Initial Management of Forearm Burns

Assessment and Triage

The American Burn Association recommends accurately assessing the total body surface area (TBSA) affected using the Lund-Browder chart, which is the most accurate method for TBSA quantification, for patients with forearm burns 3, 4
For quick estimation in the field, the palm and fingers of the patient's hand (approximately 1% TBSA) can be used as a reference for patients with forearm burns 3
Determine burn depth (superficial, partial thickness, or full thickness) to guide further management for patients with forearm burns 1
Consult a burn specialist early, ideally through telemedicine if direct consultation is not available, to determine if transfer to a burn center is necessary for patients with forearm burns 2, 3

For adults with burns >15% TBSA and children with burns >10% TBSA, administer 20 mL/kg of balanced crystalloid solution (preferably Ringer's Lactate) within the first hour, as recommended by the Advanced Burn Life Support guidelines 5, 6
Establish intravenous access in unburned areas when possible; consider intraosseous access if IV access cannot be rapidly obtained for patients with severe forearm burns 5
Monitor for signs of hypovolemic shock due to inflammation, capillary leak syndrome, and microcirculation alterations in patients with forearm burns 5

Provide adequate analgesia before wound cleaning and dressing application, as burn wound care typically requires deep analgesia or general anesthesia, according to the American Society of Anesthesiologists 1
Consider the need for procedural sedation for extensive or painful forearm burns 1

Clean the burn wound with tap water, isotonic saline solution, or an antiseptic solution, as recommended by the American Burn Association 1
Perform wound care in a clean environment for patients with forearm burns 1
Consider whether blisters should be flattened or excised (ideally with burn specialist consultation) for patients with forearm burns 1
Apply appropriate dressings based on burn depth, TBSA, wound appearance, and patient's general condition, according to the Wound, Ostomy and Continence Nurses Society 1
When applying dressings to the forearm, be careful to prevent bandages from causing a tourniquet effect, as recommended by the American College of Surgeons 1
Monitor distal perfusion regularly when circular dressings are applied for patients with forearm burns 1

Evaluate the need for escharotomy if a deep burn induces compartment syndrome that compromises circulation; this procedure should ideally be performed in a burn center by an experienced provider, according to the American Burn Association 2, 7, 6
Do not routinely administer antibiotic prophylaxis unless specifically indicated for infected wounds, as recommended by the Infectious Diseases Society of America 1
Consider thromboprophylaxis for severe burns, according to the American College of Chest Physicians 1
Avoid prolonged use of external cooling devices (e.g., Water-Jel dressings) to prevent hypothermia in patients with forearm burns 1

If transfer to a burn center is indicated, the patient should be admitted directly to the center when possible, as recommended by the American Burn Association 2, 3
Continue monitoring distal circulation, especially if the burn is circumferential, according to the Society of Critical Care Medicine 1, 7

Overestimation of TBSA (occurs in 70-94% of cases), which can lead to excessive fluid administration, as warned by the American Burn Association 3, 4
Delaying specialist consultation, which may increase morbidity and mortality, according to the American College of Surgeons 2, 3
Improper dressing application that restricts circulation, as cautioned by the Wound, Ostomy and Continence Nurses Society 1
Routine use of systemic antibiotics, which is not recommended for prophylaxis, as stated by the Infectious Diseases Society of America 1
Prolonged use of silver sulfadiazine on superficial burns, which may delay healing, as noted by the American Burn Association 1
Performing escharotomy without proper training or consultation, which can increase complications, as warned by the American College of Surgeons 7, 6