Burn Wounds

Authors: Michelle Lin, MD, Christian Rose, MD
Updated: 7/2/2010

Burn Wounds

American Burn Association Classification (2009)

Superficial: EPIDERMIS depth only; painful

Partial-Thickness: Involves dermis

  • Superficial
    • Moist, blistering; skin blanches, very painful
    • Heals within 3 weeks
  • Deep
    • Looks between superficial partial-thickness and 3rd degree burn
    • May need skin graft
    • Heals in >3 weeks


  • Dark brown, charred, skin does not blanch
  • Site insensate because burned nerve fibers
  • Needs skin graft

Epidermis, dermis, and subcutaneous layers of skin

Total body surface area (TBSA)

  • Rule of 9’s
  • Patient’s palm and fingers = 1% TBSA
  • In calculating TBSA % burn, do not include 1st degree burns

Body surface area chart for an adult and child

Burn unit referral

  • Partial thickness >10% TBSA
  • Burns of face, hands, feet, genitalia, perineum, major joints
  • Full thickness burn
  • Electrical or chemical burn
  • Inhalational injury
  • Patient with co-morbidities
  • Special considerations: Social, emotional, or long-term rehab intervention

Fluid resuscitation = 4 cc/kg/% TBSA of Lactated Ringers over 24 hrs with half given in first 8 hrs

  • Titrate to urine output
Age Target urine output
Adults 30-50 cc/hr
Age > 2 yr 0.5-1 cc/kg/hr
Age < 2 yr 1-2 cc/kg/hr
  • Start if >20% TBSA involvement

Burn Management

Minor burns

  • Tetanus update
  • Pain medications
  • Debride dead skin, +/- unroof blisters >2 cm diameter
  • Apply topical antimicrobial/dressing
  • 24 hr follow-up

Large burns

  • Apply topical antimicrobial agent such as bacitracin, neomycin, mupirocin, or honey. Membrane-based dressings can be used alternatively.

Practice Change: Silver sulfadiazine has fallen out favor for burn prophylaxis in partial-thickness burns. May slow wound healing, increases frequency of dressing changes, and more painful

What is high voltage injury? >1000 volts


  • Gomez R et. al. Management of burn wounds in the emergency department.Emerg Med Clin North Am. 2007 Feb;25(1):135-46. [PubMed]
  • Int Wound J. 2010 [PubMed]
  • Cochrane Database Syst Rev 2015 [PubMed]