ICU · Resuscitation

Severe burns management

Also known as Burn resuscitation · Parkland formula · Inhalation injury · Total body surface area (TBSA) · Lund and Browder chart · Burn depth classification · Superficial dermal burn · Deep dermal burn · Full thickness burn · Escharotomy · Burn centre transfer criteria · Revised Baux score · Fluid creep · Carbon monoxide poisoning in burns · Cyanide toxicity in burns

Severe burns (≥20% TBSA in adults, 10% in children) require ICU admission for fluid resuscitation, airway management, and wound care. Burn depth is classified by tissue layer: superficial epidermal (erythema, not counted in TBSA), superficial dermal (painful, blistering, blanching), deep dermal (pale, sluggish capillary refill, may need grafting), and full thickness (dry, leathery, painless, requires excision and grafting). Adult TBSA is estimated by the Rule of Nines (head 9, each arm 9, each leg 18, trunk 18 front and 18 back, groin 1); in children the Rule of Nines is inaccurate and Lund-Browder or the child's palm (1% TBSA) is used. Fluid resuscitation uses the Parkland formula (4 mL x kg x %TBSA lactated Ringer's in first 24h, half over the first 8 hours of resuscitation from time of injury), titrated to urine output (0.5–1 mL/kg/h adult, 1.0 mL/kg/h child). Inhalation injury: suspect in enclosed space fires, facial burns, stridor, carbonaceous sputum — early intubation. Monitor for carbon monoxide and cyanide toxicity (house fires). Escharotomy for circumferential burns compromising circulation/ventilation. After the initial resuscitation, the most common cause of death is sepsis and multiple organ dysfunction. Nutrition: continuous high-carbohydrate, high-protein enteral feeding.

Checked against its sources on 3 Sept 2026