Secondary Survey

As well as being burnt, children may suffer the effects of blast, may be injured by falling objects, and may fall while trying to escape from the fire. Thus other injuries are not uncommon and a thorough head-to-toe secondary survey should be carried out. This is described in Chapter 15. Any injuries discovered, including the burn, should be treated in order of priority.

Assessing the burn

The severity of a burn depends on its relative surface area and depth. Burns to particular areas may require special care.

Surface area

The surface area is usually estimated using burns charts. It is particularly important to use a paediatric chart when assessing burn size in children, because the relative surface areas of the head and limbs change with age. This variation is illustrated in Figure 20.1 and its accompanying table.

Another useful method of estimating relative surface area relies on the fact that the patient's palm and adducted fingers cover an area of approximately 1% of the body surface. This method can be used when charts are not immediately available, and is obviously already related to the child's size. Note that the "rule of nines" cannot be applied to a child who is less than 14 years old.


Burns are classified as being superficial, partial thickness, or full thickness. The first causes injury only to the epidermis and clinically the skin appears red with no blister formation. Partial-thickness burns cause some damage to the dermis; blistering is usually seen and the skin is pink or mottled. Deeper (full-thickness) burns damage both the epidermis and dermis, and may cause injury to deeper structures as well. The skin looks white or charred, and is painless and leathery to touch.

Special areas

Burns to the face and mouth have already been dealt with above. Burns involving the hand can cause severe functional loss if scarring occurs. Perineal burns are prone to infection and present particularly difficult management problems.

Figure 20.1. Body surface area (percent). (Reproduced courtesy of Smith & Nephew

Pharmaceuticals Ltd)

Figure 20.1. Body surface area (percent). (Reproduced courtesy of Smith & Nephew

Pharmaceuticals Ltd)

Surface area at

Area indicated


1 year

5 years

10 years

15 years



















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