الحروق
Rule of nines, Parkland formula, burn depth and priorities.
الطوارئ والرعاية الحرجة
Rule of nines (adult)
| Area | % of body surface |
|---|---|
| Head and neck | 9% |
| Each arm | 9% (front 4.5, back 4.5) |
| Front of trunk | 18% |
| Back of trunk | 18% |
| Each leg | 18% (front 9, back 9) |
| Perineum | 1% |
Children have larger heads: head about 18% and each leg about 14%. The patient's palm ≈ 1% for scattered burns.
Parkland formula
- 4 mL × weight (kg) × % TBSA of lactated Ringer's in the first 24 h.
- Give half in the first 8 hours from the time of the burn, and the other half over the next 16 hours.
- Example: 48 kg, whole left arm (9%) → 4 × 48 × 9 = 1,728 mL.
- Titrate to urine output: 0.5 mL/kg/h in adults (about 30–50 mL/h), 1 mL/kg/h in children.
Depth
| Depth | Appearance | Pain |
|---|---|---|
| Superficial (1st degree) | Red, dry, no blisters (sunburn) | Painful |
| Superficial partial thickness | Red, moist, blisters, blanches | Very painful |
| Deep partial thickness | Mottled red and white, less moist | Less painful |
| Full thickness (3rd degree) | White, leathery, brown or charred | Painless (nerve endings destroyed) |
Priorities
- Airway first: facial or neck burns, singed nasal hair, soot and hoarseness suggest inhalation injury — prepare for early intubation.
- Early labs: raised hematocrit (hemoconcentration), hyperkalemia and hyponatremia.
- Infection prevention (hand hygiene), pain relief, and high-protein, high-calorie nutrition.
- First aid: stop the burning, cool running water for about 20 minutes, remove jewelry, cover with a clean dry dressing.
اختبر نفسك الآن
35 سؤالاً بنمط الاختبار في الطوارئ والرعاية الحرجة، مع شرح لكل خيار. حساب مجاني بدون بطاقة.
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