After identifying the mechanism of

After identifying the mechanism of injury and depth of burn injury, estimate the extent of burn injury. The extent of burn injury is expressed as a numerical value indicating a calculated percentage of TBSA injured by partial-thickness or full-thickness burns. Therefore, when calculating TBSA, exclude superficial burns. The TBSA is the basis for determining fluid resuscitation requirements.
The rule of nines, which divides the body into areas of 9% and provides a gross estimate of TBSA, is useful for adults, but not very accurate for children. You can use the patient’s palm to estimate TBSA when burns are small or patchy and are distributed over multiple surfaces. The patient’s palm defines approximately 1% of TBSA.
Consider using a Lund-Browder diagram because it takes into consideration the patient’s age (specific categories for birth to 1 year; 1to 4 years; 5 to 9 years; 10 to 14 years; 15 years; and associated body surface area.
Not all pediatric patients need I.V. fluid resuscitation. Some children with burns of less than 15% TBSA may be treated with oral rehydration and I.V. fluid supplementation.

All about escharotomy
Definition: An escharotomy is a surgical incision through burn eschar (necroticskin). This procedure is usually performed within the first 24 hours of burn injury. Burn eschar has an unyielding, leathery consistency and characterized by denatured proteins and coagulated vessels in the skin, which are the result of thermal, chemical, or electrical injury.
Purpose: When the burn eschar circumferentially surrounds any body structure (including digits, extremities abdomen, chest, or neck), the tissues within are subject to increasing interstitial pressures exacerbated by tissue edema that develops during the acute phase of burn resuscitation in the first 48 hours after injury. As interstitial pressure rises, venous outflow is initially impaired, followed by diminution of arterial inflow. This condition, often termed compartment syndrome, will cause dysfunction, ischemia, or necrosis within or distal to that body structure, often within hours In the limbs, nerve and muscle cellular death may occur causing permanent functional impairment or even the need for amputation. In the abdomen, impaired blood supply to the bowels, kidneys, and other internal organs results in the rapid intestinal ischemia, renal and hepatic failure, and restriction of diaphragmatic excursion .Compression of the chest by bum eschar worsene pulmonary compliance associated with smoke inhalation injury.
Suspicious burn injuries in children
These assessment findings suggest possible child abuse.
• any burn injury involving a child
• burns in a pattern
• history and physical findings inconsistent with the burn injury
• burn injuries incompatible with child’s developmental level
• burns to buttocks, perineum, or genitals
• excessive delay in seeking treatment
• burns involving immersion into hot tap water
• multiple old and new burns in different stages of healing
• presence of splash marks, areas of skin that weren’t burned, and burns that are symmetrical in a stocking or glove distribution
• burns involving the bottom of the feet
• presence of other nonburn injuries.