# Burns Emergency Care > Emergency and Critical Care Technology notes on burns: rule of nines, Parkland formula, airway burns, escharotomy triggers and Indian referral criteria. - Canonical URL: https://prepelephant.com/topics/allied/emergency-and-critical-care-technology/burns-emergency-care-ecct - Exam / course: Allied Health · Subject: Emergency and Critical Care Technology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Burns Emergency Care", PrepElephant, https://prepelephant.com/topics/allied/emergency-and-critical-care-technology/burns-emergency-care-ecct ## Direct answer Burns emergency care stops the burning, secures an airway that may swell shut over hours, replaces the fluid weeping from burnt skin on a calculated schedule, and keeps the patient warm — hypothermia deepens coagulopathy. Depth decides healing and surface area drives volume: the rule of nines (or the patient's palm as roughly one per cent) sizes the burn, and the Parkland formula — 4 mL per kilogram per per cent of body surface area in 24 hours, half in the first 8 — sets Ringer lactate against the clock from the moment of injury, not from the moment of arrival. Any hint of an inhalation component, a face or circumferential burn, or an electrical or chemical mechanism changes the plan and usually the destination. ## What you must remember - **Rule of nines, adult:** head and neck 9, each upper limb 9, each lower limb 18, anterior trunk 18, posterior trunk 18, perineum 1; the patient's palm (fingers included) approximates 1 per cent for patchy burns. - **Parkland formula:** 4 mL × weight (kg) × per cent TBSA of Ringer lactate over 24 hours from the burn time, half in the first 8 hours — recalculate against urine output, which is the true endpoint. - **Resuscitation targets:** urine 0.5 mL/kg/hour in adults, 1-2 mL/kg/hour in children — falling output means the rate is behind; a child's head is relatively larger (about 18 per cent) and limbs smaller, and only partial and full-thickness areas count. - **Inhalation injury markers:** singed facial hairs, carbonaceous sputum, hoarseness, stridor, soot, entrapment history — early intubation before the swelling, not after the stridor matures. - **Depth in one line:** superficial blanches; superficial dermal blisters and is painful; deep dermal is mottled with sluggish refill; full-thickness is leathery and painless. - **Escharotomy triggers:** circumferential full-thickness burns compromising limb perfusion or chest excursion — deep release incisions under analgesia. - **First aid and chemical specifics:** 20 minutes of cool running water (not ice); chemical burns get copious irrigation; electrical burns carry visible and hidden contact wounds and a dysrhythmia risk on ECG. - **Referral is broad:** burns over 10 per cent TBSA in adults, 5 in children; any burn of face, hands, feet, perineum or joints; inhalation, chemical, electrical and non-accidental patterns — all move to a burns-capable centre. ## Sizing and running a 60-kg kitchen-fire patient A 30-year-old sari catches fire at a stove; she arrives 45 minutes after the burn with blistered anterior trunk and both arms. Counting the surface: 18 per cent anterior trunk plus 9 and 9 for the arms gives 36 per cent partial thickness. The Parkland arithmetic: 4 × 60 × 36 = 8640 mL in 24 hours, and because the clock started at the stove, the remaining half of the first 8-hour volume — about 4300 mL over 7 hours 15 minutes — sets the rate now. A urinary catheter goes in: if she makes 20 mL in an hour at the calculated rate, the rate rises — the formula is a starting estimate that urine output continuously corrects. Her face has singed nasal hairs and her voice is hoarse — the airway decision is made early while the glottis is still visible, and she is intubated electively, not crash-intubated later. She is covered with dry sheets and warmed, rings cut off swollen fingers, both arms elevated and checked for circulation — a circumferential burn strangles a limb like a tourniquet. ## How the exam frames it The numerical trap leads: candidates who start the clock at ED arrival calculate a gently wrong rate — the formula runs from injury time. The second is depth-versus-area confusion: superficial erythema (sunburn-like) is excluded from TBSA counting, and a stem that includes it inflates the answer. Indian exam questions carry social gravity — stove and kerosene burns, firecracker injuries around Diwali, and the safeguarding question whenever a child's burn pattern does not fit the story. The viva asks why ice is forbidden (vasoconstriction, further injury) and why the first 8 hours matter most — capillary leak is fastest then. ## Frequently asked questions ### What is the Parkland formula and its clock? 4 mL × body weight in kg × per cent total body surface area of Ringer lactate over the first 24 hours, half within 8 hours — counted from the time of the burn, not hospital arrival. ### How is burnt surface area estimated quickly? The rule of nines for regions plus the patient's palm including fingers as about 1 per cent for scattered areas, counting only partial- and full-thickness burns. ### What marks inhalation injury and what does it trigger? Singed nasal hairs, carbonaceous sputum, hoarseness, soot and an entrapment history — prompting early elective intubation before airway oedema closes the window. ### When is escharotomy indicated? Circumferential full-thickness burns that compromise limb circulation or chest-wall expansion, releasing the leathery eschar along defined incision lines. ### What urine output confirms adequate burn resuscitation? About 0.5 mL/kg/hour in adults and 1-2 mL/kg/hour in children — the bedside endpoint that continuously corrects the calculated Parkland rate.