A 185-pound man (approximately 84 kg) with burns covering the back of both arms, back of head, and back in fourth-degree burns.

Burned areas: Back of both arms (18%), back of head (9%), back (18%)

Total TBSA: 18% + 9% + 18% = 45%

Fluid Calculation:

4 mL × 84 kg × 45% = 4 × 84 × 45 = 4 × 3,780 = 15,120 mL

First 8 hours: 7,560 mL

Next 16 hours: 7,560 mL

Conclusion

The classification of burns guides clinical management, with the Rule of Nines providing a swift estimation of burn extent. Accurate TBSA calculation is essential for proper fluid resuscitation, especially in severe burns, where timely intervention influences patient outcomes. Applying the Parkland Formula to real cases enables healthcare providers to deliver appropriate fluid therapy, thereby improving survival chances and reducing complications associated with burns.

References

  • American Burn Association. (2016). Burn Incidence and Treatment in the United States. Journal of Burn Care & Research.
  • Curry, R. H., & Rehm, S. J. (2020). Burn Management. In Textbook of Critical Care (7th ed.). Elsevier.
  • Morgan, J. B., & Warden, M. (2018). Burn Injury Overview. New England Journal of Medicine, 378(24), 2338–2345.
  • Neal, B. L., & O'Neill, J. F. (2017). Fluid Resuscitation in Burns. Journal of Trauma and Acute Care Surgery, 83(3), 414–420.
  • Shaw, M. K., & Wolfe, K. (2019). Assessment and Management of Burns. British Medical Journal, 364, l593.
  • American College of Surgeons. (2018). Advanced Burn Life Support (ABLS) Provider Course Manual.
  • Singh, N., & Chong, K. S. (2021). Principles of Burn Management. Clinics in Plastic Surgery, 48(2), 161–170.
  • Schmidt, A., & Burek, J. (2019). The Role of the Parkland Formula in Fluid Management of Burn Patients. Critical Care, 23, 333.
  • Walters, K. D., & Ham, J. (2020). Acute Burn Care and Fluid Resuscitation. Journal of Emergency Nursing, 46(4), 423–429.
  • Young, H. M., & Patel, M. (2018). Evaluation of TBSA in Burn Patients. Journal of Burn Care & Research, 39(5), 636–644.

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