I. Burn area and depth
Burn area and depth are the main factors in estimating the severity of burns and are also an important basis for treatment.
1.The estimation of burn area
(1) Chinese new nine-point method
The human body parts as 11 9%, the head, face and neck for the body surface area of 9%; double upper limbs for 18%; trunk (including perineum 1%) for 27%; double lower limbs (including buttocks) for 46% (5 9% + 1%) 11 × 9% + 1% = 100%
Children with larger heads and smaller lower limbs should be combined with age calculations: head = 9 + (12 – age); lower limbs = 46 – (12 – age)
(2) Palm method
Regardless of age or gender differences, the five fingers of the patient’s palm are placed together and the area of a single palm is 1% of the body surface area.
2.The identification of burn depth
According to the international customary three degrees and four divisions, that is, I degree, shallow II degree, deep II degree, III degree. The clinical characteristics of the three degrees and four divisions.
(1) I degree burns (erythematous burns)
The local area is dry, painful, slightly swollen and red, without blisters. 3-5 days later, the local area turns from red to light brown, and the epidermis wrinkles and peels off to reveal the red and smooth epithelial surface and heals.
(2) Shallow second-degree burns (blistering burns)
Local redness and swelling are obvious, with large, full blisters forming, containing yellowish plasma-like fluid or protein-consolidated jelly. The wound base is flushed, soft in texture, high in temperature, severe in pain and sensory allergy. 7 – 14 days to heal. No scarring after healing, but there is pigmentation.
(3) Deep II degree burns
Local swelling, small, flat and thin blisters, slightly wet wound base, red and white, tough texture, sluggish sensation, low temperature, slightly painful hair pulling. 3-4 weeks barely heal, scarring after healing, basic preservation of skin function. (4) Third-degree burns (scorched burns)
The cause of injury is different, local performance can be pale, yellow-brown, scorched yellow, serious charring, skin loss of elasticity, hard as leather when touched, the wound surface is dry, no exudate, cool, loss of sensation, hair plucking is not painful, visible embolism of the vascular network. Surgical implantation is required.
Second, the severity of burns graded
(1) Mild burns: Ⅱ° burns with a total area of 9% or less;
(2) moderate burns: 10%-29% of the total area or less than 10% of the Ⅲ° burns;
(3) severe burns: burns with 30% to 49% of the total area or Ⅲ° with 10% to 19% of the total area; or Ⅱ°, Ⅲ°
burns with an area of less than the above percentages, but with one of the following conditions.
(4) combined shock; with compound injuries (severe trauma, impact injuries, chemical poisoning, etc.); moderate or severe inhalation injuries.
(5) extra-severe burns: total area of more than 50% or Ⅲ° area of more than 20% burns.
(6) Children’s burn severity classification is reduced by half according to adult standards.