Discuss the routine clinical assessment of a burns patient and specific clinical assessment
of a pediatric patient presenting with a burn. This answer should include Total Body
surface area (TBSA) assessment, location of burn and depth of a burn.
- Review the literature on complications in burns (localized infection) and discuss possible
treatment options, include in your answer a rationale as to why you have chosen this as a
treatment option.
Burns Case Study
Clinical assessment of a burnt adult patient differs from that of a pediatric patient
presenting with a burn. In both cases, however, the clinician must remember to gather
information related to Total Body Surface Area (TBSA), location, and depth of a burn
(Henderson, 2015). The “Rule of Nines” is normally applied during clinical assessment of an
adult patient who presents with a burn. This rule allows for division of the human body into
regions that represent either 9 percent or multiples of 9 percent, of the total surface of the body.
In this regard, 9 percent is used for each of the upper limbs and the head, while 18 percent is
used for the trunk, back, the front of the trunk, and each of the lower limbs. The surface of the
patient’s palm, which is considered to represent about 1 percent of the body surface, it used
during the assessment to establish the total body surface area that is covered by burns. Some
features are used to assess the depth of burns. When the color of the burnt surface is used,
epidermal burns are red are glistening, superficial dermal burns are pale pink, deep dermal burns
BURNS CASE STUDY 2
are blistering, and cherry red and full-thickness burns are either white or black (Henderson,
2015).
Instead of using the ‘Rule of Nines,’ the clinician should use the Lund and Browder chart
to assess the total body surface area (TBSA) when assessing a pediatric patient presenting with a
burn (The Royal Children’s Hospital Melbourne, 2017). The chart can be used to assess burns in
children of different ages. In the case of children who are aged one year and below, the total
body surface area is usually 18 percent for the head and 14 percent for the leg. For children aged
above one year, the clinician should subtract 1 percent from the head and add 0.5 percent to leg,
for every additional year up to the time when the adult level will be reached. For instance, for a
child who is two years old, the total body surface area for the head should be 17 percent while
that of the leg should be 13.5 percent. The depth of burns in children is assessed differently from
that of adults. For instance, superficial burns are erythema and painful, superficial dermal burns
are reddened and painful, deep dermal burns are moist, white and painless, while full-thickness
burns are charred, whitish and painless (The Royal Children’s Hospital Melbourne, 2017; &
Women’s & Children’s Hospital, 2010).
An example of complications in burns is bacterial chondritis. Bacterial chondritis is a
localized infection of the ear, which may occur following a deep dermal burn (Sarabahi, 2013).
There are two possible treatments of bacterial chondritis of the ear: nonsurgical treatment and
surgical treatment. Non-surgical treatment involves the use of topical antibiotics while coupled
with epithelialization. The rationale of this treatment option is that it helps to prevent further
infection by the bacteria (Sarabahi, 2013). Bacterial chondritis may also be treated through
surgical means. The rationale behind the surgical treatment is that it facilitates removal of the
affected areas, thereby preventing the infection from spreading to other tissues. To achieve the
BURNS CASE STUDY 3
best results in both cases, the clinician must put some recommendations into consideration. For
instance, the initial assessment must be timely, comprehensive, and accurate; the affected area
must be cleaned thoroughly; and hair around the affected area must be shaved before treatment
(Sarabahi, 2013).
Reference List
Henderson, R. (2015). Burns: Assessment and management.
Sarabahi, S. (2013). Management of hear burns. Indian Journal of Burns, 20(1): 11-17.
The Royal Children’s Hospital Melbourne. (2017). Burns/Management of burn wounds.
Women’s & Children’s Hospital. (2010). Guidelines for the management of pediatric burns.