Patients who suffer burns are at risk for shock because they lose so much fluid volume. In order to calculate fluid resuscitation requirements for patients with burns, we need to know the percentage of body surface area burned. In children and adolescents, body proportions are different than in adults. Instead of using the Rule of 9’s, we use what’s called the Lund Browder Chart. You’ll notice some areas have set percentages, like the front of the chest is 13%, as is the back, the front of the upper arms are 2%, and the back of the upper arms are also 2%. Remember you’re looking at just the front and just the back of the child. Areas that aren’t set percentages are lettered A, B, and C. At the bottom you’ll see the percentages assigned to that letter based on the age of the child. It covers birth, 1, 5, 10, and 15 year olds, but we can make inferences about the ages in between. Ultimately we are estimating Burn Surface Area as closely as possible. We use that to initiate fluid resuscitation and then titrate based on appropriate urine output. Let’s look at one example. (color in the front right arm and half of the right chest, plus the front upper thigh of the adolescent). The right arm is 2 + 1.5 + 1.25, half of the front of the chest is 6.5, and the front upper thigh would be B on the chart. If this is a 10 year old child, that would be 4.5 percent. So 2 + 1.5 + 1.25 + 6.5 + 4.5 = 15.75%. Using the Lund Browder chart gets you the most accurate estimate of body surface area for children and adolescents, keep practicing to get comfortable with it!
Date Published - Aug 2, 2018
Date Modified - May 22, 2018